Total, Added, and Free Sugar Consumption and Adherence to Guidelines in Switzerland: Results from the First National Nutrition Survey menuCH

The World Health Organization (WHO) recommends reducing free sugars to less than 10% of total energy intake (TEI) due to their potential implications in weight gain and dental caries. Our objectives were to (1) estimate the intake of total, added, and free sugars, (2) define the main sugar sources, and (3) evaluate the adherence to sugar guidelines. The first national nutrition survey 2014–2015 included non-institutional adults aged 18–75 years. Diet was assessed with two non-consecutive 24-hour dietary recalls in 2057 participants. Added and free sugar content was systematically estimated by two dietitians using available information from the manufacturer and/or standard recipe/composition. Usual daily intake distributions were modeled and weighted for sampling design, non-response, weekdays, and seasons. Total, added, and free sugar intake was respectively 107 g (±44), 53 g (±36), and 65 g (±40), representing 19%, 9%, and 11% of TEI. Sugar consumption was higher among younger adults and lower among people living in the Italian-speaking region. The three main food sources of free sugars were: (1) sweet products (47% of total free sugars), in particular sweet spreads (15%) and cakes/cookies (11%); (2) beverages (29%), mainly fruit and vegetable juices (13%), and sugar-sweetened beverages (12%, but 20% in younger adults); and (3) dairy products (9%), with yogurt accounting for 6%. Respectively, 44% of women and 45% of men had free sugar intake below 10% of TEI. Of people aged between 18–29, 30–64, and 65–75 years, 36%, 45%, and 53% had free sugar intake below 10% of TEI, respectively. The prevalence of Swiss people with free sugar intake that was <5% of the TEI was 8%. Adherence to the WHO recommendations guidelines was generally low in Switzerland, particularly among young adults, and in line with other high-income countries.

. Decision flow chart of estimated percentage for added sugars from total sugars. Free sugars are assumed to be the same as added sugars except where marked with an asterisk (*), in which case 100% of the total sugars were assumed to be free sugars. These decisions were largely based upon the definition by Sluik et al. in the Netherlands, Bowman in the United States (USA), and Swan et al. in the United Kingdom (UK).

Food Group
Decision (% of added sugars from total sugars) Proportion of all consumed foods 1

Tubercles and potatoes products
Cooked, baked, and mashed potatoes and other tubercles, without sauces or fillings, do not contain added sugars (0%) 1.2 Processed potatoes (e.g., French fries, rösti, gnocci), without sauces and fillings, may contain a negligible amount of added sugars (50% of total sugars)

Vegetables
Excluding olives, herbs, vegetable juices, or if contained in small amounts in salty snacks, bread, or sauces (e.g., ketchup, pesto sauce) Fresh, boiled, baked, and dried vegetables and mushrooms, without sauces or fillings, do not contain added sugars (0%) 11.2 Canned vegetables and mushrooms may contain a negligible amount of added sugars (20% of total sugars) Pickled and marinated vegetables and mushrooms may contain a negligible amount of added sugars (50% of total sugars)

Fruit
Excluding fruit juices, fruit jams, candied fruits or if contained in small amounts in yogurts, ice cream, and other sweets Fresh, boiled, baked, and dried fruits, fruits canned in their own juice, and fruit and vegetable salads do not contain added sugars (0%)

5.1
Fruits canned in syrup contain 30% added sugars (estimation based on total sugars minus natural occurring sugars in fruits canned without syrup, with pineapple slices as a reference)* Fruit-based puree and compote contain 15% added sugars (estimation based on total sugars minus natural occurring sugars in an unsweetened fruit-based puree and compote, with apple puree as a reference)*

Nuts, seeds, and olives
Excluding peanut butter, nuts coated with chocolate or caramel Natural, roasted, and/or salted nuts and seeds do not contain added sugars (0%) 1.3 Olives are often conserved in a liquid that may contain a negligible amount of added sugars (20% of total sugars)

Milk
Plain milk does not contain added sugars (0%) 3.8 Sweetened condensed milk contains 80% added sugars (estimation based on total sugars minus natural occurring sugars in unsweetened condensed milk as a reference)

