Sugar, a multifunctional food ingredient
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1 Sugar, a multifunctional food ingredient Basic concepts on sugars in nutrition and health Janine Verheesen PhD Director knowledge centre sugar & nutrition The Netherlands
2 Content of this presentation Introduction to knowledge centre sugar & nutrition Carbohydrates and sugars in the diet Reference intakes Sugar statistics Sugar functionalities Sugar and nutrition/health Conclusions
3 Knowledge centre sugar & nutrition (1) Aim: To contribute with evidence based information to a balanced discussion on the position of sugar in the diet; especially with respect to chronic diseases, oral health, physical and mental performance and sensory aspects.
4 Knowledge centre sugar & nutrition (2) Activities: 1. Research (in cooperation with research institutions and universities) 2. Dissemination of balanced evidence based information Output: News letters, position papers, scientific publications, expert meetings, workshops and courses for health professionals, education material, websites brochures, press releases Advices and answers to questions
5 Carbohydrates in the diet (1) Polysaccharides (complex digestible CHO, mainly starch) Mono- and disaccharides (intrinsic and extrinsic sugars) Dietary fiber (non-starch polysaccharides; non-digestible oligosaccharides)
6 Carbohydrates in the diet (2) Poly saccharides (> 10 units) Starch (alpha-glucans): Amylose (1,4-alpha-bond) Amylopectin (1,4-alpha and 1,6-alpha-bonds) Glycogen ( animal 1,6-alpha-bonds) non-starch: - Cellulose, hemicellulose - Psyllium - Guar - Pectin - Beta-glucans - inulin
7 Carbohydrates in the diet (3) Mono/disaccharides (1-2 units) Glucose Fructose Saccharose (sucrose, beet sugar, cane sugar) Maltose Trehalose Lactose Sugar alcohols (sorbitol, lactitol, xylitol, maltitol)
8 Carbohydrates in the diet (4) Differences: Digestibility Glycaemic index Glucose: high Sucrose: medium Fructose: low Cariogenicity Sensoric aspects (sweetness, structure) Similarity: - 4 kcal/gram (except poly alcohols: 2.4 kcal/gram, erythritol: 0.2 kcal/gram) - empty calories
9 Carbohydrates in the diet (4a) Glycemic index: Glucose 100 Fructose 19 Lactose 46 Sucrose 68 boiled white rice 83 Maltose 105 Cooked potatoes 85 French fries 75 White bread 95 Foster and Powel et al (2002) The evidence for a role in weight maintenance and prevention of diet-related diseases is inconclusive (EFSA, 2010).
10 Reference intakes digestible CHO s (1) Total CHO (En%) Added sugars (En%) The Netherlands: Health Council(2006) 40 No USL (healthy weight) Europe: EFSA (2010) No USL USA: IOM (2010) < 25 Nordic Countries (2012) Not indicated < 10 UK (1991,2006) 50 < 11 WHO (2003) < g/d for both children and adults has been estimated to be sufficient to cover the needs of glucose for the brain (EFSA,2010) Intake levels of g/day will prevent ketosis (EFSA, 2010)
11 Reference intakes digestible CHO s (2) Health Council of the Netherlands (2006) For people with undesirable weight gain or overweight: 1. Daily 1 hr. (at least) physical activity 2. Reduce energy intake, in particular by limiting Consumption of high energy-dense foods Sugar-rich beverages Large portions
12 Sugar statistics (1) Sugar availability in 28 European countries: Mean Range Availability (kg/head/year) % of available energy From FAO Statistics (2009)
13 Sugar statistics (2) Sugar availability (kg/head/year) in the Netherlands
14 Sugar statistics (3) Sugar use in the Netherlands Household: Industrial+Catering 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,
15 Sugar statistics (4) Total CHO and mono/disaccharide intake (En%) in the Netherlands The Netherlands (VCP , y) Men : total mono/di g/d, 21,5 En% Women: total mono/di g/d, 19,2 En%
16 Sugar statistics (5) Total mono/disaccharide intake (En%) in The Netherlands 24, , ,5 Added Sugar: approx. 12 en% 22 21, ,
17 UK Sugars Consumption over 35 past 30 years 30 Total sug gars (% E) Children <5y Children >5y Adults Year of survey Total sugars intake relatively constant over time
18 Latest UK consumption figures (% Food Energy) ,6 14,4 14, ,8 11,8 11, , % Government 8 Recommendation made in relation to 6 dental caries & not obesity (SACN, 1991) Mean NMES Age range (y) Males Females National Diet and Nutrition Survey: Headline Results from Years 1, 2 and 3 (combined) of the Rolling Programme 2008/ /11, DoH25 th July 2012
19 Functional roles of sugar (1) Good source of energy and glucose (moderate GI) Physical and mental performance High solubility Sweet taste, excellent profile (golden standard) Flavour and colour precursor (Maillard reactions, caramel) Texture modifier (biscuits, cakes, confectionary) Stabiliser (colours) Preservative (jams, chutneys) Glazing agent Freezing point depression (ice cream) Fermentation substrate (bread) Formation of glasses
