Sugar has complex effects on health according to the literature. While sugar provides calories and taste, high intake is linked to issues like obesity, diabetes, heart disease, and more. Children in particular should limit added sugars to less than 6 teaspoons per day and avoid sugar-sweetened drinks. The evidence suggests that sugar intake should make up no more than 5-10% of total daily calories. Moderation is key, and parents can help by modeling healthy habits, making nutritious options available, and focusing children on enjoying mealtimes with family over sugary snacks.

2. What is Sugar

3. Sugar Metabolism

4. Why Children need Sugar?
Sugar is Energy
Food Texture Food Taste
So sugar is not inherently harmful

5. An Ecstacy Appeal of Sugar
Neuroscience and Biobehavioral Reviews 32 (2008)
Binging on sugar affects the part of the brain that’s
associated with emotional control.

6. Anecstacy Appeal of Sugar
Neuroscience and Biobehavioral Reviews 32 (2008)
Researchers concluded that
“intermittent access to sugar can lead to behavioral and neurochemical
changes that resemble the effects of a substance of abuse.”

7. Sugar Metabolism

8. The sweet danger of sugar

9. The sweet danger of sugar
Sugar has a bittersweet reputation when it comes to health.
Source Quantity

10. The sweet danger of sugar
Source
Added sugar can be found in even the most unexpected products.
In the US, added sugars account for up to 14% of the total calorie intake
for children.
Nutr J. 2017
The main contributor to empty calories in the Western diet is
added sugars.

11. The sweet danger of sugar

12. The sweet danger of sugar
Hidden Sugars
Offering low-fat options, often adding sugar to make them more palatable.

13. The sweet danger of sugar
Hidden Sugars
These hidden sugars can make it harder for people to accurately gauge their
daily sugar consumption.

14. The sweet danger of sugar
Hidden Sugars
Almost all sugar in drinks marketed to children were added sugars, averaging
more than 20 grams per serving.
That’s more than half the recommended daily amount for adult men.

15. The sweet Danger of Sugar
Free Sugar
The term free sugars is adopted, replacing the terms Non Milk Extrinsic
Sugars (NMES) and added sugars.
Free sugars are those added to food or those naturally present in honey,
syrups and unsweetened fruit juices, but exclude lactose in milk and milk
products.

16. The sweet danger of sugar
Free Sugar
Free sugars should account for no more than 5% daily dietary energy intake.

17. Doing the Math
How much sugar is OK for Kids?
Every 4 grams of sugar equals 1 teaspoon
Quantity

18. The sweet danger of sugar
How much sugar is OK for Kids?
The new guidelines call for less than 25 grams (6 teaspoons) of sugar
per day for children ages 2 to 18 years
That includes no more than 8 ounces ( 236 ml) of sugar-sweetened
drinks per week.

19. The sweet danger of sugar
How much sugar is OK for Kids?
“Children younger than 2 years should have no sugar at all,”

20. The sweet danger of sugar
How much sugar is OK for Kids?
“Children younger than 2 years should have no sugar at all,”

21. The sweet danger of sugar

22. Bad Mood
Bad Mood Food
 Mood Dip
 Irritable
 anxious
 fatigue
The sweet danger of sugar

23. The sweet danger of sugar
ADHD Asthma Obesity
Heart Disease Type 2
Diabetes
High Blood
Pressure
NAFLD

24. The sweet danger of sugar
ADHD Asthma Obesity
Heart Disease Type 2
Diabetes
High Blood
Pressure
NAFLD
Obese children who regularly consume sugar, their livers are getting the
one-two punch normally reserved for older alcoholics.

25. There’s misplaced attention given to soda related to obesity.
The sweet danger of sugar
The latest scientific data from the U.S. Centers for Disease Control and Prevention
show that beverages are not driving the rising rates of obesity and obesity-related
conditions in the United States.
The rates for obesity continued to go up steadily as soda consumption went down,
showing no connection.”

26. “Strong and consistent” evidence that added sugars in foods and beverages are
associated with excess body weight in children.
Added sugars, particularly those from sugar-sweetened beverages, increases risk of
type 2 diabetes.
“Moderate” evidence that it increases the risk of hypertension, stroke, and coronary
heart disease.
The sweet danger of sugar

27. The sweet danger of sugar
Eating lots of added sugar early in life is linked to obesity, high blood
pressure and type 2 diabetes.
Risk for Heart Disease.

28. The sweet danger of sugar
Filling up on sugary treats leaves less room in young tummies for
heart-healthy fare

29. The sweet danger of sugar
Emerging research suggests that fructose:
 Damages communication between brain cells
 Increases toxicity in the brain
 Long-term sugar diet diminishes the brain’s ability to learn and
retain information.

