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New Zealand study into eating patterns and the WHO sugar guidelines

Might there be unintended nutritional consequences of a diet very low in free sugars?

The WHO sugar guidelines recommend populations consume less than 10% of energy as free sugars. They also suggest countries consider a lower target of less than 5% energy for additional dental health benefits, according to their circumstances.

There is little research about the eating patterns that meet these guidelines. New Zealand researchers analysed data from the NZ Adult Nutrition Survey (2008-2009) – the most recent survey on nutrition and dietary patterns in New Zealand - and identified eight dietary patterns using principal component analysis (a tool in exploratory data analysis that reveals the internal structure of the data in a way that best explains the variance in the data). Positive and negative associations between these dietary patterns and WHO sugar guidelines were then assessed using logistic regression analyses. The results are summarised in the following table.

Diet pattern

Characterising foods

Association with

Association with

‘Take-away foods and alcohol’

Potato products, fish and seafood, alcoholic beverages, takeaway foods

Positive ✓

Positive ✓

‘Contemporary’

Grains and pasta, poultry, snack foods, nuts and seeds, low-sugar beverages. Low intakes of biscuits

Positive ✓ (males only)

Negative X

‘Fast foods, sugar-sweetened beverages and dessert’

Sugar sweetened beverages, takeaway foods, puddings and desserts and pies and pasties. Low intakes of vegetables

Negative X

Negative X

‘Traditional’ (N.Z.)

Potatoes, kumara and taro, savoury sauces and condiments, vegetables, red meats, puddings and desserts, cakes and muffins

Negative X

Negative X

‘Breakfast foods’

Milk, breakfast cereals, sugar and sweets, puddings and desserts, cakes and muffins. Low intakes of alcoholic beverages, eggs and egg dishes.

Negative X

Negative X

‘Sandwich’

Bread and sandwiches, unsaturated fats (including margarine), cheese, red meat, sugar and sweets (including sweet spreads).

NA (No association)

Negative X

‘Snack foods’

Snack bars, cheese, crackers, dairy products, fruit.

NA

Negative X 

‘Saturated fats and sugar’

Saturated fats, cheese, sugar and sweets. Low intakes of unsaturated fats, nuts and seeds

Negative X

NA

The only dietary pattern that met both WHO 10% and 5% recommendations was the ‘take away foods and alcohol’ pattern.

This pattern was characterised by high intakes of potato products (hot chips and wedges), fish and seafood (battered, fried, crumbed), alcoholic beverages and take away foods. Despite being low in sugar, this pattern is not healthy. It is likely to be high in energy, sodium and saturated fat, which are all associated with poor health outcomes. A ‘contemporary’ diet pattern characterised by high intakes of grains and pasta, poultry, snack foods, nuts and seeds and low-sugar beverages, and low intakes of biscuits, was associated with

The study also found:

  • Adults 30 years and over were more likely to meet WHO 10% sugar guideline (34% vs 20% in those under 30 years of age).
  • Participants consuming diets high in free sugars had higher mean energy intake than those consuming moderate or low amounts.
  • Median BMI did not differ between groups according to their sugar intake (low, moderate or high).

The authors concluded future nutrition interventions would benefit from focusing on establishing healthier overall diets including wholegrains, lean protein, healthy fats and unsweetened beverages, consistent with current New Zealand dietary guidelines. Find the paper here.

Postscript:

These results are consistent with the idea of a sugar-fat seesaw (read more here).

 

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