With global concerns regarding obesity and excess energy availability, trends in added sugars consumption have been suggested to be linked to obesity and associated chronic diseases [1
]. Understanding national consumption levels and recent trends is essential for program and policy considerations. Both food supply data and dietary surveys are important in providing country-specific data to monitor estimated added sugars intakes in relation to trends in caloric intake and obesity. Unfortunately, there are relatively few published studies reporting added sugars intakes. This may be due in part to the difficulties in estimating added sugars consumption. National food supply (availability) economic data can be used to estimate trends in added sugars consumption, however these data represent the amount purchased not consumed, and do not account for losses. To correct for this, some reports adjust availability data for waste (e.g., retail, institutional and household losses) to provide an estimate of apparent consumption, but this approach is recognized to still underestimate wastage [2
While availability data are useful to indicate trends, they provide little insight into individual consumption patterns or variability of intake within the population. For this, food intake data from dietary surveys needs to be combined with accurate data on the sugars content in foods. The lack of a comprehensive database of added sugars content in foods provides an additional complication, thus limiting analyses to total sugars. Further, the global variation in terminology used to describe sugars also makes it difficult to compare estimated intakes across countries. In Canada, by definition, the term “sugar” describes sucrose from sugar cane or beets [3
]. “Added sugars” describes sugars (or ingredients that functionally substitute for sugars) that are added to foods, while “sugars” or “total sugars” describes all sugars, both naturally occurring and added [4
A recent Canadian Health Report [5
] has described total sugars consumption based on Canadian Community Health Survey (CCHS) national food intake survey data. Therefore the purpose of this article was to estimate and trend added sugars intakes and their contribution to total energy intake among Canadians by first, using CCHS nutrition survey data of intakes of sugars in foods and beverages and second, using Statistics Canada availability data and adjusting for wastage to estimate intakes. Sources of sugars and their contribution to total energy among children, adolescents and adults are reported.
This is the first report of estimated added sugars intakes among Canadians. Availability data suggest added sugars consumption in Canada to be stable or modestly declining as a percentage of total energy. Analysis of both survey and availability data suggests that added sugars average about 11%–13% of total energy intake. This is similar to consumption trends observed in Australia [12
] and about three percentage points lower on average than US intakes of added sugars (2005–2010) for all age groups [13
]. In absolute amounts, Canadian adults consume almost one third less added sugars compared to the US adult population (52 g versus
77 g/day, respectively) [14
The overall decline in “sugars and syrups
” availability, in part reflects the replacement of sugar by HFCS in sweetened beverages. The transition from sugar to HFCS, which started in the 1970s, was gradual and depended on the relative prices of the two sweetening agents. This caused annual variations in “sugars and syrups
” availability, which can be seen until the late 1990s (Figure 2
). Sugar has now been fully replaced by HFCS in almost all sweetened beverages in Canada, so there is much less annual variability. The previous variability in usage of HFCS and sugar in soft drinks did not allow for a precise trend in added sugars intake over the last 30 years. Still, with the decline of soft drink intake over the past decade and the overall decline of “sugars and syrups
” availability, Statistics Canada data show that added sugars consumption has been stable or modestly declining as a percentage of total energy. Further, as food waste has progressively increased over the past four decades [2
], early estimates for “sugars and syrups
” availability may be higher than those reported here given our use of a 40% waste factor across all years.
Taken together, availability data indicate a modest decline of added sugars consumption in Canada. Similar trends have been observed in other developed countries, including Australia and the UK where added sugars intakes have fallen over the last 25 years [15
]. In the US intakes of sugars declined 23% between 1999 and 2008 [18
]. However, values for sugar supply on the global market are often quoted [1
], which do not reflect country specific trends nor dietary intakes [19
]. References to increasing global availability of added sugars can also be misleading when the vast majority of this growth reflects global population growth and development. Over the past 50 years, the absolute and relative (% energy) availability of sugar per capita has remained relatively stable while total food energy available for consumption has steadily increased [19
Unlike other nutrients, there is no quantitative recommendation for total or added sugars intake in Canada. The Institute of Medicine, Dietary Reference Intakes (DRIs) report (2005) which forms the basis of Canada-US dietary guidance concluded that there was insufficient evidence to set an upper limit for total or added sugars based on the available data on dental caries, behavior, cancer, risk of obesity, and risk of hyperlipidemia [10
]. Instead, a maximum intake of 25% of energy from added sugars was suggested based on the decreased intake of some micronutrients of American subpopulations exceeding this level [10
]. The average intake of added sugars among Canadians was estimated at about half this level in this report and similar to that recommended by the World Health Organization for a population average (10%) [21
]. The estimated range of intakes among different population subgroups was below the DRI 25% suggested maximum.
