The WHO recently published a set of guidelines in 2015 for the maximum sugar intake in adults and children. By conducting a meta-analysis of several randomised controlled trials they identified an association between consumption of free sugars and increased body weight as well as consumption of free sugars and dental caries.
Based on the evidence reviewed, they were able to generate guidelines on sugar consumption:
• They strongly recommend a reduced intake of free sugars throughout the life course.
• They strongly recommend reducing the intake of free sugars to less than 10% of total energy intake.
• They also recommend, although this is only a conditional recommendation, that the intake of free sugars be further reduced to below 5%.
The evidence has shown that body weight and dental caries are reduced when sugar intake is limited to a maximum of 10% of the daily energy intake.
WHO recommends a reduced intake of free sugars throughout the lifecourse
• In both adults and children, WHO recommends reducing the intake of free
sugars to less than 10% of total energy intake2 (strong recommendation).
• WHO suggests a further reduction of the intake of free sugars to below 5% of
total energy intake (conditional recommendation3).
• Free sugars include monosaccharides and disaccharides added to foods
and beverages by the manufacturer, cook or consumer, and sugars naturally
present in honey, syrups, fruit juices and fruit juice concentrates.
• For countries with a low intake of free sugars, levels should not be increased.
Higher intakes of free sugars threaten the nutrient quality of diets by
providing significant energy without specific nutrients (3).
• These recommendations were based on the totality of evidence reviewed
regarding the relationship between free sugars intake and body weight (low
and moderate quality evidence) and dental caries (very low and moderate
• Increasing or decreasing free sugars is associated with parallel changes in
body weight, and the relationship is present regardless of the level of intake
of free sugars. The excess body weight associated with free sugars intake
results from excess energy intake.
• The recommendation to limit free sugars intake to less than 10% of total
energy intake is based on moderate quality evidence from observational
studies of dental caries.
• The recommendation to further limit free sugars intake to less than 5% of
total energy intake is based on very low quality evidence from ecological
studies in which a positive dose–response relationship between free sugars
intake and dental caries was observed at free sugars intake of less than 5% of
total energy intake.
total energy intake, which is also supported by other recent analyses (15,
16), is based on the recognition that the negative health effects of dental
caries are cumulative, tracking from childhood to adulthood (21, 22). Because
dental caries is the result of lifelong exposure to a dietary risk factor (i.e. free
sugars), even a small reduction in the risk of dental caries in childhood is of
significance in later life; therefore, to minimize lifelong risk of dental caries,
the free sugars intake should be as low as possible.
• No evidence for harm associated with reducing the intake of free sugars to
less than 5% of total energy intake was identified.
• Although exposure to fluoride reduces dental caries at a given age, and
delays the onset of the cavitation process, it does not completely prevent
dental caries, and dental caries still progresses in populations exposed to
• Intake of free sugars is not considered an appropriate strategy for increasing
caloric intake in individuals with inadequate energy intake if other options
• These recommendations do not apply to individuals in need of therapeutic
diets, including for the management of severe and moderate acute
malnutrition. Specific guidelines for the management of severe and moderate
acute malnutrition are being developed separately.
This document presents the key recommendations and a summary of the supporting
evidence. Further details of the evidence base are provided in Annex 1 and in other
documents listed in the references.
NCDs are the leading causes of death and were responsible for 38 million (68%) of
the world’s 56 million deaths in 2012 (1). More than 40% of those deaths (16 million)
were premature (i.e. under the age of 70 years). Almost three quarters of all NCD
deaths (28 million), and the majority of premature deaths (82%), occurred in lowand
middle-income countries. Modifiable risk factors such as poor diet and physical
inactivity are some of the most common causes of NCDs; they are also risk factors for
obesity – an independent risk factor for many NCDs – which is also rapidly increasing
globally (2). A high level of free sugars intake is of concern because of its association
with poor dietary quality, obesity and risk of NCDs (3, 4).
The term “sugars” includes intrinsic sugars, which are those incorporated within
the structure of intact fruit and vegetables; sugars from milk (lactose and galactose);
and free sugars, which are monosaccharides and disaccharides added to foods and
beverages by the manufacturer, cook or consumer, and sugars naturally present in
honey, syrups, fruit juices and fruit juice concentrates.
Because there is no reported evidence of adverse effects of consumption of
intrinsic sugars and sugars naturally present in milk, the recommendations of this
guideline focus on the effect of free sugars intake. For the first time in 1989, the WHO
Study Group established a dietary goal for free sugars intake of less than 10% of total
energy intake (4), and this was reiterated by the Joint WHO/FAO Expert Consultation
on Diet, Nutrition and the Prevention of Chronic Diseases in 2002 (3).
Free sugars contribute to the overall energy density of diets, and may promote
a positive energy balance (5-7). Sustaining energy balance is critical to maintaining
healthy body weight and ensuring optimal nutrient intake (8). There is increasing
concern that intake of free sugars – particularly in the form of sugar-sweetened
beverages – increases overall energy intake and may reduce the intake of foods
containing more nutritionally adequate calories, leading to an unhealthy diet, weight
gain and increased risk of NCDs (9-13). Another concern is the association between
intake of free sugars and dental caries, which has received increasing interest in recent
years (3, 4, 14-16). Dental diseases are the most prevalent NCDs globally (17, 18) and,
although great improvements in prevention and treatment of dental diseases have
occurred in the past decades, problems still persist, causing pain, anxiety, functional
limitation (including poor school attendance and performance in children) and
social handicap through tooth loss. The treatment of dental diseases is expensive,
consuming 5–10% of health-care budgets in industrialized countries, and would
exceed the entire financial resources available for the health care of children in most
lower income countries (17, 19).