Commentary: Understanding Fructose Exposure across Childhood, Implications for Nutrition Policy, and Family-based Interventions in Greece

Fructose, a naturally occurring monosaccharide present in fruits, honey, and added sugars, has long been implicated in metabolic health outcomes, including obesity, insulin resistance, type 2 diabetes, and nonalcoholic fatty liver disease. The study published in this issue of Journal of Atherosclerosis, Prevention and Treatment, by Kotopoulou et al.,[1] based on data from the Hellenic National Nutrition and Health Survey provides valuable and timely insights into fructose consumption patterns among Greek children and adolescents, a topic of growing importance amid rising rates of childhood obesity and metabolic risk in the Mediterranean region. The findings reveal distinct age-related patterns in both the quantity and sources of fructose intake. Although school-aged children exhibited the highest absolute fructose intake, toddlers consumed the most relative to their total energy intake. This suggests that early childhood represents a critical window of vulnerability, where dietary habits and taste preferences are being formed. Notably, fruits were identified as the main source of fructose across all age groups, yet their contribution steadily declined with age. In contrast, sugar-sweetened beverages (SSBs) emerged as a major contributor from middle childhood onward. This shift from natural to added sugar sources underscores a broader nutritional transition in children’s diets, one that mirrors global trends of increasing processed food consumption and declining adherence to traditional Mediterranean dietary patterns. From a public health perspective, these findings carry several implications. First, early nutritional education and family engagement are essential for establishing healthy beverage and snack choices during the formative years. Parents play a pivotal role in shaping children’s exposure to sweetened foods; thus, interventions must extend beyond individual behavior to include family-based and school-based strategies that promote whole fruits, water, and minimally processed foods. Second, the study supports the need for policy measures such as front-of-pack labeling, taxation of SSBs, and restrictions on marketing sugary products to children, policies that have proven effective in other European contexts. Finally, the observed patterns highlight the value of national dietary surveillance in identifying shifting sources of nutrient intake and evaluating the impact of public health initiatives. Continued monitoring will be essential to track progress and guide evidence-based recommendations. In conclusion, this study provides a critical foundation for targeted, age-specific dietary guidance in Greece. By addressing the early onset of high fructose exposure and the progressive substitution of natural sugars with added ones, public health authorities can better safeguard children’s long-term cardiometabolic health and preserve the nutritional integrity of the Mediterranean lifestyle. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.