How much sugar is hidden in drinks marketed to children? A survey of fruit juices, juice drinks and smoothies.

OBJECTIVE: To investigate the amount of sugars in fruit juices, juice drinks and smoothies (FJJDS) marketed to children. DESIGN: We surveyed the sugars content (per 100 ml and standardised 200 ml portion) of all FJJDS sold by seven major UK supermarkets (supermarket own and branded products). Only products specifically marketed towards children were included. We excluded sports drinks, iced teas, sugar-sweetened carbonated drinks and cordials as being not specifically marketed towards children. RESULTS: We identified 203 fruit juices (n=21), juice drinks (n=158) and smoothies (n=24) marketed to children. Sugars content ranged from 0 to 16 g/100 ml. The mean sugars content was 7.0 g/100 ml, but among the 100% fruit juice category, it was 10.7 g/100 ml. Smoothies (13.0 g/100 ml) contained the highest amounts of sugars and juice drinks (5.6 g/100 ml) contained the lowest amount. 117 of the 203 FJJDS surveyed would receive a Food Standards Agency 'red' colour-coded label for sugars per standardised 200 ml serving. Only 63 FJJDS would receive a 'green' colour-coded label. 85 products contained at least 19 g of sugars-a child's entire maximum daily amount of sugars. 57 products contained sugar (sucrose), 65 contained non-caloric sweeteners and five contained both. Seven products contained glucose-fructose syrup. CONCLUSIONS: The sugars content in FJJDS marketed to children in the UK is unacceptably high. Manufacturers must stop adding unnecessary sugars and calories to their FJJDS.

Cross-sectional survey of the amount of free sugars and calories in carbonated sugar-sweetened beverages on sale in the UK.

OBJECTIVES: To investigate the free sugars and calorie content of carbonated sugar-sweetened beverages (CSSB) available in the main UK supermarkets. STUDY DESIGN: We carried out a cross-sectional survey in 2014 of 169 CSSB. METHODS: The free sugars (sugars g/100 mL) and calorie (kcal/100 mL) were collected from product packaging and nutrient information panels of CSSB available in 9 main UK supermarkets. RESULTS: The average free sugars content in CSSB was 30.1±10.7 g/330 mL, and 91% of CSSB would receive a 'red' (high) label for sugars per serving. There was a large variation in sugars content between different flavours of CSSB and within the same type of flavour ranging from 3.3 to 52.8 g/330 mL. On average, ginger beer (38.5±9.9 g/330 mL) contained the highest amounts of sugars and ginger ale (22.9±7.7 g/330 mL) contained the lowest. Cola flavour is the most popular flavour in the UK with an average free sugars content of 35.0±1.1 g/330 mL. On average, the supermarket own brand contained lower levels of sugars than branded products (27.9±10.6 vs 31.6±10.6 g/330 mL, p=0.02). The average calorie content in CSSB was 126.1±43.5 kcal/330 mL. Cola flavour had a calorie content of 143.5±5.2 kcal/330 mL. Among the 169 products surveyed, 55% exceeded the maximum daily recommendation for free sugars intake (30 g) per 330 mL. CONCLUSIONS: Free sugars content of CSSB in the UK is high and is a major contributor to free sugars intake. There is a wide variation in the sugars content of CSSB and even within the same flavour of CSSB. These findings demonstrate that the amount of free sugars added to CSSB can be reduced without technical issues, and there is an urgent need to set incremental free sugars reduction targets. A reduction in sugars content and overall CSSB consumption will be very beneficial in reducing obesity, type 2 diabetes and dental caries.

Cross-sectional survey of salt content in cheese: a major contributor to salt intake in the UK.

