effective than previously indicated," and "cranberry juice cannot currently be recommended for the prevention of UTIs." The European Food Safety Authority reviewed the evidence and concluded a cause and effect relationship has not been established between the consumption of cranberry products and reducing the risk of UTIs. One systematic review in 2017 showed that cranberry products significantly reduced the incidence of UTIs, indicating that cranberry products may be effective particularly for individuals with recurrent infections. When the quality of meta-analyses on the efficacy of cranberry products for preventing or treating UTIs was examined, large variation was evident, resulting from inconsistencies in clinical research methods. In September 2017, Ocean Spray, a major cranberry juice manufacturer, submitted a health claim petition to the FDA. According to the FDA's February 2018 response letter, the company had "requested that FDA authorize a health claim for the relationship between the consumption of cranberry juice products and a reduced risk of recurrent urinary tract infection in healthy women." The FDA stated that they would consider the petition for a "qualified health claim." This type of health claim label does not require "significant scientific agreement" as the FDA's label with a higher standard, the "authorized health claim," does. Rather, "qualified health claims" only require that the claim be "supported by some scientific evidence." These types of health claims also do not need to "meet the significant scientific agreement standard" and must be accompanied by a disclaimer stating that there is insufficient evidence of the product affecting a disease, such as UTI. Further FDA guidance in 2019 notified cranberry juice manufacturers that added sugars necessary for making the juice appealing to consumers had to be declared on the nutrition facts panel of product labels, and the amount of sugar used would be reviewed by the FDA under its "enforcement discretion". In October 2018, the National Institute for Health and Care Excellence's recommendation for self-care for lower UTIs in people aged 16 and over states that "no evidence was found on cranberry products or urine alkalinising agents to treat lower UTI". Dental health Cranberry juice has a level of acidity (pH 2.6) that may erode tooth enamel. Manufacturing and processing Manufacturing Cranberries are a kind of tart red berry produced by various plant species, but it is the large-fruited, or "American cranberry" (Vaccinium macrocarpon), that is farmed for commercial production. Currently, the main cranberry farming Canadian provinces are British