Intake of free sugar and micronutrient dilution in Australian children and adolescents



This cross-sectional analysis aimed to investigate the association between free sugar intake and micronutrient intake in Australian children and adolescents and to assess the effectiveness of the cut-off of < 10% energy intake from free sugar (%EFS) as recommended by the World Health Organization (WHO).


Dietary data of children and adolescents from the Australian Health Survey 2011–12 were analyzed (n = 1466). Free sugar intake was estimated using a published methodology with modification to suit the definition of free sugar. Six cut-offs for %EFS were created in 5% increments. Participants’ mean intakes of 18 micronutrients, as well as their intakes of core (healthy) and discretionary (unhealthy) foods, at different cut-offs were compared using ANCOVA, with age, sex, and socioeconomic status measures as covariates. The odds ratios of not meeting the nutrient reference values (NRVs) for Australia and New Zealand of each micronutrient were calculated using logistic regression.


Micronutrient intake decreased with increasing %EFS and the peak intakes of most micronutrients appeared between 0–15%EFS. The absolute intakes of most micronutrients were not significantly different between participants who consumed < 10%EFS and ≥ 10%EFS. Those with > 20%EFS were less likely to meet the NRVs of more than half of the micronutrients. Additionally, as %EFS increased, intakes of core food groups decreased, while intakes of discretionary food groups increased.


The dilution effect in micronutrient intake with increasing free sugar intake was evident in Australian children and adolescents. However, meeting the WHO cut-off was associated with limited improvement in micronutrient adequacy.

This is a preview of subscription content, access via your institution.


  1. 1.

    World Health Organization (2015) Guideline: sugars intake for adults and children. World Health Organization, Geneva

    Google Scholar 

  2. 2.

    Sheiham A, James WPT (2014) A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health 14(1):863.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Gibson S, Boyd A (2008) Associations between added sugars and micronutrient intakes and status: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years. Br J Nutr 101(1):100–107.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Joyce T, Gibney MJ (2008) The impact of added sugar consumption on overall dietary quality in Irish children and teenagers. J Hum Nutr Diet 21(5):438–450.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Kranz S, Smiciklas-Wright H, Siega-Riz AM, Mitchell D (2005) Adverse effect of high added sugar consumption on dietary intake in American preschoolers. J Pediatr 146(1):105–111.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    National Health and Medical Research Council (Australia) (2013) Australian dietary guidelines—providing the scientific evidence for healthier Australian diets. NHMRC, DoHA, Canberra

    Google Scholar 

  7. 7.

    Institute of Medicine (2005) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. The National Academies Press, Washington, DC. doi

    Book  Google Scholar 

  8. 8.

    Louie JCY, Tapsell LC (2015) Intake of total and added sugars and nutrient dilution in Australian children and adolescents. Br J Nutr 114(11):1875–1886.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Mok A, Ahmad R, Rangan A, Louie JCY (2018) Intake of free sugars and micronutrient dilution in Australian adults. Am J Clin Nutr 107(1):94–104.

    Article  PubMed  Google Scholar 

  10. 10.

    Lei L, Rangan A, Flood VM, Louie JCY (2016) Dietary intake and food sources of added sugar in the Australian population. Br J Nutr 115(5):868–877.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Australian Bureau of Statistics (2013) Australian Health Survey: users’ guide, 2011–13 Accessed 2 June 2015

  12. 12.

    Bliss R (2004) Researchers produce innovation in dietary recall. Agric Res 52(6):10–12

    Google Scholar 

  13. 13.

    Food standards Australia New Zealand (2014) AUSNUT 2013—Australian Food Composition Tables. FSANZ, Canberra

    Google Scholar 

  14. 14.

    Harttig U, Haubrock J, Knuppel S, Boeing H (2011) The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method. Eur J Clin Nutr 65(Suppl 1):S87–S91.

    Article  PubMed  Google Scholar 

  15. 15.

    Louie JCY, Moshtaghian H, Boylan S, Flood VM, Rangan AM, Barclay AW, Brand-Miller JC, Gill TP (2015) A systematic methodology to estimate added sugar content of foods. Eur J Clin Nutr 69(2):154–161.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Louie JCY, Lei L, Rangan AM (2016) Reliability of a systematic methodology to estimate added sugars content of foods when applied to a recent Australian food composition database. J Food Compost Anal 46:36–42.

    CAS  Article  Google Scholar 

  17. 17.

    National Health and Medical Research Council (2006) Nutrient reference values for Australia and New Zealand including recommended dietary intakes. NHMRC, Canberra, Australian

    Google Scholar 

  18. 18.

    Australian Bureau of Statistics (2011) Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), cat. no. 2033.0.55.001. Australian Bureau of Statistics, Canberra

    Google Scholar 

  19. 19.