This study presents a best estimate of added sugars consumption but has several limitations, mainly due to the gaps in Canadian food composition data and the assumptions required to estimate added sugars intakes. No analytical methods currently exist to distinguish between added and naturally occurring sugars in foods as they are chemically identical and metabolized the same way. The most comprehensive analysis of naturally occurring and added sugars intakes undertaken in North America was that by US Food and Drug Administration, Sugars Task Force which estimated added sugars based on total sugars intake from dietary surveys. Added sugars accounted for approximately 50% of total sugars intake [22
], similar to our estimates. The USDA more recently attempted to develop a database for estimates of added sugars content of select foods [23
]; this database has since been withdrawn due to constant changes in formulations for commercial, multi-ingredient foods [24
]. Nonetheless, their estimates for added sugars for foods were similar to the estimates derived from our division of food categories based on the majority of sugars being either added or naturally occurring, resulting in the contribution from added and naturally occurring sugars to be more or less equal in the diet, especially among adults. The adjustments for children and adolescents based on the division of the top sources were in agreement with previous studies, which report children receive a greater percentage of sugars from naturally occurring sources and adolescents from added sugars [13
]. It was a limitation for our data to be restricted to the top 10 sources of sugars in the Canadian diet. However, foods not in the top 10 sources would include a variety of foods containing both naturally occurring and added sugars (e.g., yogurts, ice milk/ice cream, malted milk, instant breakfast, meal replacements, cheese and other dairy products, breads, cookies and other baked products, nuts, seeds and legumes, jams, soups, sauces, salad dressings and alcoholic beverages), which individually would each contribute less than 3% to total sugars intake and less than 1% to total energy (to collectively account for the remaining 15% total sugars). Since the contribution of each of these remaining categories would be so small, it is unlikely that the ratio of added sugars compared to naturally occurring sugars would be significantly changed from the ratio obtained from the division of the top 10 sources.
Our estimates of added sugars intake from availability data and intake data are remarkably close. However the availability data have potential for large error as they are based on two assumptions. First, the largest error may have arisen from the estimates of wastage. Food waste has been estimated to have increased by 50% since the 1970s [2
]. Slightly higher estimates from availability data reported in this study may be in part due to the 40% waste adjustment factor used, which may still be too low [2
]. On the other hand if we had used previous estimates of wastage of 29%, the estimated intakes for “sugars and syrups
” would have been 60 g/day (instead of 51 g/day). Interpretation of the results when expressed as a percentage of total energy (i.e.
, 13%) is not dependent on the wastage factor; however, this assumes the waste for all foods and beverages is the same, which may not be the case.
Second, because Canadian economic data for “sugars and syrups
” availability does not include corn sweeteners, the use of soft drink availability data as a proxy for corn sweetener trends was an assumption and may be an underestimate. There is much lower use of HFCS and corn sweeteners in Canada compared to the US because of lower soft drink consumption as well as the difference in sugar policies between the two countries—the US support-price for sugar generally provides a greater economic incentive to use HFCS and corn sweeteners in certain food applications. For example, liquid sugar which competes with corn sweeteners in Canada represents 22% of total sugar use compared to 12% in the US [25
]. In Canada, HFCS is predominantly used in soft drinks and there is no means to estimate use of HFCS in other foods; however, usage of corn sweeteners other than HFCS is 12% in the US. Further, Canadian soft drink availability data overestimates HFCS use (and caloric availability from soft drinks) because the data includes both regular and diet soft drinks [8
], but we could not adjust for this as the distribution is unknown in Canada. US availability data show the population share of soft drinks from diet drinks to be 29% in 2004 and 31% in 2007 (when data was discontinued) [9
]. From CCHS data, diet soft drinks contributed approximately 30% to total soft drink consumption among Canadian adults in 2004 [27
] and ranged from 4% to 20% for adolescents [28
], but this estimate may be low given the increase in diet soft drink consumption in recent years [29
]. The overestimation of HFCS in soft drinks due to diet drinks however may balance the use of corn sweeteners in other foods not captured in this analysis. The use of soft drink data as a proxy for corn sweetener consumption appears reasonable, as intake data from the CCHS was similar to the consumption estimates derived from availability data. In fact, estimates from availability data were slightly higher. CCHS data reported soft drink consumption by Canadians of all ages to be 2.2% of daily calories [27
], while availability data for the same time period (2004) indicated that soft drinks accounted for 3.5% of total energy [8
]. Similarly, added sugars were estimated to account for 11% of total energy for all Canadians using food intake data compared to 13% of total energy using availability data.