JPGN Volume 66, Number 3, March 2018 Letters to the Editor REFERENCES 3. Mennella JA, Bobowski NK, Reed DR. The development of sweet taste: From biology to hedonics. Rev Endocr Metab Disord 2016;17: 171–8. 1. Zizzo AN, Valentino PL, Shah PS, et al. Second-line agents in pediatric 4. Welsh JA, Welsh JA1, Sharma A, et al. Consumption of added sugars and patients with autoimmune hepatitis: a systematic review and meta- indicators of cardiovascular disease risk among US adolescents. Circula- analysis. J Pediatr Gastroenterol Nutr 2017;65:6–15. tion 2011;123:249–57. 2. Sciveres M, Caprai S, Palla G, et al. Effectiveness and safety of 5. Harrison D, Stevens B, Bueno M, et al. Efﬁcacy of sweet solutions for ciclosporin as therapy for autoimmune diseases of the liver in children analgesia in infants between 1 and 12 months of age: a systematic review. and adolescents. Aliment Pharmacol Ther 2004;19:209–17. Arch Dis Child 2010;95:406–13. 3. Czaja AJ. Autoimmune hepatitis: focusing on treatments other than 6. Vos MB, Kaar JL, Welsh JA, et al., American Heart Association steroids. Can J Gastroenterol 2012;26:615–20. Nutrition Committee of the Council on Lifestyle and Cardiometabolic 4. Alvarez F, Ciocca M, Can˜ero-Velasco C, et al. Short-term cyclosporine Health; Council on Clinical Cardiology; Council on Cardiovascular induces a remission of autoimmune hepatitis in children. Hepatol 1999; Disease in the Young; Council on Cardiovascular and Stroke Nursing; 30:222–7. Council on Epidemiology and Prevention; Council on Functional 5. Cuarterolo M, Ciocca M, Velasco CC, et al. Follow-up of children with Genomics and Translational Biology; and Council on Hypertensio- autoimmune hepatitis treated with cyclosporine. J Pediatr Gastroenterol nAdded sugars and cardiovascular disease risk in children. A scientiﬁc Nutr 2006;43:635–9. statement from the American Heart Association. Circulation 2017;135: e1017–34. How Much Free Sugars Intake Should Response to Letter: How Much Free Be Recommended for Children Sugars Intake Should Be Younger Than 2 Years Old? Recommended for Children Younger Than 2 Years Old? o the Editor: A recent publication addressed the European Society for Paediatric, Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition position about eply: Dr Vitolo (1) asks what led the ESPGHAN CoN ‘‘to sugar in infants, children, and adolescents (1). Based on the step away from a definite statement about sugar intake and World Health Organization guideline (2), the Committee stated infants’’ in our recent Position paper (2). We would like to clarify that free sugar intake should be less than 5% of total calories for that our recommendation certainly does not mean that we are children and adolescents aged 2 to 18 years, suggesting that this ‘‘stepping away’’ or establishing a ‘‘safe amount’’ of sugars for figure should be lower to children younger than 2 years old. this age group. Establish a safe amount of sugar for infants may be a mistake The American Heart Association (AHA) recommends that because the evidence for this age group goes to the direction of ‘‘added’’ sugars should be avoided for children younger than 2 years nonexposure to the sweet taste early in life. Sweet taste experi- (3). As explained in our article, the European Food Safety Authority ence in infancy triggers the preference for this flavor, which will (EFSA) and US definitions of ‘‘added sugars’’ (4,5) do not include determine children’s poor dietary habits and consequently be a sugars present in unsweetened fruit and vegetable juice and fruit risk factor for noncommunicable diseases (3,4). Is the pediatric juice concentrate, all of which are, however, captured in the WHO clinical use of sugar as an analgesic agent during painful pro- definition of free sugars (6), which we favour. Thus, children younger cedures the main reason for the Committee to step away from a than 2 years who drink fruit juices and/or consume fruit juice definite statement about sugar intake and infants (5)? Guidelines concentrate, jellies, jams, preserves, and fruit spreads would still are intended for the general population and not for an individual be following the AHA recommendation to avoid added sugars, whilst one, which should be left open for the professional in clinical and still consuming ‘‘free’’ sugars. Our recommendations state that technical responsibility. Therefore, based on evidence, the Amer- ‘‘there is no nutritional requirement for free sugars in infants, children ican Heart Association committee recommended (6): ‘‘Because and adolescents’’ and suggest that the intake in those younger than there is minimal room for nutrient-free calories in the habitual 2 years should ‘‘probably be even lower’’ than the less than 5% of diets of very young children, added sugars should be avoided in energy intake recommended for older children (2), partly considering the diet of children <2 years of age’’. That is the statement we are the potential for sugar in infancy to influence taste and/or food expecting to be internationally widespread and hopefully help to preferences. We, however, did not provide a definitive figure because build a healthy food environment for children. we found the evidence-base for doing so in this age group is not sufficiently robust, consisting largely of observational studies. Marcia Regina Vitolo Furthermore, we have noted throughout the article the need Graduate Program of Health Sciences, Universidade Federal de to limit the intake of free sugars at all ages, and to clarify the ˆ ´ Ciencias da Saude de Porto Alegre Brazil terminology and labelling of sugars because consumers may not be aware that free sugars are present in foods and beverages, even when they are labelled as having ‘‘no added sugar’’ and ‘‘naturally REFERENCES occurring sugars.’’ We hope that such measures would contribute to 1. Mis NF, Braegger C, Bronsky J, et al., ESPGHAN Committee on building a healthier food environment for infants and children. NutritionSugar in infants, children and adolescents: a position paper of the European Society for Paediatric Gastroenterology, Hepatology and ESPGHAN Committee on Nutrition Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017. y z Natasˇa Fidler Mis, Christian Braegger, Jiri Bronsky, [Epub ahead of print]. § jj Cristina Campoy, Magnus Domello ¨ f, Nicholas D. Embleton, 2. World Health OrganizationGuideline: Sugars Intake for Adults and # yy Children Geneva, Switzerland: World Health Organization; 2015. Iva Hojsak, Jessie Hulst, Flavia Indrio, www.jpgn.org e87 Copyright © ESPGHAN and NASPGHAN. All rights reserved.
Journal of Pediatric Gastroenterology & Nutrition – Wolters Kluwer Health
Published: Mar 1, 2018
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