    Fisher RA (1992) The arrangement of field experiments. In: Kotz S, Johnson N (eds) Breakthroughs in statistics. Springer Series in Statistics. Springer, New York, pp 82–91.

    Google Scholar 

  20. 20.

    Fisher RA (1922) On the interpretation of X2 from contingency tables, and the calculation of P. J Roy Stat Soc Ser A (Stat Soc) 85(1):87–94.

    Article  Google Scholar 

  21. 21.

    Goldberg GR, Black AE (1998) Assessment of the validity of reported energy intakes-review and recent developments. Food Nutr Res 42:6–9

    Google Scholar 

  22. 22.

    Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45(12):569–581

    CAS  PubMed  Google Scholar 

  23. 23.

    Louie JCY, Buyken AE, Heyer K, Flood VM (2011) Dietary glycaemic index and glycaemic load among Australian children and adolescents. Br J Nutr 106(08):1273–1282. doi

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Ferrari P, Slimani N, Ciampi A, Trichopoulou A, Naska A, Lauria C, Veglia F, Bueno-de-Mesquita HB, Ocke MC, Brustad M, Braaten T, Jose Tormo M, Amiano P, Mattisson I, Johansson G, Welch A, Davey G, Overvad K, Tjonneland A, Clavel-Chapelon F, Thiebaut A, Linseisen J, Boeing H, Hemon B, Riboli E (2002) Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5(6B):1329–1345.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Gibson S, Francis L, Newens K, Livingstone B (2016) Associations between free sugars and nutrient intakes among children and adolescents in the UK. Br J Nutr 116(7):1265–1274.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Forshee RA, Storey ML (2004) Controversy and statistical issues in the use of nutrient densities in assessing diet quality. J Nutr 134(10):2733–2737

    CAS  Article  Google Scholar 

  27. 27.

    Ruxton CHS, Gardner EJ, McNulty HM (2009) Is sugar consumption detrimental to health? A review of the evidence 1995–2006. Crit Rev Food Sci Nutr 50(1):1–19.

    CAS  Article  Google Scholar 

  28. 28.

    Khan TA, Sievenpiper JL (2016) Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes. Eur J Nutr 55(2):25–43.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Azaïs-Braesco V, Sluik D, Maillot M, Kok F, Moreno LA (2017) A review of total & added sugar intakes and dietary sources in Europe. Nutr J 16:6.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Sluik D, van Lee L, Engelen A, Feskens E (2016) Total, free, and added sugar consumption and adherence to guidelines: the Dutch National Food Consumption Survey 2007–2010. Nutrients 8(2):70

    Article  Google Scholar 

  31. 31.

    Louie JCY, Moshtaghian H, Rangan AM, Flood VM, Gill TP (2016) Intake and sources of added sugars among Australian children and adolescents. Eur J Nutr 55(8):2347–2355.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Øverby NC, Lillegaard ITL, Johansson L, Andersen LF (2004) High intake of added sugar among Norwegian children and adolescents. Public Health Nutr 7(2):285–293.

    Article  PubMed  Google Scholar 

  33. 33.

    Alexy U, Sichert-Hellert W, Kersting M (2002) Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents. J Nutr 132(9):2785–2791

    CAS  Article  Google Scholar 

  34. 34.

    Marriott BP, Olsho L, Hadden L, Connor P (2010) Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003–2006. Crit Rev Food Sci Nutr 50(3):228–258.

    CAS  Article  PubMed  Google Scholar 

Download references


We would like to acknowledge that the original data of the 2011–12 AHS were collected by the Australian Bureau of Statistics and Department of Health and Aged Care. The authors declare that those who carried out the original analysis and collection of data bear no responsibility for further analysis and interpretation.


This work did not receive any funding.

Author information




The authors’ responsibilities were as follows—AR and JCYL: jointly designed, supervised, and guided the study. THTW and AM: conducted statistical analyses including the Pearson’s χ2 test, ANOVA, ANCOVA and logistic regression on nutrients. TWHT, AM and RA: conducted statistical analyses ANCOVA on food groups. THTW and AM: wrote the first draft of the manuscript. All authors: interpretation of data, contributed to the discussion, and critically reviewed the final manuscript. JCYL has the primary responsibility for the content of this manuscript.

Corresponding author

Correspondence to Jimmy Chun Yu Louie.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 45 KB)

Supplementary material 2 (DOCX 80 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wong, T.H.T., Mok, A., Ahmad, R. et al. Intake of free sugar and micronutrient dilution in Australian children and adolescents. Eur J Nutr 58, 2485–2495 (2019).

Download citation


  • Free sugars
  • Micronutrient dilution
  • Australia
  • Diet quality
  • National Nutrition Survey