student profile: Ms Xiao Luo


Thesis work

Thesis title: Systematic Review of reducing sugar in bakery goods and its potential health impact

Supervisors: Timothy GILL , Anna RANGAN

Thesis abstract:

Thesis Abstract�br /� �strong� �br /� �br /� Reduction of Free Sugar in Baked Products and Its Impact on Public Health�/strong��br /� �strong�1.�/strong��strong�Back ground: Sugar-A Health Issue�/strong��br /� Free sugar is defined by WHO as all monosaccharides and disaccharides added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and fruit juices.(1) In many of the baked products, sucrose plays an important role in both sensory and technological function.�br /� However, excessive intake of free sugar became a health problem recently, as WHO indicated that high level intake of free sugars is related to lower quality of dietary, obesity and non-communicable diseases.(1, 2) Free sugar intake may promotes a positive energy balance which is associated with decreased nutrient density of diet and weight gain.(1, 3-5) By increasing the total energy intake, risk of dental caries is also increasing; as dental diseases are the most common non-communicable diseases which take 5-10% health-care budgets in developed countries. (1, 6, 7)�br /� Based on the above evidence, WHO/FAO Expert Consultation has published recommendations regarding free sugar intake for adults and children firstly in 2003, then had an updated guidelines regarding free sugar intake in 2015 as following:(8)�br /� A reduction in free sugar throughout whole life is strongly recommended.�br /� Less than 10% of total energy intake for both adults and children is strongly recommended, which threshold is also in line with 23 national reports.(9)�br /� A further reduction of free sugar intake to less than 5% of total energy intake is conditionally recommended and no adverse effects were associated with such reduction.(1)�br /� In respond to the evidence based recommendations, Public Health England firstly urged food industry including retailers, restaurants, cafes and take-away outlets for reducing sugar by 20% in addition to cut the portion size as well in 2016.(10)�br /� �br /� �br /� �br /� �strong�2.�/strong��strong�Food Reformulation and Sugar Reduction�/strong��br /� �br /� Food Reformulation Background�br /� In the recent decades, WHO has put more emphasises on cutting free sugar, trans fat, saturated fatty acids and sodium in processed foods based on its joint WHO/FAO Expert Consultation report(8), which revealed strong evidence for undesirable health outcomes associated with low quality diet. Chronic diseases are, to some extent, are related to poor quality of diet, positive energy balance due to high energy density that is mostly found in processed foods.(1, 11) A large number of people world widely are consuming such energy dense processed foods which are high in saturated fat, free sugar and salt,(11)that may in turn aggravate the public health concern of chronic diseases in relation to quality of diet. In respond to WHO/FAO’s report, many governments in collaboration with food companies have put food reformulation in action to meet the above recommendations. Salt reduction campaign applied in the UK successfully leads the reformulation trend world widely.�br /� �br /� Sugar Reduction�br /� Like salt reduction programme implemented in UK, sugar reduction in foods by food reformulation can necessarily be considered as an essential action to achieve WHO’s free sugar intake recommendation--<10% of total energy and further down to <5%. As Lei �em�et al �/em�2016 reported that high-sugar energy dense products contribute to 80-90% of Australians’ daily added sugar intake.(12) Except for table sugar added by consumers, food industry is responsible for all other high-sugar energy dense products, thus food reformulation could be very efficient in reducing total sugar intake.�br /� Food industry covers a diverse set of companies with various sizes as commodity companies with fresh produce, giant food companies such as Nestle and Campbell-Arnott’s, quick-service restaurant such as McDonald’s and local grocery stores Woolworths and Coles. (13)These food companies provide ranges of foods from raw and fresh foods to highly-processed ready to eat products which widely influence and reflects consumers’ choices and further impact their health.�br /� Under the dual pressures from meeting WHO dietary guidelines and increasing number of health-savvy consumers, food reformulation became one of the most important way to respond this healthy food trend. The definition of food reformulation is reformulation the existing food products by reducing negative food components such as free sugar, trans- and saturated fats, salt, or by adding positive nutrients including vitamins, minerals, phytosterols, dietary fibres, prebiotics and probiotics; the latter foods are usually known as “fortified foods”. (14)�br /� In European market, initiatives on food reformulation regarding sugar reduction have been applied to some basic foods such as cereal products, milk and dairy products, fats and oils, beverages etc.