20 Functional roles of sugar (2) Sugar reduction in products: - need for several additives - in solid products no or not relevant energy reduction (no nutritional benefit)
21 Sugar and nutrition/health issues (1) Micronutrient Dilution, Oral Health, Obesity, Type II Diabetes, Metabolic Syndrome, Cardio Vascular Disease, Cognitive Performance, Behaviour, Addiction, Sports Nutrition
22 Sugar and nutrition/health issues (2) Micronutrient Dilution > en% added mono- and disaccharides increases risk of too low nutrient intakes. There are insufficient data to set an upper limit. Health Council of the Netherlands (2006); IOM (2002); EFSA (2010) Gibson SA (2007), Dietary sugars and micronutrient adequacy: a systematic review of the evidence. Nutr Res rev 20: Livingstone MB and Rennie KL (2009), Added sugars and micronutrient dilution. Obes rev 10, suppl 1: Ruxton C et al (2010), Is sugar consumption detrimental to health? A review of the evidence Crit Rev Food Sci Nutr 50: 1-19
23 Sugar and nutrition/health issues (3) Oral Health: Cariogenic effect of sucrose is positively related to the frequency of its use. Insufficient data to set an upper limit for intake of added sugars (EFSA, 2010).
24 Sugar and nutrition/health issues (4) Overweight, Diabetes, Metabolic Syndrome: No evidence for a specific role of mono-and disaccharide intake on development of type II diabetes. No evidence for a specific role of sucrose in development of overweight, increased blood lipids, type II diabetes and hypertension.
25 Increase of prevalence of overweight and obesity in NL; no increase of added sugars
26 Sugar and nutrition/health issues (5) Cardio Vascular Disease: High fructose intakes may increase plasma TG. Adverse effects on blood lipid profile in humans may occur at fructose intake levels > 12 en%. No evidence that current fructose intake levels of g/day influence blood lipid profile. Bantle JP, Dietary fructose and metabolic syndrome and diabetes. The Journal of Nutrition 139 (2009) 1263S-1268S. Nederlandse Diabetes Federatie, Voedingsrichtlijn voor diabetes. Nederlandse Diabetes Federatie, Amersfoort, augustus 2010.
27 Sugar and nutrition/health issues (6) Cognitive Performance, Behaviour, Addiction: Digestible carbohydrates may increase brain serotonin synthesis. Sugar, food additives and sometimes all forms of processed foods have been blamed for increasing anti-social behaviour, as hyperactivity, aggressiveness and violence. No evidence for a specific role of sucrose. No support for hypothesis that sucrose may be physically addictive (according DSM-IV/5) Bellisle F (2004), Effects of diet on behaviour and cognition in children. British Journal of Nutrition 92, Supplement 2; S227-S232. Fernstrom JD and Wurtman RJ (1971), Brain serotonin content: increase following ingestion of a carbohydrate diet. Science 174: Benton D (2008), Sucrose and behavioral problems. Crit Rev Food Sci Nutr 48: Benton D (2010), The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition 29:
28 Sugar and nutrition/health issues (7) Sports Nutrition: Intake of highly digestible CHO intake is required before-, during-, and directly after endurance exercise to promote performance and recovery (sparing of glycogen depletion and promotion of glycogen recovery). Sucrose may have advantages over glucose: 1. Lower osmotic load 2. Distinct transport mechanisms for glucose and fructose may enhance CHO delivery to the blood. Cermak NM and Van Loon LJC, The use of carbohydrates during exercise as an ergogenic aid.sports Medicine (in press) Wallis G and Wittekind A, Is there a specific role for sucrose in sports and exercise performance? International Journal of Sport Nutrition and Exercise Metabolism (in press)
29 Conclusions 1. No evidence to differentiate between digestible complex- and simple carbohydrates (including sucrose) with respect to their metabolic effects 2. No evidence to differentiate between intrinsic and extrinsic (added) sugars in the diet with respect to metabolic effects 3. Sugar intake is stable for the last decennia 4. Sugar has many functionalities. Makes a range of foods palatable. Sugar reduction does not always give a nutritional benefit. Reduced sugar claims may mislead consumers 5. Sugar not a specific risk factor for chronic diseases/poor nutrition (except frequency in dental caries) 6. Sugar may have a benefit in sports nutrition
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