Intake of free sugars and micronutrient dilution in Australian adults

Abstract

Background:The negative health effect of excessive intake of free sugars has been gaining increasing public awareness.Objective: This secondary analysis aimed to evaluate the impact of free-sugar intake on micronutrient dilution, and estimate a threshold level of free-sugar intake at which a decrease in micronutrient intake becomes evident, based on data from the Australian Health Survey 2011-2012. Design: Dietary data from adult respondents (weighted n = 6150) who had completed two 24-h recalls were analyzed. A published 10-step methodology was adopted and used to estimate the free-sugar intake of the respondents. Six modified cut-offs for percentage of energy of free sugars (%EFS) were created based on recommendations from the WHO and the Institute of Medicine to examine the association between %EFS on micronutrient intakes. Estimated marginal means and SEs were calculated using ANCOVA. Logistic regression was used to calculate the ORs of not meeting the nutrient reference values for Australia and New Zealand for each micronutrient with an increase in free-sugar intake. Analyses were adjusted for age, sex, socioeconomic status, country of birth, whether dieting, smoking status, and remoteness of living area. Results: Peak intake for most micronutrients was observed at %EFS between 5% and <15%. A significant reduction in most micronutrient intakes was observed at >25%EFS. At <5%EFS, some micronutrient intakes were reduced. Only small variations in micronutrient consumptions were observed when %EFS was between 5% and 25%. Core food intake decreased and discretionary food increased with an increase in free-sugar intake. Conclusion: A high free-sugar intake, particularly >25%EFS, was found to have a significant diluting effect on most nutrients. However, a free-sugar intake <5%EFS may increase the risk of undesirably low micronutrient consumption related to inadequate total energy intake. This secondary analysis was registered at anzctr.org.au as ACTRN12617000917336.Am J Clin Nutr 2018;107:94-104.

Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009–2014

“…Little is known about the potential for micronutrient dilution at higher added sugar intakes in the diet of the U.S. adult population. One study based on the National Health and Nutrition Examination Survey (NHANES) 2003-2006 has shown an inverse relationship with added sugars intake for some micronutrients [14]; however, there is a paucity of other evidence, most of which is from populations outside of North America [15][16][17] and/or on other measures of sugars intake, such as sugar-sweetened beverages [18] and free sugars [19]. It is also reasonable to speculate that micronutrient dilution of the diet might not be as evident in adults compared with children because adults have a higher calorie intake and a generally more varied food intake than children.…”

Outcome of the public consultation on a draft protocol for the Scientific Opinion on dietary sugars

“…from 5 E% to 25 E%) of sugar intake (IoM, 2005;Moshtaghian et al, 2016;Mok et al, 2018). In addition, the Panel considers that the way in which sugar intakes may be related to the micronutrient (and fibre) density of the diet and micronutrient (and fibre) intake largely depends on the particular foods in which sugars are present (e.g.…”

“…In the new release of the EFSA Comprehensive Food Consumption Database (published on 26 April 2018) 10 , data from national food consumption surveys which was available in FoodEx (4 levels) has been reclassified in FoodEx2 (7 levels, plus facets).…”

“…a) It was questioned why a systematic approach was not applied; b) it was noted that the effects of the intake of free sugars on the micronutrient intake and status may have a J-shaped relationship, that micronutrient dilution really starts at above 25 E% free sugars intake, and that major contributors to the intake of free sugars, such as micronutrient-fortified cereal products and flavoured milk, are one of the main sources of micronutrients such as folate and iron, meaning that a high intake of foods rich in free sugars contributes to the micronutrient supply and to the prevention of micronutrient deficiencies (Mok et al, 2018); it was considered that a focus solely on micronutrients does not reveal whether a high intake of free sugar-containing foods will dilute or diminish the nutritional quality of the whole diet; c) it was suggested to include dietary fibre in the assessment, in addition to micronutrients; d) it was unclear whether the intake of free sugars from all dietary sources and micronutrient status will be limited to assessments from Europe; e) it was unclear whether sugars intake (as E%) will be calculated as % of total energy or as % of non-alcohol energy.…”

Sugar taxation: a good start but not the place to finish

“…A vast body of modern research has concluded that while sugar is associated with several conditions, its role in their causation remains confounded, with the possible exception of dental caries. Of course, extreme high-sugar diets displace more nutritious foods and deplete essential micronutrients (7,8). When the city of Glasgow expanded from a small regional town to become the second city of the empire in the 19th century, there was no food provision service, and the population demand was met with a stereotypic imported diet of white bread, jam and sugary tea, which persisted through habit and regional poverty as ship-building declined, well into the 20th century.…”