30. The sweet danger of sugar
Fructose can damage hundreds of the genes central to metabolism and
lead to major diseases, including ADHD.
Q. Meng et al. / EBioMedicine 7 (2016)

31. Attention deficit hyperactivity disorder
in children & adolescents
 Sensitivity to refined sugar.
 Functional reactive hypoglycemia after ingesting sugar.
(which triggers release of stress hormones such as adrenaline)
Adverse behavior effects, including hyperactivity, are commonly
attributed to excess sugar intake by parents and teachers
Two proposed mechanisms
Pediatr Clin North Am. 2007

32. Attention deficit hyperactivity disorder
in children & adolescents
Even when intake exceeds typical dietary levels, neither dietary sucrose nor
aspartame affects children's behavior or cognitive function.

33. Attention deficit hyperactivity disorder
in children & adolescents
Found that sugar does not affect the behavior or cognitive performance of
children. The strong belief of parents may be due to expectancy and common
association.
jama.1995

34. Attention deficit hyperactivity disorder
in children & adolescents
A 2005 systematic review that included a slightly different set of trials supported the
conclusion of the earlier meta-analysis but points out that most of the trials used
relatively low-sugar challenges (equivalent to roughly one 16 ounce bottle of soda)
Ment Retard Dev Disabil Res Rev . 2005

35. Attention deficit hyperactivity disorder
in children & adolescents
Nevertheless, giving the number and the design of most of the studies available in
the literature, the current evidence is weak.
Epub 2019 Apr 10.
This study suggests that a diet high in refined sugar and saturated fat can increase
the risk, whereas a healthy diet, characterized by high consumption of fruits and
vegetables, would protect against ADHD or hyperactivity.
More studies using longitudinal design need to be performed to reinforce this
evidence.

36. Attention deficit hyperactivity disorder
in children & adolescents
Indicated a positive relationship between overall sugar and sugar-sweetened
beverages consumption and symptoms of ADHD; however, there was heterogeneity
among included studies.
Future well-designed studies that can account for confounds are necessary to
confirm the effect of sugar on ADHD.

37. Cognitive Dysfunction
The majority of studies identified report diet-induced memory problems when diet
exposure began in adolescence but not adulthood.
These findings lend support to the hypothesis that adolescence is a sensitive period
during which palatable diets may contribute to negative neurocognitive effects.
Frontiers in Neuroscience. 2019

38. Cardiometabolic Risk
Higher SCB consumption was associated with small elevations of CMR in preschool
children.
Support recommendations to limit overall intake of SCBs in early childhood, in effort
to reduce the potential long-term burden of CMR.
Preventive Medicine Repor. 2020

39. Obesity
The objective of this study was to study the association between total sugar intake
(TSI) levels of children aged 6–8 years old, nutrient intake and anthropometry.
It is not clear what the effect of up to an average of 21% of energy coming from total
sugars has on childhood obesity and further research is needed in the pediatric
population, however, opportunities exist to improve sugar intake patterns.
Nutrients 2020

40. Obesity
Meta analysis of prospective cohort studies, with follow-up times of 1 year or more,
found that children with the highest intakes of sugar-sweetened beverages had a
greater likelihood of being overweight or obese than children with the lowest
intakes.

41. Obesity
Confirms that SSB consumption in young children is an important risk factor for
prospective weight gain and overweight.
Nutrients 2020

42. Immunity
Eating or drinking too much sugar curbs immune system cells that attack bacteria.
This effect lasts for at least a few hours after downing a couple of sugary drinks.
Trends in Immunology, June 2016

43. Asthma
The effect of maternal intake of free sugar (estimated by questionnaire) during
pregnancy on childhood respiratory and atopic outcomes was examined in a large
birth cohort in the United Kingdom
Eur Respir J 2017
The increase in childhood asthma rates has occurred contemporaneously with a 25
percent increase in per capita consumption of refined sugars in the United States.

44. Asthma
Eur Respir J. 2020
The likelihood of childhood atopic asthma was increased in the quintile with the
highest sugar consumption compared with the lowest quintile
Additional study is warranted.

45. Asthma
Al-Zalabani AH 2019
A positive association between soft drinks consumption and asthma prevalence,
mostly from cross-sectional studies.
Therefore, more longitudinal research is required to establish causality.

46. Dental Caries
An analysis of cohort studies in children suggests a positive association between the
level of free sugars intake and dental caries.
The evidence suggests higher rates of dental caries when the level of free sugars
intake is more than 10% of total energy intake compared with it being less than 10%
of total energy intake.

