Naturally occurring and added sugar in relation to macronutrient intake and food consumption: results from a population-based study in adults

Abstract

Associations between sugar intake and the remaining diet are poorly described in modern food environments. We aimed at exploring associations of high naturally occurring and added sugar intakes with sociodemographic characteristics, intake of macronutrients, fibre and selected food groups. Our data comprised 4842 Finnish adults aged 25–74 years, who participated in the population-based DIetary, Lifestyle and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) study. Diet was assessed by a validated 131-item FFQ. The food item disaggregation approach was used to estimate sucrose and fructose intakes from natural sources (naturally occurring sugar) and all other sources (added sugar). Sex-specific trends in macronutrient, fibre and food group intakes across sugar type quartiles were determined with general linear modelling adjusting for age, energy intake, leisure-time physical activity, smoking, education and BMI. Overall, results were similar across sexes. Young age was found to be a determinant of higher added sugar and lower naturally occurring sugar intakes (P < 0·0001). High added sugar intake was associated with low fibre intake (P < 0·0001) accompanied with lower fruit (P < 0·0001 women; P = 0·022 men) and vegetable consumption (P < 0·0001) and higher wheat consumption (P = 0·0003 women; P < 0·0001 men). Opposite results were found for naturally occurring sugar. Butter consumption increased by 28–32 % (P < 0·0001) when shifting from the lowest to the highest added sugar intake quartile, while a decrease of 26–38 % (P < 0·0001) was found for naturally occurring sugar. Therefore, the associations of sugar types with dietary carbohydrate and fat quality seem opposing. Proper adjustments with dietary variables are needed when studying independent relationships between sugar and health.

Influences of added sugar consumption in adults with type 2 diabetes risk: A principle‐based concept analysis

“…Because added sugar is found in a variety of dietary foods and beverages, terms were often interchanged to describe added sugar or components of added sugar (eg, glucose and fructose). These examples include words like sugar, sucrose, free sugars, dietary sugars, nutritive sweeteners, sugar‐sweetened beverages (SSB), high glycemic carbohydrates, high‐fructose corn syrup (HFCS), fructose, and fructose‐containing sugars . Several publications studied SSB consumption which was not always portrayed as an exclusive “added sugar product”, but rather as a product containing HFCS .…”

“…Lastly, the logical principle examines how a concept, when incorporated with related concepts, “holds its boundaries” and maintains a clear meaning . This analysis found that several studies used added sugar proxies (eg, HFCS, SSB, sucrose) as a way to examine added sugar's impact on T2D risk . Other studies examining added sugars effect on T2D risk did not distinguish added sugar proxies as actual added sugar‐containing products (eg, sweets, HFCS) and alternatively referred to these products as simply, dietary sugars .…”

“…The concept of added sugar and its relationship to the development of T2D risk is of interest and applicable to the field of nursing. Added sugar is reliably operationalized by use of dietary questionnaires like food diaries, food-frequency, beverage intake, and food habit questionnaires, or dietary interviews, daily collection records, or recalls, 12,14,25,28,29,32,40,41,43,44,46,[49][50][51][52] however, the validity of these methods varies by whether dietary intake is self-reported or calculated from controlled feeding trials. 11,38 Specifically, dietary self-report is associated with intentional misreporting; typically, under-reporting of dietary intake.…”

“…1 Added sugars differ from natural sugars because they are associated with a nutrient-poor diet and increased calorie intake whereas natural sugars are typically derived from healthier, nutrient-rich foods like fruits, vegetables, and dairy products. 3,25 Currently, the relationship between added sugar consumption and T2D risk is unclear. Therefore the purpose of this concept analysis is to define added sugar and establish the current state of the science surrounding added sugar consumption in the context of T2D risk.…”

“…While commonly used sugars like honey and cane sugar (ie, sucrose) are derived from nature, they are considered “added sugars” because they are used to sweeten food and beverage products . Added sugars differ from natural sugars because they are associated with a nutrient‐poor diet and increased calorie intake whereas natural sugars are typically derived from healthier, nutrient‐rich foods like fruits, vegetables, and dairy products …”