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What’s Hiding in Your Food? The Link Between Label Literacy, Hidden Sugars, and Long-Term Health

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dr. Karunia Valeriani Japar

Table of Contents
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Introduction

The global burden of metabolic disease including type 2 diabetes, obesity, non-alcoholic fatty liver disease, and cardiovascular morbidity continues to rise at an alarming pace, fuelled by profound shifts in dietary patterns and increased consumption of processed foods [1,2]. According to the World Health Organization, the prevalence of obesity has nearly tripled worldwide since 1975, with more than 1.9 billion adults classified as overweight , placing millions at risk for consequential metabolic disorder [1]. These conditions are no longer confined to high-income countries, but have rapidly emerged as leading contributors to morbidity and mortality worldwide [2].

Within this landscape, the nutrition label represents a critical and evolving public health tool, not merely as static information, but as can actionable resource empowering individuals to make informed dietary choices [3]. Food label literacy, therefore, must be reframed as an active strategy for disease prevention and health promotion, equipping consumers with the skills needed to navigate increasingly complex food environments [3]. Active engagement with food labels has been associated with healthier dietary behaviours, improved nutrient intake and better chronic disease outcomes, emphasizing its underappreciated role in population health management [3].

A particular threat, however, lies in the domain of hidden sugars, added sugars are often listen under inconspicuous names or embedded within ingredient list, escaping detection by even health-conscious consumers [2,3]. The disconnect between front-of-package claims and the actual sugar content within products contributes to the insidious intake of excessive sugars, perpetuating metabolic risk and undermining disease prevention efforts[2]. Decoding hidden sugars on food labels, therefore, transcends basic literacy; it is foundational practice for mitigating the dietary drivers of metabolic disease in the modern era [2,3].

Understanding Hidden Sugars: A Guide to the Label

Added vs. Naturally Occurring Sugars on the Nutrition Facts Panel

The revised nutrition facts panel now distinguishes between total sugars (the sum of all sugars present in a product) and added sugars (sugars introduced during processing or preparation. This distinction is critical for public health, as naturally occurring sugars in foods like milk and fruit come packaged with essential nutrients, fiber, and beneficial compounds, while added sugars contribute only calories without nutritional value [4].

  • Locating the Added Sugars Line: The “Includes X g Added Sugars” entry appears directly beneath “Total Sugars” on the Nutrition Facts panel, intended and accompanied by a percent Daily value (%DV) [4]. For example, a flavoured yogurt may display “Total sugars 15g” followed by “Includes 7g Added Sugars (14% DV),” indicating that 7 grams come from added sweeteners and 8 grams occurs naturally in the milk [4].
  • Interpreting the Daily Value: The FDA established a Daily Value of 50grams (200 calories) for added sugars based on a 2,000-calorie diet, representing the Dietary guidelines recommendations to limit added sugars to less than 10% of total daily calories [4,5,6,7]. The American Heart Association recommends more stringent limits: no more than 25 grams (100 calories or 6 teaspoons) per day for most women and 36 grams (150 calories or 9 teaspoons) per day for most men. The World Health Organization strongly recommends limiting free sugars to less than 10% of total energy intake, with conditional guidance for further reduction to below 5% (approximately 25 grams or 6 teaspoons daily) [6,10,12]. Products with 5% DV or less are considered low in added sugars, while those with 20% DV or more are high [4].

Decoding the Ingredients List: A Guide to Sugar’s Many Aliases

Food manufacturers employ over 60 different names to disguise added sugars in ingredient lists, making comprehensive label literacy essential for identifying hidden sweeteners. Research from Brazil identified 179 different terms for added sugars in packaged foods, with sugar, maltodextrin, and glucose syrup being the most common. These aliases fall into several categories that consumers must recognize to make informed choices about sugar consumption [7,8,9,10].

