There is a lot of talk about the risks of overconsumption of added sugars in foods, but how much exactly is too much? How much are we eating and which foods are they coming from? Who are those most likely to be eating too much? How do we meet intake recommendations?

Sugars intake recommendations

Recommendations on sugars focus on added sugars and or free sugars. Although they may sound similar they are defined differently. Free sugars include fruit juice and fruit juice concentrates, whereas added sugars usually do not.

The Dietary Guidelines for Australians say:

“Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.”

This is a food-based (rather than nutrient-based) guideline, consistent with the overall approach of the revised guidelines.

The advice is based on a ‘probable association’ between sugary beverages and the increased risk of weight gain, and a ‘suggestive association’ for the remainder of health associations.

The New Zealand Eating and Activity Guidelines say to

“choose and prepare food and drinks with little or no added sugars”.

This advice is based on a combination of dietary guidelines from around the world. It largely reflects the relationship between sugars and body weight and non-communicable diseases, WHO advice (see below), evidence on empty kilojoules, and data which shows 30% men and 17% women consume sugary beverages or energy drinks >3 times/week.

Across the globe there are a variety of recommendations on sugars, added/free sugars. The most well-known is that of the World Health Organisation (WHO). The 2015 World Health Organisation (WHO) report recommended that free sugars* intake (see definition below) should be less than 10% total energy. This was based on moderate quality evidence for a positive relationship between free sugars intake and dental caries, as seen in observational studies.

*The WHO free sugars definition includes fruit juice and fruit juice concentrates as well as added sugars.

The 10% limit can be calculated to 50g a day (12 teaspoons) for the average women and 60g (14 teaspoons) for men based on average energy requirements.

Note: the WHO recommendations were derived as average population intakes and are not specifically for individuals.

The WHO report made an additional, conditional recommendation to lower intakes of free sugars further to 5% of total energy intake. This recommendation is based on ecological studies that are considered very low-quality evidence.

There is less certainty about the balance between the benefits and harms of implementing this conditional recommendation and WHO note it requires substantial debate and stakeholder involvement for translation into action. Currently only about 12% of New Zealanders and 10% Australians meet this recommendation.

How much sugar are we eating now?

The most recent national dietary survey undertaken by the Australian Bureau of Statistics (ABS) was in 2011-12. The Added sugars data sets were calculated using a specially developed food composition database.

• Added sugars intake was 59g/d in men and 42g/d in women (average 52g).
• Percent energy from added sugars in adults was around 9.4%
• Percent energy from added sugars in children and youth (2-18yrs) was 11%.

Overall mean usual intake of free sugars for Australians aged 2 years and over is 60g a day. This equates to 10.9% total energy

Adolescent males aged 14-18 years had the highest intake of free sugars of 92g a day. The top 10% of male teenagers consumed at least 160g a day.

Consumption of added sugars decreased between the 1995 and 2011-12 surveys, with the largest declines seen among children; most of the decline was as a result of a decrease in consumption of sugar sweetened beverages.

In New Zealand, free and added sugars intakes have been estimated in a 2017 paper from the University of Otago. They adapted methodology used by Sydney University to re-analyse the data from the NZ Nutrition Adult Survey 2008-9.

For adults aged 15 years and over:

• Median free sugars was 57g a day (higher in males 66g vs 49g in females). This is 11% total energy.
• Median added sugars was 49g a day (higher in males 58g vs 42g in females). This is 10% of total energy.
• Younger age groups had higher intakes; males aged 15-18 years consumed 84g free sugars a day.
• There were no significant differences in free and added sugar by ethnicity.

Overall median usual intake of free sugars for New Zealand adults is 57g a day. This equates to 11% of total energy

For children, there is no data on added or free sugars consumption, however sucrose content was derived by chemical analysis to give an approximation of sugars intake from food intake data from the last nutrition survey in 2008-9.

In children 5-14 years, sucrose intake was:

• 67g/day in males (12.4% total energy)
• 61g/day in females (13.3% total energy)
• 72g/day in male children who identify as Maori
• 69g/day in female children who identify as Maori

What foods contain the highest amounts?

The overwhelming majority of free sugars come from discretionary or occasional foods. The 2011-12 Australian Health Survey sugars consumption report shows the highest contributors were:

• Soft drinks and sports drinks (19%)
• Pastries, biscuits, cakes, muffins, scones and cake-type desserts (14%)
• Fruit juice and fruit drinks (13%)
• Sugar, honey and syrups (11.6%)
• Confectionary and cereal/nut/fruit/seed bars (8.7%) - most are discretionary.

In New Zealand, sugar and sweets are seen as the highest contributors (23%) followed by non-alcoholic beverages (16%).

What is their contribution to energy intakes?

While sugar sweetened drinks are the highest contributors to added sugars intakes, their contribution to energy intake is relatively small in comparison to other discretionary or occasional foods.

Contribution to total energy Intake from discretionary foods in Australia:

Alcoholic beverages 4.8%

Cakes, muffins, scones, cake-type desserts 3.4%

Confectionery and cereal/nut/fruit/seed bars (2.8%)

Pastries 2.6%

Sweet biscuits and savoury biscuits 2.5%

Soft drinks and flavoured mineral waters 1.9%

Potato chips/fries 1.7%

Snack foods 1.5%

Frozen milk products 1.5%

Sugar, honey and syrups 1.3%

Who are the high sugar consumers?

While we look at average intakes to compare to WHO recommendations, looking closely at national data provides insights as to who the larger consumers off added/free sugars are, by population sub groups.

According to last national dietary survey in Australia, teenage boys 14-18 years have the highest intake of free sugars, particularly from sugary drinks.

They obtained 35% of their free sugars from soft drinks, sports and energy drinks. New Zealand data also supports the idea that sugar intake is greater in teens and young adults. There are also differences by location - highest intakes were found in inner regional and remote areas of Australia.

How do we meet recommendations?

In order to meet dietary recommendations, reducing intake of discretionary/occasional treat foods and drinks is paramount. Their overall 35% contribution to energy intake remains very high considering they are recommended to be consumed in limited and small amounts.

As well as reducing added sugars intake, research points to additional benefits to focussing on discretionary/occasional foods as a group: reduced kilojoule, saturated fat, alcohol and sodium intake (as well as an increase in core foods intake). Interventions to reduce added/free sugars intake from discretionary/occasional foods specifically targeting teenagers and young adults, regional and remote communities and the most socially disadvantaged groups could improve the national average and performance against the WHO 10% target.