Dietary patterns associated with meeting the World Health Organization free sugar guidelines in New Zealand adults

Abstract

Background: The majority (57.8%) of New Zealand (NZ) adults do not meet the World Health Organization (WHO) guideline recommending free sugar intakes be reduced to less than 10% of total energy (TE) intake. The WHO guidelines were set in part to encourage new public health nutrition interventions aimed at reducing dietary free sugars intake and, therefore, the prevalence of associated non-communicable diseases (NCDs). Evidently, such interventions are urgently required in NZ. However, evidence surrounding free sugars is currently lacking. Objective: The primary aim of this study was to determine dietary patterns in NZ adults associated with meeting the WHO free sugar guidelines (10% and 5% TE). Secondary aims were to determine (1) major dietary sources of free sugars, (2) the macronutrient content of diets considered low, moderate, and high in free sugars, (3) dietary patterns associated with moderate and high intakes of free sugars, and (4) whether dietary patterns low, moderate, or high in free sugars differ by sex, age, or ethnicity. Design: Dietary patterns were derived for NZ adults 15+ years (n=4,721) using principal component analysis (PCA) and repeat 24-hour diet recall data from the 2008/09 New Zealand Adult Nutrition Survey (NZANS 08/09). Logistic regression analyses were used to determine associations between dietary patterns and the <5% TE and <10% TE WHO free sugar guidelines. The mean usual free sugar intake for each NZANS 08/09 food group, and mean usual macronutrient intakes were determined for the total population and by sex, age, and ethnicity. Results: Six dietary patterns were identified in NZ adults: ‘sandwich’, ‘junk foods’, ‘traditional’, ‘snack foods’, ‘breakfast foods’, and ‘Mediterranean’. The ‘Mediterranean’ dietary pattern was positively associated with meeting the <5% TE WHO free sugar guideline, while the ‘sandwich’ pattern was negatively associated with meeting the <5% TE guideline. ‘Junk foods’, ‘snack foods’, and ‘breakfast foods’ patterns were negatively associated with meeting both the <5% TE and <10% TE guidelines. There was no association between the ‘traditional’ pattern and the WHO guidelines. Adults >30 years and of New Zealand European and Other (NZEO) descent adhering to the ‘Mediterranean’ pattern were significantly more likely to meet the WHO <5% TE guidelines. Overall, major dietary sources of free sugars were ‘non-alcoholic beverages’ (36.2%), ‘sugar and sweets’ (26.0%), ‘cakes and muffins’ (7.1%), ‘dairy products’ (5.5%), ‘biscuits’ (4.7%), and ‘alcoholic beverages’ (3.9%). NZ adults with moderate and high intakes of free sugars also had higher intakes of energy, carbohydrate, total sugars, and added sugars. Conversely, adults with diets high in free sugars had lower intakes of protein and total fat as a proportion of total energy intake. Conclusion: Dietary patterns characterised by discretionary foods were associated with not meeting the WHO free sugar guidelines, while a pattern of minimally processed foods (‘Mediterranean’) was associated with an increased likelihood of meeting the guidelines. Likewise, major dietary sources of free sugars were predominantly discretionary foods. Future public health nutrition interventions would, therefore, benefit from focusing on establishing dietary patterns lower in discretionary foods and reformulating such products.