2/22/2018
behind the label a look at added sugar
Wednesday, February 21 1pm EST / 10am PST
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1 2/22/2018
Webinar Speakers
Rachel Johnson, PhD, MPH, RD, FAHA
Jenna Amos, RDN
Added Sugars and Rachel K. Johnson, PhD, MPH, RD, FAHA Health Professor of Nutrition Professor of Pediatrics The University of Vermont
2 2/22/2018
Disclosures
Board Member/Advisory Panel o Member, National Academy of Sciences WIC Food Package Review Committee o Member, Nutrition Committee the American Heart Association o Member, Medical Advisory Board the Milk Processors Education Program o Member, Nutrition Research Scientific Advisory Council the National Dairy Council Employee o The University of Vermont Research Support o United States Department of Agriculture Spokesperson o The American Heart Association
History of Added Sugars Recommendations
Dietary Guidelines Americans (DGA) 2000 – no quantifiable recommendation o “Choose beverages and foods to moderate your intake of sugars.” DGA 2005 – no quantifiable recommendation o “Choose and prepare foods and beverages with little added sugars or caloric sweeteners such as amounts in USDA Food Guide or DASH.” DGA 2010 – no quantifiable recommendation o “Reduce the intake of calories from solid fats and added sugars. “ o “Choose water instead of sugary drinks.” Consumers needed a number! o What do “moderate”, “little” and “reduce” mean?
3 2/22/2018
AHA Weighs in on Added Sugars
“The American Heart Association is taking aim at the nation's sweet tooth, urging consumers to significantly cut back on the amount of sugar they get from such foods as soft drinks, cookies and ice cream.”
“In a scientific statement the organization says most women should limit their sugar intake to 100 calories, or about six teaspoons, a day; for men, the recommendation is 150 calories, or nine teaspoons.”
-Wall Street Journal, August 2009
Added Sugars and Children AHA Recommendations
4 2/22/2018
WHO Guideline
“Adults and children should reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits.” -March 2015, WHO
DGAs 2015-2020
Healthy eating patterns limit added sugars. Less than 10% of your daily calories should come from added sugars. o 12.5 tsp in a 2000 calorie diet
Current average added sugars intake in the US o 290 calories/day o 21 tsp/day o 13 percent of calories per day
Only 42% of Americans age 2 and older meet the Bowman et al. USDA Data Brief No. 18. May 2017. recommendation.
5 2/22/2018
Dietary Intakes Compared to Recommendations. Percent of the U.S. Population Ages 1 Year and Older Who are Below, At, or Above Each Dietary Goal or Limit. DGA 2015-2020
Average Intakes of Added Sugars as a Percent of Calories per Day by Age-Sex Group, in Comparison to the Dietary Guidelines Maximum Limit of Less than 10% of Calories
6 2/22/2018
JAMA Online First, March 23, 2016.
What does the AHA say?
“When sugars are added to otherwise nutrient-rich foods, such as sugar-sweetened dairy products like flavored milk and yogurt and sugar-sweetened cereals, the quality of children’s and adolescents’ diets improves, and in the case of flavored milks, no adverse effects on weight status were found.”
“Soft drinks, sugar, and sweets are more likely to have a negative impact on diet quality, whereas dairy foods, milk drinks, and presweetened cereals may have a positive impact.”
–Johnson et al. Circulation 2009.
7 2/22/2018
Nutrition Facts Panel
FDA rationale for including added “Scientific data shows that it is difficult to meet nutrient needs while staying sugars on the label within calorie limits if you consume more than 10 percent of your total daily calories from added sugars, and this is consistent with the 2015-2020 Dietary Guidelines for Americans.”
8 2/22/2018
How does FDA define added sugars?
o Includes sugars that are added during the processing of foods and includes sugars (free, mono- and disaccharides), sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices that are in excess of what would be expected from the same volume of 100 percent fruit or vegetable juice of the same type. o Excludes 100 percent juice concentrate sold directly to consumers (e.g. frozen orange juice concentrate). o Excludes whole fruit, fruit pieces, dried fruit, pulps, and purees because they are nutrient rich and maintain the basic properties of a fruit when added to foods.
WHY do consumers need added sugars on the label?
o Total sugars include naturally occurring sugars such as fructose in fruit and lactose in milk. o Currently, the only reliable way to identify added sugars is to read the ingredient list. o Manufacturers may use many different types of added sugars.
