Associations between free sugar intake and markers of health in the UK population: an analysis of the National Diet and Nutrition Survey rolling programme

Abstract

Recommendations for free sugar intake in the UK should be no more than 5% of total energy due to increased health risks associated with overconsumption. It was therefore of interest to examine free sugar intakes and associations with health parameters in the UK population. The UK National Diet and Nutrition Survey (NDNS) rolling programme (2008-2017) was used for this study. Dietary intake, anthropometrical measurements and clinical biomarker data collated from 5121 adult respondents aged 19-64 years, were statistically analysed. Compared to the average total carbohydrate intake (48% of energy), free sugars comprised 12.5%, with sucrose 9% and fructose 3.5%. Intakes of these sugars, apart from fructose, were significantly different over collection year (P<0.001), and significantly higher in males (P<0.001). Comparing those consuming above or below the UK recommendations for free sugars (5% energy) significant differences were found for BMI (P<0.001), triglyceride (P<0.001), HDL (P=0.006) and homocysteine concentrations (P=0.028), and significant gender differences were observed (e.g lower blood pressure in females). Regression analysis demonstrated that free sugar intake could predict plasma triglycerides, HDL and homocysteine concentrations (P<0.0001), consistent with the link between these parameters and cardiovascular disease. We also found selected unhealthy food choices (using the UK Eatwell Guide) to be significantly higher in those that consumed above the recommendations (P<0.0001) and were predictors of free sugar intakes (P<0.0001). We have shown that adult free sugar intakes in the UK population are associated with certain negative health parameters that support the necessary reduction in free sugar intakes for the UK population.

The Impact of Excessive Fructose Intake on Adipose Tissue and the Development of Childhood Obesity

“…Mexico also introduced a similar system in 2014, adding a 15% cost to SSBs to discourage consumer purchase [149]. Both countries have observed a reduction in sugar intake since the introduction of the levy, by 4-12% in Mexico [149] and 10% in the UK [54]. In accordance, a meta-analysis also concluded that the implementation of taxes in SSBs around the world is an effective approach for reducing SSB purchase and intake [150].…”

“…Both the World Health Organization [52] and the UK's Scientific Advisory Committee on Nutrition [53] recommend limiting free sugar intake to less than 5% of overall energy intake. Free sugar is defined as sugar added by the manufacturer, cook, or consumer, plus sugar found in honey, syrup, or fruit juice [49,54]. It is often added as a sweetener to food and drink in the form of sucrose (table sugar) or HFCS (55% fructose), which are commonly used in sugar-sweetened beverages (SSBs) [37].…”

“…Most European countries consume far less HFCS, such as the United Kingdom (UK), consuming <0.5 kg per person per year [55]. However, nutritional surveys in the UK show that most people consume far more free sugar compared to the recommendations, with a mean intake of 12.5% of energy coming from free sugar, including 9% and 3.5% of energy from sucrose and fructose, respectively [54]. There appear to be no figures for fructose consumption in Brazil, but the consumption of SSBs is reported to be high.…”

“…Studies have shown that a reduction in fructose and/or free sugar intake might contribute to diminishing metabolic disorders and obesity both in adults and children [54,143]. In that matter, a possible recommendation is consuming foods and beverages sweetened with low-and no-calorie sweeteners (LNCS) such as aspartame, saccharin, and sucralose.…”

“…Several countries, including the UK, in 2018, have introduced financial penalties (a sugar levy) to dissuade the food industry from adding free sugar to food and beverages, aiming to reduce free sugar consumption by 20% [54]. Mexico also introduced a similar system in 2014, adding a 15% cost to SSBs to discourage consumer purchase [149].…”