  • Syrups and Liquid Sweeteners: Common disguises include high-fructose corn syrup brown rice syrup, barley malt syrup, corn syrup, rice syrup, and maple syrup [7,8,9,11,12]. Agave nectar, despite its “natural” marketing, is extremely high in fructose and functions metabolically as an added sugar [7,9].
  • Chemical Names Ending in “-ose”: These scientific terms identify specific sugars sugar molecules: dextrose (glucose), fructose, maltose, sucrose, galactose, and lactose [7,8,9,11]. While lactose occurs naturally in dairy products, the other “-ose” sugars are typically added during processing.
  • Fruit-Based Concentrates and Juices: Fruit juice concentrate, grape fruit concentrate, and similar ingredients are added sugars despite their fruit origin, as the concentration process removes fiber and most nutrients while concentrating the sugar content [6,7,9].
  • Strategic Label Placement: Manufacturers may split different sugar types across the ingredient list to prevent any single sugar source from appearing prominently. Since ingredients are listed by weight in descending order, recognizing all sugar aliases prevents underestimating total sugar content [7,9]. This practice, known as “ ingredient splitting,” allows products with substantial sugar content to avoid having sugar appear as the first or second ingredient [8,12].

Front-of-Package Claims vs. Back-of-Package Facts

Front-of-package (FOP) marketing claims create powerful “health halo effects” that can mislead consumers about a product’s true nutritional profile [5,6,8,9]. Research demonstrates that claims like “natural,” ”low-fat”, or “organic” significantly influence consumers perceptions, often causing people to underestimate calorie content, overestimate nutritional value, and increase consumption of products that may be high in added sugars [6,8,10].

  • The Deceptive Nature of Health Claims: Studies show that when a snack item displays health-related claims, participants are less likely to look for nutrition information on the Nutrition Facts label, more likely to select the product for purchase, more likely to perceive the product as healthier, and less likely to correctly choose the healthier product [6,8]. The Institute of Food Technologists notes that health halos are particularly powerful psychological effects that lead consumers to believe certain foods are healthier than they are, simply because of appealing claims on the label [5,9].
  • Low-Fat Claims and Sugar Compensation: systematic research reveals that “low-fat” and “fat-free” products consistently contain higher sugar content than their regular counterparts across multiple food categories including dairy, baked goods, and processed foods [7,13]. Swedish research examining products with “ no added sugar” claims found that manufacturers commonly use alternative sweeteners including acesulfame K, aspartame, barley malt syrup, maltodextrin, oligofructose, and various fruit derivatives [4,9].
  • Organic Halo Effects: Recent research on organic labelling found that organic labels led to significant underestimation of calorie content for high-calorie items and overestimation for low-calorie items [6,10]. Interestingly, participants who frequently read nutritional information were more sensitive to organic labels, showing a stronger organic halo effect, contradicting previous assumptions about informed consumers being less susceptible to marketing influences [6,10].
  • The Antidote: Back-of Package Scrutiny: Only systematic examination of the nutrition facts panel and complete ingredient list can counteract FOP marketing effects. Consumer education research emphasizes that even health-conscious consumers are susceptible to health halo effects, emphasizing the need for active, informed label reading that focuses on quantitative nutritional data rather than marketing claims [6,8,10]. The University of Kentucky research team notes that breakfast cereals often highlight vitamin additions, creating health halos that appeal to time-strapped parents even when core nutritional content like sugar remains high [14,15,16].

Biochemical and Clinical Implications

Metabolic Pathways Of Excess Sugar Intake: The Journey From Ingestion To Metabolic Consequence.

Excess dietary sugar intake, particularly from refined and added sugars such as sucrose and high-fructose corn syrup, initiates a cascade of biochemical responses that significantly affect human metabolism and long-term health outcomes. Upon ingestion, sugars are rapidly absorbed in the small intestine; glucose uptake is mediated via the sodium-glucose co-transporter 1 (SGLT1), while fructose is transported through GLUT5. This distinction in absorption pathways marks the beginning of divergent metabolic fates, with both monosaccharides eventually entering the portal circulation and reaching the liver as a primary site for further processing [17,18,19].