OBJECTIVE: To investigate the salt (sodium chloride) content in cheese sold in UK supermarkets. STUDY DESIGN: We carried out a cross-sectional survey in 2012, including 612 cheeses available in UK supermarkets. METHODS: The salt content (g/100 g) was collected from product packaging and nutrient information panels of cheeses available in the top seven retailers. RESULTS: Salt content in cheese was high with a mean (±SD) of 1.7±0.58 g/100 g. There was a large variation in salt content between different types of cheeses and within the same type of cheese. On average, halloumi (2.71±0.34 g/100 g) and imported blue cheese (2.71±0.83 g/100 g) contained the highest amounts of salt and cottage cheese (0.55±0.14 g/100 g) contained the lowest amount of salt. Overall, among the 394 cheeses that had salt reduction targets, 84.5% have already met their respective Department of Health 2012 salt targets. Cheddar and cheddar-style cheese is the most popular/biggest selling cheese in the UK and has the highest number of products in the analysis (N=250). On average, salt level was higher in branded compared with supermarket own brand cheddar and cheddar-style products (1.78±0.13 vs 1.72±0.14 g/100 g, p<0.01). Ninety per cent of supermarket own brand products met the 2012 target for cheddar and cheddar-style cheese compared with 73% of branded products (p=0.001). CONCLUSIONS: Salt content in cheese in the UK is high. There is a wide variation in the salt content of different types of cheeses and even within the same type of cheese. Despite this, 84.5% of cheeses have already met their respective 2012 targets. These findings demonstrate that much larger reductions in the amount of salt added to cheese could be made and more challenging targets need to be set, so that the UK can continue to lead the world in salt reduction.

Surveys of the salt content in UK bread: progress made and further reductions possible.

OBJECTIVES: To explore the salt reductions made over time in packaged bread sold in the UK, the biggest contributor of salt to the UK diet. STUDY DESIGN: Cross-sectional surveys were carried out on the salt content of breads available in UK supermarkets in 2001(40 products), 2006 (138) and 2011 (203). MAIN OUTCOME MEASURES: The primary outcome measure was the change in salt content per 100 g over time. Further measures included the proportion of products meeting salt targets and differences between brands and bread types. RESULTS: The average salt level of bread was 1.23±0.19 g/100 g in 2001, 1.05±0.16 in 2006 and 0.98±0.13 in 2011. This shows a reduction in salt/100 g of ≈20% between 2001 and 2011. In the 18 products which were surveyed in all 3 years, there was a significant reduction of 17% (p<0.05). Supermarket own brand bread was found to be lower in salt compared with branded bread (0.95 g/100 g compared with 1.04 g/100 g in 2011). The number of products meeting the 2012 targets increased from 28% in 2001 to 71% in 2011 (p<0.001). CONCLUSIONS: This study shows that the salt content of bread has been progressively reduced over time, contributing to the evidence base that a target-based approach to salt reduction can lead to reductions being made. A wide variation in salt levels was found with many products already meeting the 2012 targets, indicating that further reductions can be made. This requires further progressive lower targets to be set, so that the UK can continue to lead the world in salt reduction and save the maximum number of lives.

WASH-world action on salt and health.

There is overwhelming evidence that our current high-salt intake is the major factor increasing blood pressure (BP) and, thereby, a major cause of cardiovascular disease and kidney disease worldwide. A reduction in salt intake to the recommended level of <5-6 g/day is very beneficial, and could prevent millions of deaths each year and make major savings for healthcare services. Several countries, e.g., Finland and the UK, have already reduced the amount of salt being consumed by a combined policy of getting the food industry to decrease the amount of salt added to foods, clear labelling on food products, and increasing public awareness of the harmful effects of salt on health. Many other developed countries, e.g., Australia, Canada, and the US, are also stepping up their activities. The major challenge now is to spread this out worldwide, particularly to developing countries where ≈80% of global BP-related disease burden occurs. In many developing countries, most of the salt consumed comes from salt added during cooking or from sauces; therefore, public health campaigns are needed to encourage consumers to use less salt. A modest reduction in salt intake across the whole population will result in major improvements in public health and have huge economic benefits in all countries around the world. World Action on Salt and Health (WASH) is a coalition of health professionals from different countries who know very well the harm of high BP and has a major role in implementing changes in their own countries. We welcome nephrologists to join (http://www.worldactiononsalt.com).