Abstract
Background: Due to associations between added sugar intake and non-communicable diseases, health authorities recommend that people restrict their added sugar intake. The World Health Organization also regard dietary sugar from honey, syrups, fruit juice and juice concentrates to be detrimental in excess, referring to any added sugar, including from the food groups listed above, as free sugars. There is little work published on the ‘added’ and ‘free’ sugar intakes of adolescents.
Objective: To analyse and compare the total, assumed added and assumed free sugar intakes of New Zealand (NZ) female and male adolescents aged between 15-18 years, enrolled in NZ secondary schools.
Design: Survey of Nutrition Dietary Assessment and Lifestyle (SuNDiAL) is a nationwide cross-sectional, observational study using a convenience sample of female (n=266) and male (n=135) adolescents enrolled from consenting schools. Participants completed an online questionnaire, dietary assessment and anthropometric measurements.
Methods: University of Otago Master of Dietetics (MDiet) students recruited and collected data from English speaking, 15-18-year-old females and males across NZ. Consented participants completed an online dietary habits questionnaire and attended a session during which height and weight measurements and an MDiet interviewer-administered 24-hour recall were undertaken. A second recall was conducted at least one-week later on a non-consecutive day, in-person or via phone/video call. Recall data were entered into FoodWorks, producing total and sucrose sugar intake values. In the absence of ‘added’ and ‘free’ sugar variables, ‘assumed added’ sugar intakes were estimated as total sucrose intake minus two-thirds (67%) of the fructose intake to account for sucrose naturally present in fruit. Assumed added sugar plus sugars contained in fruit juice were summed to estimate ‘assumed free’ sugar intakes. Foods entered into FoodWorks were categorised into food groups and their contribution to total sugar calculated.
Results: Presented as mean (95% confidence interval) for female and males, respectively, daily total sugar intakes were 99.9g (94.8, 105.1) and 99.8g (92.0, 107.6), corresponding to 21.1% (20.3, 21.8) and 16.9% (16.0, 17.8) of dietary energy intake. Mean daily assumed added sugar intakes were 31.3g (28.9, 33.8) and 32.4g (28.7, 36.1), corresponding to 6.6% (6.1, 7.1) and 5.4% (4.9, 5.9) of dietary energy intake. Mean daily assumed free sugar intakes were 34.2g (31.7, 36.7) and 38.4g (33.2, 43.5), corresponding to 7.2% (6.7, 7.6) and 6.7% (5.9, 7.5) of dietary energy intake. Eighty-six percent and 95% of females and males, respectively, had intakes of <10% energy from added sugar; 82% and 91% from free sugar, 34% and 27% had intakes of <5% energy from free sugar. No between-sex differences in absolute sugar intakes were observed, while as a percentage of energy, females had significantly higher intakes of total and assumed added sugar, but not assumed free sugar. Fruit, non-alcoholic beverages, milk and sugar/sweets were the top contributors to sugar intake for both sexes.
Conclusion: Sugar intakes of SuNDiAL participants were substantially lower than that of adolescents worldwide and the majority were meeting international recommendations. As a proportion of dietary energy, females were consuming more total and assumed added sugar than males. Sugar-sweetened beverages (SSB) have a role to play in the sugar intakes of NZ adolescents. Further research among nationally representative samples and using added and free sugar values from a food composition database, is required.