Research Roundup

The contribution of free sugars to energy intake in mid to late childhood: Comparisons between nutrient and food group intakes and antecedents of diets high and low in free sugars

29 January 2025

This article (1) investigates the impact of free sugars (FS) on children’s diets and identifies factors that contribute to high FS consumption. The study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol UK, which collected 3-day food records from children at ages 7, 10, and 13.

The primary aim of the study was to compare nutrient and food group intakes between children with high FS consumption (defined as more than 20% of energy from FS) and those with low FS consumption (15% or less of energy from FS). This comparison aimed to identify which foods could be targeted to improve overall dietary quality. The secondary aim was to assess the factors that placed a child in the high FS group compared to the low FS group to determine the most effective age for interventions.

The study found that 70% of children consumed more than 15% of their energy from FS, with one-third consuming more than 20% (indicating high intake). Results showed that energy intakes were higher in the high FS group, while protein, fat, starch, and fibre intakes were lower. Several micronutrient intakes, such as calcium, zinc, selenium, and retinol, were also found to be lower in the high FS group. Children in this group consumed more confectionery, sweet foods, sugar-sweetened soft drinks (SSSD), and fruit juice, but less bread, fat spreads, milk, and vegetables.

The study also explored the factors related to high FS consumption. It found no association between being in the high FS group and maternal education, age, or breastfeeding duration. However, children who were difficult to feed at 15 months or identified as picky eaters during preschool years were more likely to fall into the high FS group. Additionally, a dietary pattern characterised by low intake of nutrient-dense core foods and high intake of nutrient-poor discretionary foods at ages 2 and 3 was associated with high FS consumption later in childhood.

The study concluded that children who regularly consumed a high FS diet in mid to late childhood had higher intakes of SSSD and fruit juice while consuming lower amounts of some core foods. This dietary pattern was recognisable by age 2 and was associated with being a picky eater. To reduce children’s FS intake, the study suggests that parents should receive support in introducing a healthy, balanced diet during the first two years of a child’s life.

The findings align with other research indicating that high FS intake is associated with lower nutrient intakes and higher consumption of discretionary foods. For instance, a Norwegian study (2) found lower intakes of protein, fat, fibre, calcium, retinol, vitamin D, and riboflavin among children with high added sugar intake. Similarly, an Australian study (3) reported that high FS intake was linked to poor micronutrient profiles and increased consumption of discretionary foods.

The study highlights the importance of early dietary interventions to reduce FS intake and promote the consumption of core foods such as bread, milk, and vegetables. It also emphasises the need for further research in different cultural contexts to better understand the impact of FS consumption based on diverse dietary patterns.

The study has several limitations: misreporting of dietary intake, particularly underreporting of energy intake, is a common issue in dietary studies. The findings are based on Western-style diets, where bread and milk are considered core foods, which may not apply to populations with different dietary patterns. Additionally, the dietary data were collected between 1998 and 2006, a time when FS intakes were rising. Changes in public health policies, such as the UK’s Soft Drinks Industry Levy implemented in 2018, may have since influenced FS consumption patterns, potentially making these findings less relevant to current dietary behaviours.

Despite these limitations, the study offers valuable insights into the dietary patterns and factors associated with high FS consumption in children, highlighting the necessity for early dietary interventions to foster healthier eating habits.

* Free sugars, as defined by the World Health Organization (WHO) and the UK Scientific Advisory Committee on Nutrition (SACN), include all mono- and disaccharides in the diet except those in milk and intact whole fruits and vegetables.

References

1. Emmett PM, Taylor CM. The Contribution of Free Sugars to Energy Intake in Mid to Late Childhood: Comparisons Between Nutrient and Food Group Intakes and Antecedents of Diets High and Low in Free Sugars. Nutrients. 2024; 16(23):4192. https://doi.org/10.3390/nu16234192
2. Øverby, N.C.; Lillegaard, I.T.; Johansson, L.; Andersen, L.F. High intake of added sugar among Norwegian children and adolescents. Public Health Nutr. 2004, 7, 285–293.
3. Mok, A.; Ahmad, R.; Rangan, A.; Louie, J.C.Y. Intake of free sugars and micronutrient dilution in Australian adults. Am. J. Clin. Nutr. 2018, 107, 94–104.