47. Recommendations
Fruit Juice Added sugars
Soft drinks and sweetened beverages
Low-calorie sweetened beverages

48. Dietary recommendations for toddlers, preschool, and school-
age children
Recommended to limit fruit juice to 8 ounces (236 ml) for children
7 to 18 years of age.
Recommend to limit fruit juice to:
 no more than 4 ounces (118 ml) for children 1 to 3 years of age
 4 to 6 ounces (118 – 170 ml) for children 4 to 6 years of age
Fruit Juice

50. Dietary recommendations for toddlers, preschool, and school-
age children
Fruit juice should be offered as part of a meal or snack and not sipped
throughout the day; it should not be consumed at bedtime or in bed.
Pediatrics. 2017

51. Dietary recommendations for toddlers, preschool, and school-
age children
Consumption of 100 percent fruit juice within the recommended limits does
not appear to be associated with weight gain.
Pediatrics. 2017
Overconsumption of fruit juice may be associated with dental caries, diarrhea,
bloating, excessive flatulence, abdominal distension, undernutrition, and
overnutrition

52. Dietary recommendations for toddlers, preschool, and school-
age children
Sugars and syrups that are consumed directly (eg, candy, cookies)
Pediatrics. 2019
Added sugars
Added during preparation and processing (eg, high fructose corn
syrup)
Added before consumption of food and beverages (eg, sugar, honey, maple syrup,
agave nectar, malt syrup)

53. Dietary recommendations for toddlers, preschool, and school-
age children
Added sugars

54. Dietary recommendations for toddlers, preschool, and school-
age children
The AHA recommends that consumption of:
 Added sugars be avoided in children <2 years of age
 Added sugars be limited to ≤25 g (approximately 100 kilocalories or 6
teaspoons) in children ≥2 years of age
Epub 2016
Added sugars

55. Dietary recommendations for toddlers, preschool, and school-
age children
Limit discretionary kilocalories (ie, those available for consumption as added sugars
or solid fats after essential daily nutrient requirements are met) to 6 to 10 percent of
total daily energy intake
US Department of Health and Human Services. 2016
Added sugars

56. Dietary recommendations for toddlers, preschool, and school-
age children
Added sugars be limited to ≤6 percent of total daily energy intake
USDA Scientific Report of the 2020 Dietary Guidelines Advisory Committee
Added sugars

57. Dietary recommendations for toddlers, preschool, and school-
age children
Studies evaluating added sugars in children are limited
Added sugars
Pending additional information, these consensus guidelines seem reasonable.

58. Dietary recommendations for toddlers, preschool, and school-
age children
The consumption of soft drinks and other sweetened beverages
(eg, fruit drinks, flavored water) should be discouraged
Grove Village, IL 2017.
Soft drinks and Sweetened Beverages
An expert panel consensus recommends that children <5 years avoid
consumption of these beverages
For older children, consumption should be limited to ≤8 ounces
(approximately 240 mL) per week

59. Dietary recommendations for toddlers, preschool, and school-
age children
Sweetened beverages (eg, regular soda, fruit drinks, sweetened tea and coffee) are a
major source of added sugar in the diet and an important contributor to the
development of obesity
Soft drinks and Sweetened Beverages
Sweetened beverage consumption also is associated with lower intake of key
nutrients (particularly calcium) because sweetened beverages generally are
consumed instead of milk.

60. Dietary recommendations for toddlers, preschool, and school-
age children
Sweetened with low-calorie or no-calorie sweeteners (eg, saccharin, aspartame,
sucralose, stevia).
Low-calorie Sweetened Beverages
Consumption of low-calorie sweetened beverages should be limited in children and
adolescents
There is no evidence that these beverages have benefits over plain water.
Healthy Eating Research, Durham, NC, 2019.

61. Dietary recommendations for toddlers, preschool, and school-
age children
Evaluation of adverse effects of low-calorie beverages is an active area of research
Low-calorie Sweetened Beverages
Pediatrics. 2019
Potential adverse effects include:
 Decreased intake of healthier beverages (eg, cow milk)
 Development of a taste preference for sweetened beverages
 Altered sensations of fullness and hunger

62. What should we Do?

63. Let Hunger be your Guide
Children have an innate ability to adjust their diet to their energy
intake.
Self-regulate when they need protein, fat and carbohydrates.

64. Let Hunger be your Guide
Children have an innate ability to adjust their diet to their energy
intake.
Self-regulate when they need protein, fat and carbohydrates.

65. Let Hunger be your Guide
“Eating brings joy, but that joy should be geared toward the process
of satisfying hunger and spending time with family.
Children can’t choose a well-balanced diet.
But adults can, and should — right from the beginning.”

66. Let Hunger be your Guide
Refocusing where children’s joy should come from
Find other means to reinforce good behaviors

67. Let Hunger be your Guide
It helps when parents model good Eating Habits
The experience of enjoying food when they’re hungry and meal
time with family (without distractions like TV)

68. So to Conclude

69. So to Conclude
Sugar should preferably be consumed as part of a main meal and in a
natural form as human milk, milk, unsweetened dairy products and
fresh fruits, rather than as SSBs, fruit juices, smoothies and/or
sweetened milk products.
Free sugars in liquid form should be replaced by water or
nonsweetened milk drinks.
National Authorities should adopt policies aimed at reducing the
intake of free sugars in infants, children and adolescents.
This may include education, improved labelling, restriction of
advertising, introducing standards for kindergarten and school meals,
and fiscal measures, depending on local circumstances.

70. Think practical

71. Think practical
Parental Model Availability
Never Say No
Education
Gradual Change

72. Think practical
Insulin resistanceEnergy intake
Physical ActivityMediterranean Diet

73. Thank You