9 2/22/2018
WHY do consumers need added sugars on the label?
Ingredients are listed in descending order by weight. Thus, individual added sugars may be listed lower down on the ingredient list obscuring the total amount.
FDA Policy Roadmap for 2018
“Nutrition will be among FDA's top areas of focus this year.”
-FDA Commissioner Scott Gottlieb, Politico, Nov 2017
FDA Nutrition Action Plan Provide guidance for industry to implement the new requirements for updating the Nutrition Facts Label.
10 2/22/2018
Current compliance dates
The FDA extended the compliance dates for the Nutrition Facts label final rule o Jan 1, 2020 for manufacturers with $10 million or more in annual food sales o Jan 1, 2021 for manufacturers with less than $10 million in annual food sales
Added sugars and health
11 2/22/2018
There is solid consensus on the negative health effects of sugary drinks
o Weight gain/obesity o Type 2 diabetes o Cardiovascular disease o Some cancers
-RK Johnson. Circulation. 2016;133:347-349
.
Do sugar sweetened beverages (SSBs) promote obesity? Intervention trials
o 224 overweight and obese adolescents randomly assigned to experimental and control groups. o Experimental group (n=110) received a one-year intervention. – home deliveries of bottled water and diet drinks for one year. – encouraged to avoid sugary drinks. o Ebbeling et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Eng J Med 2012.
12 2/22/2018
Do SSBs promote obesity? Intervention trials
o 641 normal weight Dutch school children ages 4-11 o Randomly assigned to – receive 8 oz/day of sugar-free beverage OR – receive 8 oz/day of 104 calorie SSB in an identical can. o De Ruyter JC et al. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Eng J Med 2012.
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Results
“We found that masked replacement of a sugar Over 18 months the children in the sugar- containing beverage with a sugar-free beverage free group gained an average of 13.9 pounds. significantly reduced weight gain and body fat gain in healthy children. Children in the US consume on Those drinking SSBs gained 16.2 pounds. average almost three times as many calories from sugar-sweetened beverages as the amount provided in our trial. We speculate that decreased consumption of such beverages might reduce the high prevalence of overweight in these children.”
-Janne C. de Ruyter, M. Sc., University Amsterdam
Framingham Heart Study
Sugary drink o First large, prospective, cohort study to link regular SSB consumption to adverse changes consumption in visceral adipose tissue (VAT) independent associated with of weight gain. VAT linked with the development of type 2 increased visceral diabetes mellitus and cardiovascular disease. adipose tissue
Jiantao Ma et al. Circulation. 2016;133:370-377.
14 2/22/2018
SSBs and visceral adipose tissue
Study provides new knowledge about the potential mechanisms linking SSBs with cardiometabolic disease. Findings show SSBs raise the risk of heart disease and type 2 diabetes mellitus not solely because they make people heavier.
-Johnson RK. Circulation. 2016;133:347-349
Added sugars and dyslipidemia
US adults (n = 6113) from NHANES 1999-2006 A mean of 15.8% of calories consumed were from added sugars. Significant correlations between added sugars and blood lipid levels among US adults.
-Welsh et al. JAMA. 2010;303(15):1490-1497.
15 2/22/2018
Multivariable-Adjusted Mean HDL-C Levels by Level of Added Sugars Intake Among US Adults, NHANES 1999-2006
Welsh, J. A. et al. JAMA 2010;303:1490-1497.
Copyright restrictions may apply.
Multivariable-Adjusted Geometric Mean Triglyceride Levels by Level of Added Sugars Intake Among US Adults, NHANES 1999-2006
Welsh, J. A. et al. JAMA 2010;303:1490-1497.
Copyright restrictions may apply.
16 2/22/2018
Dietary sugars and The more added sugars people reported consuming cardiometabolic risk – ↑ triglyceride levels systematic review ↑ total and LDL cholesterol ↑ blood pressure These associations were independent of body weight
“Although effects of free sugars on lipids and blood pressure were modest, a reduction of intake is likely to have public health relevance.” -Te Morengo LA et al. AJCN. 2014:100(1):65-79
Added sugars and inflammation o Consuming too many added sugars can increase chronic inflammation, one pathological pathway to heart disease. o Proposed mechanism o Hyperglycemia and hyperinsulinemia increase inflammation. o DiNicolantonio JJ et al. Prog Cardiovasc Dis. 2016;58(5):464-472.
