Sugar Reduction in Dairy Food: History
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1. The World Health Organization (WHO) and Public Health England (PHE) recommend cutting down added sugar in processed foods

2. Flavoured milk is one the sources of sugar and calorie intake in all age groups

3. Sugar reduction by partial substitution with natural non-nutritive sweeteners like stevia and monk fruit is one of the most suitable options for food industries

4. Sugar reduction will help manage the chronic diseases like obesity, cardiovascular diseases and diabetes

  • sugar reduction strategies
  • flavoured milk
  • sweeteners
  • stevia
  • monk fruit

1. Introduction

The consumption of excessive free or added sugar contributes to total energy intake, and, possibly, to increased body weight [1], the occurrence of obesity [2][3], and associated chronic diseases such as type 2 diabetes [4][5]. Flavoured milk is used to promote milk intake to meet the recommended dietary allowances (RDA) for vitamin D and calcium [4]. Milk appears to be the principal dairy product consumed by children worldwide. It is estimated that between 60–80% of American children’s dairy product consumption is comprised of fluid milk [6]. Furthermore, 68% of all milk available to children in schools in the USA is flavoured, of which the majority is chocolate milk [7]. However, the regular consumption of sweetened flavoured milk has been reported to increase energy intake more than 10% as compared with non-consumers [8][9][10]. The increased energy intake is further linked to the occurrence of overweight, obesity [1][2][3], and type 2 diabetes [4][5].

The World Health Organization (WHO) recommends less than 10% of total energy intake from free sugars per day in both adults and children (strong recommendation). A further reduction to below 5% is a conditional recommendation [11]. These guidelines have been considered by Public Health England (PHE), which recommends a 20% sugar reduction in processed foods and beverages by 2020 [12]. A well-tested model of an epidemiological triad (hosts, vectors, and environments) provides a framework to address such public health concerns [13][14]. The vectors rule of this model suggests ”small changes × large volumes = significant population benefits”. Therefore, even a small reduction can significantly benefit a larger population in the long term.

2. Nutritive Sweetener (NS)

The NSs include sugars such as sucrose, fructose, and lactose, as well high-fructose corn syrup (HFCS), trehalose, and polyols (erythritol, isomaltitol, lactitol, maltitol, sorbitol, mannitol, and xylitol) [15][16]. NSs have various advantages when added to foods and beverages (Table 1), however, they provide calorie contribution. For these reasons, they are not preferred for sugar reduction strategies where calorie reduction is important.

3. Non-Nutritive Sweeteners (NNSs)

Non-nutritive (intensive) sweeteners (NNSs) are food additives with high sweetness potency. They are usually added in low amounts, and therefore their calorie contribution is almost negligible and are preferred for use where calorie reduction is desired (Table 2) [15]. NS and NNS can both be either natural or artificial [17][18][19]. Natural sweeteners are intrinsic to a food substance or commonly occur in nature, e.g., stevia and monk fruit [20], while artificial sweeteners are not found in nature but are synthesized from an existing natural source. The first artificial sweetener approved by the FDA was Saccharin in 1958, while Advantame was the most recent one approved by the FDA in 2014. Similarly, the first natural NNS approved for use by the FDA in 2009 was steviol glycosides with rebaudioside A as the main component. Furthermore, the physiological effects relating to NNSs and NSs vary greatly. NSs play more of a role in the regulation of hormonal secretion and brain activation to control appetite as compared with NNSs [21]. Considering this evidence, NNSs may serve as a good substitute for sugar reduction strategies.

Table 1. Natural and artificial nutritive sweeteners (NSs), their advantages, disadvantages, sweetness potency, and calorie contribution.