Once in the liver, glucose is subjected to a well-regulated cascade of enzymatic reactions including glycolysis, where it is broken down into pyruvate. In conditions of excess, pyruvate enters mitochondria, and, via acetyl-CoA, may contribute to the tricarboxylic acid (TCA) cycle or be diverted toward de novo lipogenesis (DNL) to synthesize fatty acids. Additionally, insulin secretion is stimulated following glucose absorption, promoting glycogenesis (storage as glycogen) and inhibiting gluconeogenesis and lipolysis. Chronic consumption of high-sugar diets, however, overwhelms these regulatory networks, leading to persistent hyperinsulinemia and eventual insulin resistance, a hallmark of metabolic syndrome [17,18,19].

Fructose metabolism contrasts sharply with that of glucose. Once delivered to hepatocytes, fructose bypasses the key glycolytic rate-limiting enzyme, phosphofructokinase, allowing rapid phosphorylation by fructokinase to fructose-1-phosphate. The downstream intermediates overwhelmingly drives lipogenesis, resulting in increased hepatic triglyceride synthesis and very-low-density lipoprotein (VLDL) export to peripheral tissues. This fructose-induced DNL is largely unregulated, thereby accelerating hepatic steatosis and systemic lipid disturbances. Additionally, fructose metabolism consumes ATP and increases uric acid production, mechanisms implicated in oxidative stress, inflammation, and impaired insulin signalling [17,20,21].

Figure 1. Excessive Consumption of Dietary Sugars Is Closely Related To The Occurrence and Development of Inflammation [20]

Clinically, the metabolic consequences of sustained high-sugar intake are profound. Chronic exposure drives the progression of non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and insulin resistance, with epidemiological evidence linking excess sugar consumption to heightened risk of type 2 diabetes, obesity, and cardiovascular disease. The resultant metabolic disturbance, such as increased circulating triglycerides, elevated glucose, and free fatty acids, propagate inflammation, endothelial dysfunction, and atherogenesis. Furthermore, excess fructose intake can elevate uric acid levels, which has been associated with hypertension and gout. Importantly, recent systematic reviews and umbrella analyses reinforce the causal relationship between dietary sugar, metabolic disease, and cardiovascular morbidity, highlighting increased all-cause and cardiovascular mortality among populations with persistently high sugar consumption [21,22,23].

Hidden Sugars And Insulin Resistance: Connecting The Grams On The Label To Cellular Impact.

Hidden sugar refers to added sugars and carbohydrate-based sweeteners present in processed foods, often under names like maltodextrin, corn syrup, or fruit juice concentrate, which are not immediately recognized as sugar by consumers. Reading a nutrition label, you might see a granola bar advertise “only 8g of sugar,” but a closer inspection reveals multiple sources of sugar derivatives, each contributing to your total intake, even when not listen as ‘sugar’ directly [24,25].

When you ingest foods containing hidden sugars, the glucose and/or fructose components are rapidly absorbed into the bloodstream, causing a swift rise in blood glucose levels. The pancreas responds by releasing insulin, the hormone responsible for shuttling glucose out of the blood and into tissues like muscle or liver, where it is either stored or used for energy. If this high-intake, high-insulin cycle is repeated consistent overstimulation of insulin receptors throughout the body. Over time, cell become desensitized to insulin’s signal, a phenomenon called insulin resistance [26,27].

At a cellular level, insulin resistance first manifests as a decrease in glucose uptake by skeletal muscle and adipose tissue, where the normal movement of glucose transporter proteins (GLUT4) to the cell surface is blunted. This is largely due to biochemical changes inside cells, including the accumulation of intermediates like diacylglycerol that disrupt insulin signalling pathways. Liver cells, facing high glucose and fructose influx from hidden sugars, further convert this excess energy into fatty acids through de novo lipogenesis, worsening hepatic insulin resistance and contributing to fatty liver disease [26,27,28].

As insulin becomes less effective, the pancreas compensates by producing more, resulting in chronically elevated insulin (hyperinsulinemia). This state is not benign: it causes additional disruptions, favouring fat storage, especially around the abdomen, while impairing the body’s ability to burn stored fat. Persistently high insulin and blood sugar levels elevate the risk for metabolic syndrome, type 2 diabetes, and cardiovascular disease [26,29].

