Challenges and opportunities in the use of low‐energy sugar replacers

In 2015, the government adopted new recommendations on dietary carbohydrate intake proposed by the Scientific Advisory Committee on Nutrition (SACN) (2015), namely to increase dietary fibre intake to 30 g/day (proportionally lower levels for children, 15– 25 g/day) and to decrease free sugars to below 5% of energy intake. Public Health England (PHE) will be publishing a set of working principles to allow the free sugar content of foods to be estimated. It is understood that these will centre on the following definition: free sugars include all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups, and unsweetened fruit and vegetable juices and pur ees. A summary of the findings to support the recommendations on free sugars and fibre can be found in Buttriss (2017). For both fibre and free sugars, current average intakes are substantially different to these recommendations and achieving the recommendations will require major dietary changes for most of the UK population because, currently, only 4% and 13% of teenagers and adults, respectively, meet the sugar recommendation (expressed as nonmilk extrinsic sugars, NMES) and few achieve the fibre recommendation. Fibre intakes among adults are currently about 18 g/day, on average, with the dominant sources being cereals and cereal products, vegetables and potatoes. Some of the challenges faced with regard to increasing fibre intakes are discussed in Lockyer et al. (2016). It will not have gone unnoticed that the revised sugar recommendations have attracted considerable media attention, with reports predominately focussing on concerns about the high prevalence of childhood obesity which affects close to 10% of children in England by the time they start primary school and almost 20% at age 11 years (NHS Digital 2016). There is clearly an urgent need to rebalance children’s diets, and decreasing intake of free sugars is one of the steps that can be taken to help reduce the current overconsumption of calories in relation to energy requirements. Average intake of non-milk extrinsic sugars (the former descriptor of ‘free sugars’) is 12.3% of energy intake among adults. The highest intakes, providing more than three times the new recommendation, are found in teenagers. The National Diet and Nutrition Survey (NDNS) reveals that the dominant source for teenagers is sugars-sweetened beverages [providing 40% of the total NMES intake (Bates et al. 2016)]. There has been far less focus on fibre despite the fact that a shift towards a higher fibre intake is likely to have a beneficial effect on intakes of free sugars. A main feature of the government’s Childhood Obesity Plan, published in 2016 (Department of Health 2016), is a set of measures to reduce sugars in the products that contribute most to children’s sugar intake. As already mentioned, the biggest contributor is sugars-sweetened beverages, and the government has taken the step of introducing a levy on sugarssweetened beverages containing more than 5 g added sugars per 100 ml, which comes into force in April 2018, as a means of driving reformulation to reduce sugar content. Other contributors to intake of sugars are being tackled via a programme being led by PHE on behalf of the government, which is initially focussing on the nine categories of foods that make the greatest contribution, according to the NDNS, namely yogurts and fromage frais; breakfast cereals; biscuits; cakes and morning goods; puddings; ice cream; sweet spreads; chocolate confectionery; and sweet confectionery. For each of these, three different aspects are being considered: reformulation to reduce sugar levels, portion size reduction and shifting purchasing towards lower sugar alternatives. All sectors of the food and drink industry [retailers, manufacturers and the outof-home sector (e.g. restaurants, takeaways and caf es)] are being challenged to reduce overall sugar content across a range of product categories by at least 20% by 2020, including a 5% reduction in year one (PHE 2017). PHE is using 2015 food composition data as Correspondence: Professor Judith Buttriss, Director General, British Nutrition Foundation, Imperial House, 15-19 Kingsway, London, WC2B 6UN, UK. E-mail: j.buttriss@nutrition.org. uk