17 2/22/2018
Added Sugars Intake and Cardiovascular Diseases Mortality Among US Adults
JAMA Intern Med. 2014;174(4):516-524.
Copyright © 2014 American Medical Association. All rights reserved.
Added Sugars Intake and Cardiovascular Diseases Mortality oMost US adults consume more Among US Adults added sugars than is recommended for a healthy diet oA significant relationship between added sugars Conclusions and consumption and increased risk Relevance for CVD mortality was observed -JAMA Intern Med. 2014;174(4):516-524
18 2/22/2018
Fructose in sugary drinks vs. fruit
What’s the difference? o Sugar consumed in fruit is not linked to any adverse health effects, no matter how much you eat. o Observational studies – Increased fruit consumption is linked to lower body weight and lower risk of obesity-associated diseases. o Whole fruits contain fiber, which promotes satiety and provides other metabolic benefits. o Fruit’s fiber slows the absorption of fructose.
-Ludwig D. JAMA, 2013.
Lactose in milk and dairy products vs. sugary drinks
What’s the difference?
Lactose o Disaccharide sugar derived from glucose and galactose o Found in milk and dairy products o Milk and dairy products are nutrient dense o Contains 3 of 4 “shortfall” nutrients - Calcium - Potassium - Vitamin D
19 2/22/2018
Thank you!
20 2/22/2018
Consumers’ Perception of Sugar
Jenna Amos, RDN Nutrition Communications Lead, siggi’s dairy
The Rise of Sugar Consumption
1 2/22/2018
Sugar Evolution
2016 Nielsen Survey reports in the U.S. today, 22% of Americans are restricting their sugar intake.
‘Clean Eating’ Influence
Organic Cane Sugar 100% Maple Syrup
Coconut Sugar
This image cannot currently be displayed. Sugar in the Raw
Honey Agave Nectar Beet Sugar
No High Fructose Corn Syrup
2 2/22/2018
Confusion Around Added Sugars
Added Sugar Labeling Confusion
3 2/22/2018
Label Comparison
Defining Added Sugar Question: How are the sugars in the ‘Added Sugars’ line different?
“Added sugars are calculated separately “Added Sugars sound since they are added into the mixture in the as if they are form of a syrup, so they really don't need to “I consider Added completely artificially be present.” Sugars something added to enhance added to a product by flavor, rather than the manufacturer, and being a natural not naturally occurring “They are already in “It is probably byproduct of the within an ingredient there, as in baked in, just a different grains in the cereal.” such as fruit.” and the added sugars type of sugar.” are additional.” “I really do not know. If they “Processed instead “Added sugars were regular sugars they would of natural.” “They are are artificial “Not sure. be listed in the Total Sugars.” not naturally sweeteners.” However, they present in are included in the list of “This may indicate the label and I “Sugar is natural ingredients.” a sweetener that presume they sugar like beet isn't as healthy but are hidden in sugar or cane sugar the manufacturer some other naturally found. includes it to make “They could be man made and source.” Added sugars are not naturally occurring.” processed sugars.” it taste better.”
4 2/22/2018
Nutrition Comparison
Identifying Added Sugar Ingredients
According to Nielsen and Label Insight, there are 206 variations of high fructose corn syrup that manufacturers can list on a label, many of which consumers may not associate as an added sugar.
5 2/22/2018
Classifying Different Sugars
An online survey asked participants to classify 13 commonly used food ingredients as a natural sugar, added sugar, or artificial sweetener. Only four percent of respondents correctly classified ten or more ingredients while almost half could only correctly identify three ingredients or fewer.
Educational Tools
6 2/22/2018
Key Takeaways
Consumers are more aware of sugar in their food than ever before, and based on consumer research and insights, likely need counseling around the following when it comes to added sugars:
– How to read the ‘Added Sugars’ line on the new NFP – How to calculate daily percentage from grams of added sugars, translating %DV and understanding their daily calorie needs – Understanding the definition of added sugars vs. natural occurring sugars. The following are examples of added sugars that are commonly misclassified: • Honey • Agave Nectar • Maltose • Fructose • Molasses – How to identify added sugar sources on an ingredient list – Using tools to help calculate and manage added sugars consumption
Q&A
7 2/22/2018
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