Alarmingly, even seemingly moderate amounts of hidden sugar, measured in grams on nutrition labels can, over time, create a cycle of metabolic stress that is largely invisible until clinical disease emerges. This underscores the importance of not only monitoring visible, labelled sugars but also being mindful of hidden sources, reading ingredient lists carefully, and understanding that all dietary sources of sugar add up at the cellular level [28].

Numerous clinical and mechanistic studies have established that excessive dietary sugar consumption, particularly from fructose-rich sources, is intricately linked to lipid abnormalities and the pathogenesis of NAFLD. Upon ingestion, fructose is prefentially metabolized in the liver, where it circumvents the tightly regulated steps of glycolysis and is rapidly phosphorylated. This directs a substantial fraction of carbon substrates toward de novo lipogenesis (DNL), significantly increasing hepatic triglyceride synthesis. The consequent lipid overload not only leads to intrahepatic fat accumulation, a defining feature of NAFLD, but also drives the export of triglycerides via very-low-density lipoprotein (VLDL) particles, resulting in systemic hypertriglyceridemia and reduced high-density lipoprotein (HDL) cholesterol levels, a profile characteristic of atherogenic dyslipidemia [30,31,32].

Additionally, the continual hepatic exposure to high fructose flux promotes hepatic insulin resistance, further stimulating DNL, worsening glucose intolerance, and perpetuating a pathogenic metabolic cycle. Clinical populations with elevated intake of added sugars consistently exhibit increased rates of NAFLD and display prominent lipid derangements such as elevated fasting triglycerides, low HDL cholesterol, and increased VLDL secretion. Large-scale epidemiological data confirm a dose-dependent relationship between dietary sugar intake and NAFLD prevalence, independent of total caloric intake and obesity. Beyond hepatic steatosis, this triad of excess sugar intake, disordered lipid metabolism, and NAFLD markedly elevates the risk of cardiovascular disease and adverse metabolic outcomes, emphasizing the necessity for dietary strategies aimed at reducing added sugars to mitigate NAFLD and its complications.

Figure 2. Biological Mechanisms of NAFLD Development By A High Free Sugar Diet [30]

Chronic Inflammation And Oxidative Stress As Key Mediators

Chronic inflammation and oxidative stress are two interrelated pathophysiological processes that serve as key mediators of the harmful effects of excessive sugar intake. High consumption of dietary sugars, especially from processed foods and sweetened beverages, can disrupt glucose and lipid homeostasis, triggering immune system activation and elevating levels of metabolic stressors. Experimental and clinical studies consistently demonstrate that excessive sugar intake enhances the expression and systemic circulation of pro-inflammatory mediators, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), and C-reactive protein (CRP). This low-grade, persistent inflammation is primarily driven by increased nutrient influx into metabolic tissues, changes in gut microbiota composition, and altered adipose tissue signalling. Adipocytes and liver cells exposed to excess sugars secrete inflammatory cytokines, which propagate insulin resistance and metabolic dysfunction, establishing a vicious cycle in the development of cardiometabolic diseases [20].

Parallel to the inflammatory response, high sugar intake induces oxidative stress by overwhelming mitochondrial and enzymatic antioxidant defence systems. Rapid spikes in blood glucose result in increased generation of reactive oxygen species (ROS) as glucose is metabolized through glycolysis, the Krebs cycle, and mitochondrial oxidative phosphorylation. When ROS production outpaces detoxification by enzymes like superoxide dismutase and glutathione peroxidase, oxidative stress ensues, damaging cellular macromolecules, including DNA, lipids, and proteins. This oxidative insult further stimulates pro-inflammatory gene expression through pathways involving key transcription factors such as NF-kB, amplifying the chronic inflammatory state [33,34].

The reciprocal relationship between oxidative stress and chronic inflammation caused by high sugar consumption underlies the development of insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, and heightened cardiovascular risk. Both processes are not only triggered by excess sugar, but also sustain each other, oxidative stress upregulates inflammatory signalling, while inflammation enhance ROS production, forging a central mechanistic link between dietary habits and long-term metabolic health outcomes [20,34,35].