Nutritive Sweeteners (NS)

 

Type

Advantages

Disadvantages

*Sweetness Potency

Calorie/g

References

Sucrose

 

Natural

Provides colour, flavour, bulkness and preservative actions against microbes

Contributes calories to diets

1.0

4.0

[22]

Glucose

 

Natural

Essential energy source for the brain

Contributes calories to diets and affects satiety

0.75×

4.0

[23]

Fructose

 

Natural

Sweetest carbohydrate in nature

Contributes calories to diets but does not affect satiety like glucose

1.5–1.8×

4.0

[24]

Lactose

 

Natural

Raw material and prebiotics for probiotics

Less contribution to sweetness

0.11–0.13×

3.9

[25][26]

Trehalose

 

Artificial

Antioxidant activity, food flavour enhancer; prevents starch aging; odor reduction and extension of the shelf life

Contributes calories

0.5–0.7×

3.6

[27][28][29][30]

Erythritol

 

Artificial

Highly stable, low calorie contribution, tooth-friendly sweetener providing volume, texture, and microbiological stability

Can cause gastrointestinal symptoms

0.7×

0.2

[31]

Isomalt (Isomaltitol)

 

Artificial

Heat resistant and tooth-friendly

Laxative effect along with gastrointestinal symptoms (abdominal discomfort, bloating and flatulence if consumed in excess i.e., >50 g)

0.45–0.6×

2.0

[31][32]

Lactitol

 

Artificial

Low calories suitable for sugar-free foods

Similar to Isomalt

0.35–0.4×

1.9

[31]

Maltitol

 

Artificial

Heat resistance, strong flavour consistency, and tooth-friendly as it is not fermented by tooth plaque forming microorganisms

Similar to Isomalt

0.5–0.9×

3.0

[31][33]

Sorbitol

 

Artificial

Bulking agent, humectant, sequestrant and acts as stabilizer

Similar to Isomalt

0.6×

2.6

[31][34]

Mannitol

 

Artificial

Crystallization in the form of a colourless/white needle/rhombus with extremely low hygroscopicity

Only 18% (w/v) soluble in water at 25 °C

0.5–0.72×

1.6

[35][36][37]

Xylitol

 

Artificial

Sweetness intensity similar to sucrose

Similar to Isomalt

1.0×

3.0

[32]

* Sweetness potency-the indicated estimate values are times (×) that of sucrose.

Table 2. Natural and artificial non-nutritive sweeteners (NNSs) used for sugar reduction in dairy products.

Non-nutritive Sweetener (NNS)

Structure

ADI (mg/kg Body Weight/day)

Onset

Lingering

Off-taste

Food and Beverages

Amount of Sugar Reduction

Reference

Natural

Thaumatin

 

50

Delay

Long

Nil

Probiotic chocolate-flavoured milk

20%

[15][38][39]

Neohesperidine dihydrochalcone

 

35

Delay

Long

Like licorice

Chocolate, skimmed plain yoghurt

-

[15][40][41]

Steviol glucosides

 

4

Delay

Moderate

Bitter

Chocolate milk, chocolate dairy desserts

50%

[15][42][43][44][45]

Monk fruit (Mogrosides V)

 

25

Delay

Long

Nil

Chocolate milk

50%

[42][43][46]

Artificial

Advantame

 

5

Delay

Moderate

Nil

Strawberry-flavoured yoghurt

100%

[15][47][48]

Neotame

 

2

Delay

Strong

Nil

Prebiotic chocolate dairy dessert

100%

[15][45]

Sucralose

 

5

Slight delay

Moderate

Slight bitter

Strawberry flavoured yoghurt, dairy desserts, lassi

100%

[15][44][48]

Saccharin

 

 

5

Rapid

Non-significant

Bitter and metallic

Strawberry flavoured yoghurt, lemon whey beverages

39%-100%

[15][48][49]

Aspartame

 

40

Slight delay

Moderate

Non-significant

Strawberry flavoured yoghurt, lemon whey beverages, lassi

39–100%

[15][49][50]

Acesulfame K

 

 

9

Quick

Low

Bitter and metallic

Strawberry flavoured yoghurt, lassi

100%

[15][50]

Cyclamates

 

 

11

Rapid

Non-significant

Bitter and salty

Strawberry flavoured yoghurt

100%

[15]

This entry is adapted from the peer-reviewed paper 10.3390/foods9101400

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