A high intake of added and free sugars is associated with poor diet quality, caries, and potentially has a role in non-communicable diseases. As a result, dietary guidelines advice limitation. However, there is no standardized method for estimation of added and free sugars in food items and consequently intake is difficult to measure. This study aimed to refine a procedure for sugars estimation and apply it to a Swedish dietary survey on adolescents (Riksmaten Adolescents 2016–17). A national sample of 3099 adolescents in school year 5, 8 and 11 participated (55% girls). Individual dietary intake data from two non-consecutive days was collected retrospectively and used for analysis. A ten-step systematic procedure for estimation of sugars in a Swedish context has been developed by combining two earlier methods, one for estimation of added sugars and one for free sugars. Sugars estimates were made for all food items comprising the survey database. Mainly objective decisions were necessary to make the estimates (92% and 93% for the sugars respectively); meaning that the procedure was largely transparent. In relation to Nordic Nutrition Recommendations, 45% of the participants had an intake that adhered to the guidelines. However, the majority of intakes was close to the recommendation. Further research on how specific food sources contribute to added and free sugars is necessary to facilitate further guidance on sugars and how to reach recommended target levels in Sweden.
Objective: The Keyhole is an internationally recognized front-of-pack nutrition label, guiding consumers to healthier food options. It indicates products in accordance with specific criteria for dietary fats, sugars, fibres, salt, and whole grains. The objective of this study was to simulate the potential impact of the Keyhole on adolescents’ energy and nutrient intakes by modelling a shift from reported food intakes to foods meeting the Keyhole criteria. Design: Self-reported dietary intake data were derived from a cross-sectional survey. Multiple replacement scenarios were calculated, where foods meeting the Keyhole criteria replaced reported noncompliant foods with varying proportions of replacement. Setting: Dietary survey “Riksmaten Adolescents 2016-17” in schools across Sweden. Participants: A nationally representative sample of 3099 adolescents in school years 5, 8 and 11 (55% girls). Results: Overall, replacement with foods meeting the Keyhole criteria led to more adolescents meeting nutrition recommendations. Largest median intake improvements were seen for whole grains (+196%), saturated fats (-13%), polyunsaturated fats (+17%), and fibres (+15%). Smallest improvements were seen for free sugars (-3%) and salt (-2%), partly explained by the ineligibility of main food sources of free sugars for the Keyhole, and non-inclusion of ready meals that are often high in salt. Most micronutrient intakes were stable or improved. Unintentional effects included decreases in vitamin A, monounsaturated fats, and energy intakes. Largest potential improvements in fat and fibre sources were observed in the youngest age group. Conclusions: A shift to Keyhole alternatives for everyday foods would improve adolescents’ nutrient intakes, even with smaller exchanges.
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