# Assessment and Evaluation of the Intake of Sugars in European Countries
## 1 Introduction  
A reduction of the intake of sugars is a hot topic in relation to a decrease of energy intake to prevent body weight gain and accomplish weight loss among those with overweight or obesity. In population groups, several individuals have an intake of sugars that is not in line with the existing dietary guidelines. Basically, there are two strategies to reduce the intake of sugars: changing consumer behaviour, via nutritional education or other policy measures such as nutritional labelling, and product reformulation by the industry. A sugar-substitution strategy of the industry can be partial, total, or gradual for different product categories, such as soft drinks, bakery, and ice cream [1, 2]. Additionally, decisions have to be made on the sugar substitutes that may be artificial sweeteners, stevia, or polyols, such as malidol, xylitol or sorbitol [3]. Polyols can act as sweeteners and bulking agents for confectionery products and replace saccharose on a one-to-one basis [4]. For instance, [PERSON] et al. [5] showed that a significant reduction in the sugar content was possible, and that the reformulated product had the characteristic features of traditional meringue and lower caloric value. In the scientific literature, there is a long-standing tradition to investigate the link between the intake of sugars and health and the results are reflected in dietary guidelines when sufficient evidence is available. Guidelines for a healthy diet are established by nutrition experts and several organizations have published (some on a regular basis) such guidelines. The World Health Organization (WHO) recommended in 2015 for the whole world a reduction of the intake of free sugars to <10 energy% (en%). This recommendation is based on the association of free sugars with dental caries [6]. The European Food Safety Authority (EFSA) is currently updating their scientific opinion of 2010 on sugars [7]. In 2010 the EFSA concluded that there was insufficient evidence to set an upper limit for sugars [8]. The United States (US) dietary guidelines are updated every five years; thelatest version was published in 2020 [9]. The US guideline advises Americans to cut down somewhat, from an average intake of 13 to an intake of less than 10% of energy from added sugars. These three examples of guidelines show that the existing recommendations for the intake of sugars are not the same. Therefore, it is of interest to investigate what other guidelines recommend regarding the intake of sugars and to look at the reason of any differences in the recommendations. This is one of the aims of this study. Guidelines can be formulated for total, free, and added sugars. Total sugars are all monosaccharides and disaccharides, present in food, irrespective of the source. In most cases, this is predominantly made up of sucrose, fructose, glucose, and lactose. Added sugars are mono- and disaccharides used as ingredients in processed and prepared foods and sugars eaten separately or added to foods at the table. Added sugars do not include sugars present in intact fruit or vegetables or milk, or in juiced or pureed fruit or vegetables. Free sugars are somewhat wider ranging than added sugars and are mono- and disaccharides added to foods by the manufacturer, cook, or consumer plus sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. Sugars from intact fruit, vegetables, and milk do not belong to the free sugars. Quantitative guidelines can be used as reference values for dietary intake figures. National surveys provide aggregate data from individuals of a country. Representative dietary intake data of the population in a country are useful for determining the foods, beverages, and nutrients consumed, assessing dietary adequacies and shortcomings, when compared to dietary guidelines, and for monitoring trends. Dietary intake data can be compared with dietary guidelines to obtain an impression about the quality of the intake; this data will be searched for, and presented, from national European surveys.