Response to Letter: How Much Free Sugars Intake Should Be Recommended for Children Younger Than 2 Years Old?

__R__eply: Dr Vitolo asks what led the ESPGHAN CoN ‘‘to step away from a definite statement about sugar intake and infants’’ in our recent Position paper. We would like to clarify that our recommendation certainly does not mean that we are ‘‘stepping away’’ or establishing a ‘‘safe amount’’ of sugars for this age group.
The American Heart Association (AHA) recommends that ‘‘added’’ sugars should be avoided for children younger than 2 years. As explained in our article, the European Food Safety Authority (EFSA) and US definitions of ‘‘added sugars’’ do not include sugars present in unsweetened fruit and vegetable juice and fruit juice concentrate, all of which are, however, captured in the WHO definition of free sugars, which we favour. Thus, children younger than 2 years who drink fruit juices and/or consume fruit juice concentrate, jellies, jams, preserves, and fruit spreads would still be following the AHA recommendation to avoid added sugars, whilst still consuming ‘‘free’’ sugars. Our recommendations state that ‘‘there is no nutritional requirement for free sugars in infants, children and adolescents’’ and suggest that the intake in those younger than 2 years should ‘‘probably be even lower’’ than the less than 5% of energy intake recommended for older children, partly considering the potential for sugar in infancy to influence taste and/or food preferences. We, however, did not provide a definitive figure because we found the evidence-base for doing so in this age group is not sufficiently robust, consisting largely of observational studies.
Furthermore, we have noted throughout the article the need to limit the intake of free sugars at all ages, and to clarify the terminology and labelling of sugars because consumers may not be aware that free sugars are present in foods and beverages, even when they are labelled as having ‘‘no added sugar’’ and ‘‘naturally occurring sugars.’’ We hope that such measures would contribute to building a healthier food environment for infants and children.