Figure 3. Main Pathophysiological Mechanism of Hyperglylcemia Induced Oxidative Stress [35]

Epidemiological Evidence

Over the past five years, global sugar consumption has shown modest growth, with significant regional variations. As of 2025, worldwide sugar demand is projected to reach nearly 178-205 million tonnes annually, with the United States remaining the largest per capita consumer-averaging 126.4 grams daily. Countries like Brazil, India, and Thailand have seen production rises, but consumption in some regions like the EU has stabilized or dropped slightly due to changing dietary patterns and public health organization recommendations, particularly in developing countries where urbanization and income growth drive higher sugar consumption. Parallel to these consumption levels, the global burden of metabolic diseases (obesity, type 2 diabetes, NAFLD and cardiovascular disorders) has continues to increase, closely linked in population studies to high sugar intake [22,36,37,38,39].

Figure 4. Global Sugar Production [38]

Clinical Evidence Linking High “Added Sugar” Intake to Metabolic Syndrome

A strong clinical link exists between high added sugar intake (clearly listed on processed food labels) and increased risk of metabolic syndrome, defined by a cluster of obesity, hyperglycemia, dyslipidemia, and hypertension. Epidemiological investigations and meta-analyses have repeatedly shown that higher quintiles of added sugar intake are associated with a markedly increased prevalence of metabolic syndrome, even after adjusting for total energy intake or body mass index. For instance, a large cross-sectional analysis from the US National Health and nutrition Examination Survey (NHANES) demonstrated adolescents in the top quintile for added sugar intake had over 8-fold higher odds of metabolic syndrome compared to those in the lowest quintile, independent of BMI or total energy intake. Prospective studies also confirm that as added sugar intake rises (regardless of whether from beverages or food), so too does the risk for incident obesity, insulin resistance, and other metabolic disturbances.t he mechanism appears mediated by both the direct metabolic effect of excess glucose and fructose (promoting hepatic lipogenesis and insulin resistance) and by their broad systemic impacts on inflammatory and hormonal signalling pathways [22,40,41,42].

Pediatric and Adolescent Vulnerabilities: How sugary foods marketed to children impact long-term health

Children and adolescents are particularly vulnerable to the metabolic risks posed by high sugar consumptions, due to both biological factors and aggressive marketing of sugary products toward younger consumers. In many countries, the average sugar intake by children far exceeds recommended limit, with US children consuming about 17 teaspoons (roughly 68grams) of added sugar daily, driven by highly palatable, heavily marketed processed foods and beverages. Research indicates early-life exposure to excess sugar shapes taste preferences and eating habits, setting the stage for lifelong increased risks of hypertension, overweight, and type 2 diabetes. Clinical data now indicate that high sugar intake during childhood leads to metabolic and vascular changes persisting into adulthood, with the effects more pronounced when exposure occurs during critical developmental windows. Health campaigns and policy interventions targeting sugar reduction in children have shown some short-term success, though societal barriers and marketing pressures continue to undermine sustained improvements in dietary intake [43].

Regulatory and Public Health Perspectives

The Evolution of the Food Label

The modern history of food labelling reflects the growing recognition of the relationship between diet and health, and the importance of empowered consumer choice. Food labelling first gained regulatory attention in the early 20th century, with the U.S.Food and Drugs Act of 1906 prohibiting misleading product information. Regulatory evolution accelerated in the 1960s and 1970s, responding to an expanding body of scientific knowledge about nutrients and chronic disease. By the 1970s, consumer demand for more information on processed and packaged foods led to a proliferation of nutrient content and health claims, many of which were ambiguous or lacked definition. The lack of clear standards risked misleading consumers, prompting stricter oversight to distinguish valid health information from marketing claims [44,45].

A major turning point came with the Nutrition Labelling and Education Act (NLEA) of 1990 in the united States, which mandated standardized nutrition facts panels on most packaged foods. Later decades broadened label requirements, notably distinguishing mandatory nutrient disclosures (such as calories, fats, and sodium) and legally regulating health claims. Similar progress occurred internationally, such as the European Union’s Regulation (EU) No 1169/2011, which requires comprehensive nutrition declarations for most pre-packaged foods [46,47].