Bread, bread products, and dough
Excluding stuffed croissants (e.g., hazelnut croissants) and sweet pastries (e.g., chocolate croissants) Plain breads, bread products, and dough with a low total sugar value (≤3 g, e.g., most white and wholegrain bread, flat bread, toast bread, dough for pizza) and with unsweetened fruit (e.g., bread with sultanas) contain a negligible amount added sugar (0%) 6.1 Added sugars in bread products with a small amount of milk and nuts or with a high total sugar value (>3 g, e.g., dried bread, croissants, sweet bread, and rolls (e.g., brioche), sweetened dough for pie) are assumed to be equal to total sugars minus 3 g of natural sugars from plain bread, milk, and/or nuts

Breakfast cereals
Branded breakfast cereals without dried fruit and nuts contain 99% added sugars (estimation based on the assumption that there is 1% of natural sugar in grains and cereals), except when specified as without added sugar (0%) 0.6 Branded breakfast cereals and branded muesli mixes with dried fruit and nuts contain 75-90% added sugars (estimation based on total sugars minus natural occurring sugars in dried fruits and nuts and on the assumption that there is 1% of natural sugar in grains and cereals), except when specified as without added sugar (0%)

Sugar
Chocolate/cacao powder contain 95% added sugars, except when specified as without added sugar (0%)

Confectionary and candies
All sweets and candies (e.g., lollipop, marshmallows, candied fruit, toffee, nuts coated with chocolate or caramel, and nougat) contain 90-100% added sugars 1.1 Chocolate products and confectionary made with chocolate (e.g., filled chocolate, pralines, branded chocolate bars) contain 85-99% added sugars (estimation based on total sugars minus natural occurring sugars in milk powder and/or nuts) Sweet and sports cereal bars (e.g., energy bars) contain 90-95% added sugars (estimation based on total sugars minus natural occurring sugars in dried fruit), except when specified as without added sugar (0%)

Pure chocolate
White and milk chocolate contain 95% added sugars (estimation based on total sugars minus natural occurring sugars in milk (powder)) 0.7 Dark chocolate contain 99% added sugars (estimation based on total sugars minus natural occurring sugars in plain cocoa)

Ice-cream
Flavored, fruited, and sweetened milk-based or cream-based ice creams contain 75-95% added sugars (estimation based on total sugars minus natural occurring sugars in fruit and/or milk (powder)) 0.4 Water-based ice creams and sorbets contain 90-100% added sugars (estimation based on total sugars minus natural occurring sugars in fruit)*

Processed fish and seafood
Fish and seafood products (e.g., fish in crumbs, fish mousse, and surimi) contain 100% added sugars 0.1

Soups
Handmade soups do not contain added sugars (0%) 0.7 Non-handmade or instant soups may contain a negligible amount of added sugars (50% of total sugars) Stock contains 100% added sugars S7 of S6

Others/miscellaneous
All types of cheese (e.g., soft, hard) and branded spread cheese do not contain added sugars (0%) 16.9 Unprocessed meat, poultry, game/venison, and offals do not contain added sugars (0%) Fresh and cooked fish, seafood, and amphibians (e.g., frog) do not contain added sugars (0%) Canned fish (e.g., canned haring) may contain a negligible amount of added sugars (50% of total sugars) Eggs consumed as such do not contain added sugars (0%) Stevia and artificial sweeteners do not contain added sugars (0%) Plain fats and oils (e.g., butter, olive oil) do not contain added sugars (0%) Plain cream do not contain added sugars (0%), except sweetened whipped cream (50-70% added sugars, estimation based on total sugars minus natural occurring sugars in plain cream) Vegetable substitutes of yogurt (e.g., soya yogurts) contain 85% added sugars.
Vegetable substitutes of milk and cream (e.g., rice milk, coconut milk) may contain a negligible amount of added sugars (20% of total sugars)* Vegetable substitutes of meat (e.g., tofu, quorn, vegetarian nuggets, falafel) may contain a negligible amount of added sugars (20% of total sugars) Dietetic products (e.g., protein bars and shakes) may contain added sugars, but are a negligible source of added sugars in the general population (50% of total sugars) Others (e.g., gelatin, pollen) do not contain added sugars (0%)