Estimating added and free sugars intake in Swedish adolescents - methods, food sources, nutritional implications, and potential food label impact

Abstract

Excessive intakes of added and free sugars are associated with several adverse health effects. However, due to an absence of objective or standardised methods to measure intake, there is limited knowledge about consumption, including in Swedish adolescents.

Adolescence is a critical period for establishing healthy dietary habits, as food patterns formed during these years often persist into adulthood, influencing longterm health. Dietary habits of Swedish adolescents overall fail to meet dietary guidelines. The adolescent diet is generally low in vegetables and fruit, dietary fibre and wholegrains, alongside high in saturated fats, salt, and sugars. Despite these concerns, intake levels of added or free sugars have not previously been quantified in Swedish adolescents.

The overarching aim of this doctoral thesis is to examine dietary intake in Swedish adolescents, emphasising added and free sugars intake. This includes refining methods for estimating intake, identifying contributing food sources, investigating contextual and dietary associations, as well as the potential nutritional impact of the Keyhole symbol in guiding healthier food choices. The thesis builds on the findings of four original papers, each addressing a specific research aim and contributing unique insights to the thesis.

The thesis presents a systematic approach to quantifying added and free sugars intake, applied to the Swedish Food Agency’s nationally representative dietary survey Riksmaten Adolescents 2016-17. Main findings are that, on average, Swedish adolescents were over-consuming added and free sugars with respect to dietary guidelines; 45% respectively 30% had a lower daily intake of added respectively free sugars than the maximal recommended intake. Main sources of sugars were foods with low nutritional content, with major contributors in sugarsweetened beverages, sweets and chocolates. Intakes of added and free sugars were higher during weekends, and the sugars were mostly consumed outside of main meals, predominantly within the home environment. Furthermore, higher intakes of added and free sugars were observed to be associated with progressively less favourable dietary intakes. A shift to Keyhole alternatives for everyday foods would improve adolescents’ overall nutrient intakes, even with smaller exchanges. However, the impact on reducing sugars were limited as most contributing sources are not eligible for labelling.

As a few nutritionally poor food groups are the primary sources of added and free sugars in the adolescent diet, refining dietary guidelines to target these specific foods rather than emphasising sugars reduction alone could enhance clarity and effectiveness in public health communication.