Recent reforms have strengthened the impact of food labels. Modern Nutrition Facts labels (in the US and elsewhere) emphasize calories per serving, serving sizes (updated to reflect actual consumption), and require clear declarations of added sugars, vitamin d, potassium, calcium, and iron. “Added sugars” are now listed in grams and as a percent of daily value, allowing consumers to distinguish between naturally occurring and added sources. Internationally, color-coded or simplified labelling schemes such as traffic light labels are also being adopted to guide consumers more intuitively [48,49,50].

Despite their strengths, today’s food labels still face notable limitations. Although labels provide structured nutrient information and increasingly transparent ingredient lists, several gaps remain. First, labels rarely capture the full context of processing, sourcing, or the healthfulness of the entire dietary pattern, issues now partly addressed by voluntary eco-labels or claims such as “organic” and “non-GMO.” Second, some FOP and marketing claims remain poorly defined or inconsistently regulated, sometimes creating confusion rather than clarify for consumers. Ambiguities in serving sizes, portion distortions, and lack of information on ultra-processing or added chemical additives further limit the preventive value of current labels. Lastly, nutrition label literacy varies widely among populations, with socio-economic differences influencing both access to healthy foods and effective use of labels [51,52].

Comparing International Standards for Sugar Disclosure

International standards for sugar disclosure on food packaging have evolved rapidly in response to concerns over global sugar consumption and its contribution to chronic disease. Countries differ widely in their approach with some favouring highly visible FOP warnings while others rely on detailed nutrient calculations listed on the back or side of packages. These strategies reflect not only regulatory priorities but also public health philosophies and consumer behaviour research [53].

The FOP warning label system, pioneered in Latin America, is among the strongest in terms of public visibility and immediate impact. Nations such as Chile, Mexico, Uruguay, and Brazil require packaged foods that exceed defined thresholds for sugar, salt, or saturated fat to display prominent black and white warning symbols often shaped like stop signs or octagons on the FOP. Chile’s 2016 regulation was the first to implement a mandatory FOP warning system for foods exceeding 10g sugar per 100g solid or 5g per 10ml liquid, forbidding child-targeted marketing for products with warning labels. Similar rules have been adopted in Uruguay, Peru, and Argentina, with thresholds ranging from 10-20% of total calories from sugar and mandatory warnings for sodas and other sweetened beverages. Mexico’s law, effective since 2020, uses octagon-shaped “excessive in sugar” marks and further restricts promotions for products exceeding its established limits [53,54].

In contrast, the North American and much of the European Union approach leans on detailed, back of pack nutritional panels. The United States requires comprehensive disclosure of total and added sugars in grams as well as percent daily value, typically found on the Nutrition Facts label on the back or side. The EU mandates nutrient declarations for packaged foods but typically does not require FOP warning labels outside voluntary schemes or country-specific initiatives. Some European countries (e.g., the UK) have adopted interpretative FOP systems such as traffic-light labels, with red, yellow, or green coding to indicate relative levels of sugar, salt, or fat per serving. Voluntary FOP initiatives have also emerged in Scandinavia (e.g., Nordic Keyhole logo), signifying products with lower sugar and healthier nutrient profiles, while Australia and New Zealand use voluntary information panels and legal standards to define “low sugar” and related claim [53,55].

Recent regulatory changes in Asian countries demonstrate further innovation. Singapore’s Nutri-Grade system, effective since 2022, grades beverages from A (lowest sugar/saturated fat) to D (highest), with C and D requiring Nutri-Grade marks on the front. Indonesia announced in 2024 a draft regulation, deploying a four-level “Nutri-Level” FOP system using colour coded backgrounds to signify sugar content, with dark green for lowest and red for highest. As part of this policy, processed food must disclose sugar, salt, and fat by levels directly on the package, with restrictions on sweeteners depending on grade [56].

While FOP warning labels are easier to interpret and have been linked to reduced impulse purchases of sugary products, especially those marketed to children, back-of-pack labels provide more granular detail for consumers motivated to compare products systematically. The main challenge remains ensuring consistency and clarity: thresholds, definitions, and enforcement can differ substantially between jurisdictions. As a result, global food manufacturers face complex compliance demands, and consumers remain exposed to varied levels of transparency.