(14) Among these main categories of foods, at least one component from trans-fat, saturated fatty acids, salt, free sugar has been reduced or replaced. Sugar sweetened beverages are the most common foods that involved in sugar reduction currently, there are also some but limited initiatives of sugar reduction for dairy products, cereal-based products, baked products and cake mix.�br /� �br /� �br /� �strong�3.�/strong��strong�Sugar Reduction in Baked Products�/strong��br /� To replace sugars (sucrose, glucose, fructose, honey, syrups) in traditional bake products, low-calorie sugar substitutes are normally used to partially or completely replace sugar.�br /� There are three major categories of sugar replacers can be added to baked products including sugar alcohols, natural and artificial high potency sweeteners combined with bulking agents and other functional carbohydrates/sugars.�br /� �br /� �strong�4.�/strong��strong�Previous and current studies on reformulated baked products�/strong��br /� Low sugar or low calorie is the top trend among bakery sector.(15). However, as sugar in baked products not only gives product a sweet taste, but also contributes to many other important quality-related properties; there will be detectable losses in appearance (colour, volume), texture, flavour, and mouthfeel, thus simply decrease or remove sugar from the formulation will apparently impact the quality and acceptance of the products.�br /� In terms of low in sugar claim for baked products, it can only be claimed as “low in sugar” when the product contains no more than 5g of (free)sugars for solids, this claim is regulated by both EFSA and FSANZ but not FDA. For “sugar free “claim, all regulation agents have the same definition as less than <0.5% free sugar in the product that can be claimed as “sugar free”.�br /� �br /� �strong�5.�/strong��strong�Current government and industry initiatives of sugar reduction �/strong��br /� Three major food and public health organisations have taken actions regarding sugar reduction. Public Health England, FDA and European Union’s Food Improvement Plan are recently applied in respond to WHO’s recommendation of lower sugar intake.�br /� For industry, many food ingredients company are actively engaged in food reformulation by developing new sugar replacements. New baked products with lower or no added sugar are also developed, yet takes only a small amount of whole market.�br /� �ol� �li��strong�Modelling of Potential Product Reformulation to Reduce Sugar�/strong��/li� �/ol� This part focuses on the relation between food reformulation and its impact on free sugar intake of Australian adults and children based on data from recent Australian Health Survey.�br /� �br /� �strong�7.�/strong��strong�Limitations and Challenges of Sugar Reduction in baked products�/strong��br /� Technical difficulties, consumers’ acceptance and regulatory affairs are main problems in regards to sugar reduced baked products.�br /� �br /� �br /� �br /� �br /� References:�br /� �br /� 1. Sugars intake for adults and children [press release]. World Health Organization2015.�br /� 2. Joint WHO/FAO Consultation on Diet, Nutrition and The Prevention of Chronic Diseases. Geneva: WHO/FAO; 2002.�br /� 3. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, et al. Dietary sugars intake and cardiovascular health. Circulation. 2009;120(11):1011-20.�br /� 4. Marmot M, Atinmo T, Byers T, Chen J, Hirohata T, Jackson A, et al. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. 2007.�br /� 5. Elia M, Cummings J. Physiological aspects of energy metabolism and gastrointestinal effects of carbohydrates. European journal of clinical nutrition. 2007;61:S40-S74.�br /� 6. Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public health nutrition. 2004;7(1A; SPI):201-26.�br /� 7. Sheiham A, James WP. A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption. Public Health Nutrition. 2014;17(10):2176-84.�br /� 8. Who J, Consultation FE. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser. 2003;916(i-viii).�br /� 9. Ashraf H. WHO's diet report prompts food industry backlash. The Lancet. 2003;361(9367):1442-.�br /� 10. Iacobucci G. Government urges food industry to cut 20% of sugar and reduce portion sizes. BMJ. 2016:i5348.�br /� 11. Dunford E, Webster J, Metzler AB, Czernichow S, Mhurchu CN, Wolmarans P, et al. International collaborative project to compare and monitor the nutritional composition of processed foods. European journal of preventive cardiology. 2012;19(6):1326-32.�br /� 12. Linggang L, Anna R, Flood V, Yu Louie J. Dietary intake and food sources of added sugar in the Australian population. British Journal of Nutrition. 2016;115(5):868-77.�br /� 13. Layman DK. Eating patterns, diet quality and energy balance: A perspective about applications and future directions for the food industry. Physiology & Behavior. 2014;134:126-30.�br /� 14. van Raaij J, Hendriksen M, Verhagen H. Potential for improvement of population diet through reformulation of commonly eaten foods. Public Health Nutrition. 2009;12(3):325-30.�br /� 15. Soma G, Sudha M. A review on polyols: new frontiers for health-based bakery products. International Journal of Food Sciences and Nutrition. 2012;63(3):372-9.�br /� �br /� �br /�

Note: This profile is for a student at the University of Sydney. Views presented here are not necessarily those of the University.