Objective: To investigate added sugar intake, main dietary sources and factors associated with excessive intake of added sugar. Methods: A population-based household survey was carried out in São Paulo, the largest city in Brazil. Cluster sampling was performed and the study sample comprised 689 adults and 622 elderly individuals. Dietary intake was estimated based on a 24-hour food recall. Usual nutrient intake was estimated by correcting for the within-person variance of intake using the Iowa State University (ISU) method. Linear regression analysis was conducted to identify factors associated with added sugar intake. Results: Average of energy intake (EI) from added sugars was 9.1% (95% CI: 8.9%; 9.4%) among adults and 8.4% (95% CI: 8.2%; 8.7%) among the elderly (p < 0.05). Average added sugar intake (% EI) was higher among women than among men (p < 0.05). Soft drink was the main source of added sugar among adults, while table sugar was the main source of added sugar among the elderly. Added sugar intake increased with age among adults. Moreover, higher socioeconomic level was associated with added sugar intake in the same group. Conclusions: Added sugar intake is higher among younger adults of higher socioeconomic level. Soft drink and table sugar accounted for more than 50% of the sugar consumed.Keywords: Added sugars. Food intake. Soft drink. Survey. Adults. Elderly.
IntroductionThe new dietary pattern is characterized by high intake of energy, saturated fats and sugars and low intake of complex carbohydrates and fibers. This diet plays a role as a predisposing risk factor for chronic diseases 1 . The literature reports untoward effects from added sugar consumption on health, especially when consumed in large amounts. One of the adverse effects from sugar intake is dental caries, especially when associated with other factors such as genetics, poor oral hygiene, number of meals and fluoride exposure. Some studies show that energy from sugars is related to excessive weight gain and dilution of other nutrients [1][2][3] . Sugars can be added to foods during processing or preparation to improve palatability and increase viscosity, texture, color and durability. Added sugars refer to refined sugar, brown sugar, corn and glucose syrups, fructose-based sweeteners, honey and molasses 4 . Based on the World Health Organization (WHO), the Brazilian Food Guide recommends a dietary sugar intake that provides no more than 10% of energy intake (EI) 3,5 . Brazil is the world's largest producer of sugarcane but few surveys have been published on Brazilian dietary sugar intake.T h e Ho u s e h o l d Bu d g e t Su r v e y (2008/2009) showed that consumption of sugars remained at 16.4% of energy intake in the past five years. The maximum of 10% of energy intake from sugars is largely overcome in all socioeconomic levels 6 . The objective of the present study was to investigate the main food sources of added sugars among adults and elderly individuals living in the city of São Paulo and the factors associated with e...