Challenges in Consumer Awareness and Policy Enforcement

The adoption of FOP nutrition warning labels has become a central policy tool in global efforts to improve consumer awareness of hidden sugars in foods. While numerous studies have shown that FOP labels using clear, intuitive symbols such as “high in sugar” octagons, promote rapid recognition of unhealthy products and can reduce sugary purchases, key challenges remain in both consumer awareness and policy enforcement [57,58,59,60].

One significant challenge lies in the overall effectiveness of FOP labels to influence actual consumer behaviour. Although warning labels increase understanding of which foods are high in sugar, multiple surveys have revealed that this heightened awareness does not consistently translate into healthier choices for all population subgroups. The impact of FOP warnings can be blunted by limitations in health literacy, entrenched dietary habits, and competing marketing claims on packaging. Furthermore, studies note that while FOP warning boost immediate identification of high-sugar products, the absence of complete nutritional context, quantitative detail on grams per serving, ingredient specifics, or comparison with dietary guidelines may limit their usefulness for consumers seeking more nuanced decisions [58,60].

Policy enforcement also faces persistent hurdles. In many regions, regulatory frameworks lack uniform standards for what constitutes a “high sugar” warning, leading to variable thresholds and inconsistent application across product categories or brands. The efficacy of enforcement can be undermined further by industry lobbying, reformulation tactics, and loopholes such as substituting sugar with non-nutritive sweeteners to evade labels. For example, evidence from Chile and Mexico indicates that firms respond to FOP policies by reformulating products in some cases increasing the presence of alternative sweeteners or manipulating serving sizes to avoid mandatory warnings. Monitoring and compliance demand significant resources, and regulatory gaps often allow marketing claims that mislead consumers about sugar risks to persist [61,62,63].

Additionally, FOP labelling policies must navigate the challenge of being meaningful across diverse cultural and socioeconomic contexts. Vulnerable populations including children and those with lower nutrition literacy, are still targeted by aggressive promotion of sugary foods, and may be less likely to benefit from or understand the messages conveyed by warning symbols. Voluntary adoption, lack of education campaigns, and insufficient public engagement further limit the reach and effectiveness of these label strategies [64,65].

Overall, while FOP sugar warnings represent a practical leap in guiding healthier choices and raising awareness about hidden sugars, significant progress is needed in closing the gap between label recognition, true consumer understanding, and sustainable behavioural change. Continuous policy refinement, harmonized standards, consumer nutrition education, and robust regulatory oversight remain vital to fully realize the preventive potential of FOP labels for chronic disease mitigation [60,63,64].

Step-by-Step Guide to Reading Food Labels for Sugars

The process of reading food labels for sugar content is an empowering strategy in personal and preventive health. To start, always examine the serving size and serving per container listed at the top of the Nutrition facts label. This is essential because all nutritional data including sugars refer to single serving, and the number of servings per package can greatly affect your actual intake. If you eat the whole package, you must multiply each amount by the total servings per container to gauge your consumption [66,67].

Next, look at the total sugars and the line “include added sugars.” Total sugars reflect both naturally occurring sugars (like those in milk or fruit) and added sugars. The “includes added sugars” line presents the grams of sugars that are added during production, and often appears directly beneath the total sugars entry, helping you differentiate how much sugar has been added beyond what is naturally present [66,67].

Use the %Daily Value (%DV) for added sugars as personal reference point. The %DV helps you understand how much added sugar is present relative to the recommended daily upper limit (which is often 50 grams or about 10% of calories for a 2,000-calorie diet). For example, a serving that provides 20% DV for added sugars takes up one-fifth of your daily recommended maximum. This can be a useful guide for portion control and dietary planning [4,68].

Ingredient lists reveal sugar’s rank and aliases, scan early items (often the top three) for terms like glucose syrup, sucrose, fructose, maltose, honey, and fruit concentrates. Ingredients are ordered by weight, so a sugar source near the top signals high content; many countries now require grouped disclosures (e.g.,, Canada uses brackets to show multiple sugar-based ingredients together) [68,69].

