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Reduced Sugar Claims Misleading

New study suggests packaged food claims like “reduced in sugar” or “no added sugar” still have sugar levels too high by World Health Organization standards.

A new study evaluated differences in calories, nutrient content, overall healthfulness and use of sweetener ingredients between products with and without sugar claims.

Many health organizations like World Health Organization (WHO), US Department of Health and Human Services, US Department of Agriculture and Public Health England have come out with guidelines and recommendations of free sugar intake to be limited to a maximum of 10% of calories to avoid many health risks associated with overconsumption of sugar.

In this new study published in Applied Physiology, Nutrition, and Metabolism by the University of Toronto, a cross-sectional analysis was done. The researchers used the Food Label Information Program (FLIP) database 2013 (n= 15,342). Products were categorized into 17 sugar-focused major food groups, 77 subcategories and 207 minor subcategories to ensure comparisons of like products. Meal replacement beverages were excluded.

There was a review of the product labels conducted to identify products that had sugar claims. The sugar claims included from FLIP 2013 were “no added sugar,” “reduced in sugar,” “unsweetened,” and “sugar free.” Free sugar content was defined by WHO and was calculated using University of Toronto’s decision algorithm.

According to Pan American Health Organization’s Nutrient Profiling Model, products that have ≥ 10% of calories from free sugars contain an “excess” amount of free sugar. The guidelines from the WHO also agree that the intake of free sugar should not be greater than 10% of calories. The Nutrient Profiling Scoring Criterion (NPSC) was designed to determine a foods’ eligibility to carry health claims. The NPSC scores are calculated by assigning points for “nutrients to limit” (calories, saturated fat, sodium and total sugar) and deducting points for “nutrients and components to encourage” (dietary fiber, protein, fruit, vegetable, nut and legumes). The possible scores range from -18 to +81 and a lower score equals a higher nutritional quality.

According to the Canadian Food Inspection Agency, they describe sweeteners as a food additive that is used to give products a sweet taste and can include sugar alcohols (e.g. malitol, xylitol, sorbitol), non-nutritive sweeteners (e.g., aspartame, sucralose, acesulfame-poassium), cyclamate sweeteners, or saccharin sweeteners.

The researchers found that 21% of products evaluated had at least 1 sugar claim. The most common type was “no added sugar” claims (n= 525), then “sugar free” (n= 71), and lastly “reduced in sugar” claims (n= 46). Almost half of the products with sugar claims had excess free sugar levels greater than 10% of calories compared with 78% of products without sugar claims. 42% of the products with “no added sugar claims” and 85% of the products with “reduced in sugar” claims still had excess free sugar levels. For median caloric density, free sugar and total sugar contents, they found they were significantly lower among the products with a sugar claim compared to without. The median NPSC scores were significantly lower (healthier) among products with sugar claims overall and for most subcategories except for frozen fruit, salad dressing, vegetable drinks, and water. Vegetable drinks had higher scores with sugar claims compared to those without. The sweetener use was more prevalent in products with sugar claims (30%) compared with products without sugar claims. More than half of products with sugar claims contained sweeteners in 7 out of the 10 subcategories that contained sweeteners.

This study also assessed differences in calorie contents, nutrient contents, overall healthfulness, and use of sweeteners in Canadian prepackaged foods and beverages with sugar claims compared to similar products without sugar claims. Interestingly many of the products that had sugar claims had excess free sugar levels. As stated before, almost half (48%) of the products with the sugar claims had excessive amounts of free sugar. 36% of fruit drinks and 5.4% of sweet condiments had a “no added sugar” claim and yet 99% of them had excess free sugar.

Canadian regulations do not consider fruit juice a sweetener when it is not concentrated and is used as a fruit ingredient. Because of this, sweet condiments and fruit juice can still have a “no added sugar” claim. However, the “reduced in sugar” claim can only be present on products in which sugar content is lowered by 25% compared with a similar product, but there is no limitation on the absolute amount of free sugar in the product and 85% of the products with the “reduced in sugar” claims found to have excess free sugar levels. These sugar claims can be misleading to the consumer. Most consumers have expectations of meaningful calorie reductions in foods with the sugar claims. These findings show that consumer perceptions differ from the actual claims.

The limitations of this study included the use of nutrient values as declared on the NFt, rather than analyzed values, and the FLIP 2013 only reflects about 75% of the Canadian food retail market.

Overall, this study found that although products with sugar claims have lower free sugar and calories compared to similar products, the products had lower free sugar but not reduced calorie content. These findings show the flaws in the current regulations of sugar in foods.

Practice Pearls:

  • Foods with sugar claims were “healthier” but almost half still had excessive free sugars.
  • 100% fruit juice is considered free sugar, so if a product says “no added sugar” it’s still full of sugar from the beginning.
  • The sugar claims were found to be confusing or misleading to consumers.

Reference:

Berstein JT, Franco-Arellano B, Shermel A. et al. Healthfulness and nutritional composition of Canadian prepackaged foods with and without sugar claims. Applied Physiology, Nutrition, and Metabolism, 2017, 42(11): 1217-1224.

Jessica Quach Doctor of Pharmacy Candidate 2018, GA-PCOM School of Pharmacy