EAT FOR HEALTH Australian Dietary Guidelines

EAT FOR HEALTH – AusTRALiAn diETARy guidELinEs

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Guideline 3

Other conditions

•   Dental caries: The relationship between sucrose and dental caries was first documented more than a century

ago^772 and has been confirmed in numerous studies since then.^773 Historically, the prevalence of dental caries

has increased when dietary patterns have changed to include more added sugars and foods containing refined

starches. New evidence supports past findings and suggests that high or frequent consumption of added sugars,

particularly for infants and young children, is associated with increased risk of dental caries (Grade C; Evidence

Report, Section 14.2).774-778 The evidence also suggests that dental caries are related to sugar-sweetened drinks

(Grade C; Evidence Report, Section 15.4).774,776

•   Caries are associated with national per capita yearly sucrose consumption, with very few caries in children

consuming 10kg/year (about 30g/day) or less. A steep increase may occur from 15kg/year upwards.^88

•   The sugars contained in the cellular structure of foods, such as the intrinsic sugars of fresh fruit and vegetables,

have been found to have little cariogenic potential, whereas foods high in added sugars are most damaging

to teeth.^779

•   Bone strength: Evidence suggests an association between consumption of soft drinks and increased risk

of reduced bone strength (Grade C; Evidence Report, Section 15.3).650-653 Cola drinks (sugar-sweetened and

diet varieties), but not other carbonated drinks, are associated with significantly lower bone mineral density in

women, but not in men.^653 In young men, significant adverse changes in indices of bone remodelling and bone

resorption markers occurred when cola drinks were added to a low-calcium diet, compared with adding milk.^650

A systematic review reported an inverse relationship between soft drink consumption and milk intake.^195

•   It appears that soft drink consumption is associated with some problems related to bone health, but, with the

exception of some limited evidence related to cola drinks, it remains unclear whether soft drinks exert a direct

effect or reflect an inverse relationship with milk consumption.

•   Attention deficit hyperactivity disorder (ADHD): There is no evidence that added sugars are involved in the

aetiology of ADHD.^780

3.3.3 How limiting intake of foods and drinks containing added sugars may improve health outcomes

Dental caries: Important factors for development of caries include the bacterium Streptococcus mutans, dietary

sugars and a susceptible tooth surface. Fermentable carbohydrates (both sugars and starches) are a substrate

for bacteria such as S. mutans and S. sobrinus, which increase the acid-producing potential of dental plaque.^781

Dietary sugars other than sucrose (e.g. glucose and lactose) can also induce caries, although these sugars are

less cariogenic than sucrose because, in addition to being converted to acid metabolites, sucrose is uniquely

used for extracellular polysaccharide synthesis.

Oral hygiene, dental care, fluoridated water supplies, the type of food and salivary function are also important.

The more frequently foods containing added sugars are consumed, the greater the risk of caries, since frequent

consumption does not allow remineralisation of the teeth.^782 The duration of exposure depends on how long

sugary foods stay in the mouth and the number of eating occasions. On the basis of the scientific evidence,

advice on sugar intake for preventing dental caries should include frequency of intake as well as the amount.

The acidity of sweetened drinks is also relevant to dental erosion, a major factor in dental decay.^657 This applies

equally to sugar-sweetened or diet soft drinks, since their acidity is comparable.

Excess weight: Many foods containing added sugars (e.g. soft drinks, confectionery, cakes and biscuits) are

energy-dense but nutrient-poor. The association between sugar-sweetened drinks and weight gain appears to

be related to the reduced effect on satiety of sugars in a liquid medium. Past studies found that compensation

for energy from sugar-sweetened drinks is less complete than that for energy in solid form.^783 Newer evidence

supports this failure to compensate by reducing energy intake from other foods or drinks.^762 Sugar-sweetened

drinks therefore add to total energy intake.^784