Practicing portion control is essential: compare serving size on the label to your actual portion. For example, if a serving is listed as half a cup and you eat 1 cup, you are consuming double the indicated sugars. Use the per-100g or per portion columns to translate label information to what is on your plate [69,70].

To make informed swaps, use the label to compare products side by side. Choosing options with lower grams of total and added sugars or more green or amber rating in colour coded systems directly translates to better choices, for example a cereal with 6g of added sugars per serving is a lower sugar alternative to one with 12g [70,71].

In summary, decoding the label begins with knowing the serving size, checking total and added sugars, using %DV for context, recognizing sugar aliases in the ingredient list, practicing portion control, and comparing products for healthier swaps. These steps make nutrition label literacy a powerful bridge from everyday shopping to long-term metabolic wellness.

Future Directions in Prevention

The future of preventing hidden sugar consumption is poised to benefit tremendously from advances in artificial intelligence (AI), digital health tools, and strategic public health policies. One of the most promising innovations is the integration of AI-powered smartphone applications, which can scan nutrition labels and provide real-time, user-friendly interpretations of sugar content in packaged foods. These tools use barcode or image scanning to decipher total and added sugar, translate values into visual equivalents (e,g., sugar cubes), and even offer personalized feedback based on dietary preferences and healthy goals. Emerging research suggest that such apps, especially when powered by AI, not only boost dietary awareness but can outperform traditional FOP warning labels in guiding healthier food decisions, helping users navigate ingredient lists, track cumulative daily intake, and make comparisons across products with ease [72,73,74,75].

Public health campaigns remain essential in equipping individuals with the skills to interpret label information and make healthier choices. Recent interventions have emphasized practical strategies such as using smartphone apps for sugar tracking, understanding the significance of the “%Daily Value”  for added sugars, and teaching families how to critically compare products. Evidence from digital and in person campaigns, such as the UK Sugar Smart initiative, demonstrates that a combination of interactive learning, community engagement, and accessible tech tools can meaningfully reduce sugar intake among children and adult alike. The effectiveness of these campaigns is amplified when paired with clear, consistent FOP labelling policies and outreach tailored to diverse populations, ensuring that key messages reach individual across varying levels of health literacy and socioeconomic status [43,73,76].

However, sustained individual change must be integrated with systemic reform, fostering a food environment that supports transparency and informed decision making. This includes regulatory expansion of mandatory FOP sugar disclosures, standardization of nutrition data presentation, and continued investment in AI-based tools for automated label interpretation. Best practice now highlights the need to align product reformulation incentives, nutrition education, and financial or regulatory nudges such as sugar taxes or restrictions on sugary product marketing to drive industry change and support consumers in real time. Ultimately, the combination of digital empowerment, targeted education, and structural reform is vital to create an environment where individuals can effortlessly detect and avoid hidden sugars-helping to bridge the gap between policy, technology, and sustained metabolic wellness [72,74,75,77,78].

Conclusion

Understanding hidden sugars in foods is a critical first step on the journey from label literacy to lasting metabolic wellness. Supermarkets today are filled with products that feature added sugar presented under confusing names such as maltodextrin, glucose syrup, or fruit concentrate, making the act of decoding a nutrition label both necessary and empowering. As individuals learn to identify these concealed ingredients, every trip down the grocery aisle transforms into an opportunity to make choices that foster preventive health.

This practice does more than inform consumer behaviour; it closes the gap between knowing what appears on a nutrition panel and appreciating its direct influence on the body’s metabolic pathways. People who regularly use food labels to guide their choices have been found to consume less added sugar, demonstrating healthier weight profiles and lower risk of chronic conditions like metabolic syndrome and diabetes. With accessible knowledge, individuals can shift their daily habits to better support long-term well-being.

Moreover, striving for transparency in nutrition not only influences individual choices but also fuels a broader cultural movement toward healthier living. As public awareness grows, manufacturers and policymakers face increasing pressure to honestly disclose sugar content, adopt clearer labelling, and reduce misleading marketing, when consumers are equipped with the tools of label literacy, they become advocates for their own metabolic health and for society that values openness and evidence-based nutrition. In working toward this culture of transparency, every decoded label becomes a small victory in the wider fight against chronic disease.

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