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Carbohydrates, glycemic index and diabetes mellitus

Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age



The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors.


Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors.


Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children’s sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls.

SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order.


Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order.

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  1. van Stralen MM, te Velde SJ, van Nassau F, Brug J, Grammatikaki E, Maes L et al. Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: a pooled analysis of six European studies. Obes Rev 2012; 13 (Suppl 1), 29–41.

    Article  Google Scholar 

  2. Bray GA, Popkin BM . Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: Health be damned! Pour on the sugar. Diabetes Care 2014; 37: 950–956.

    Article  CAS  Google Scholar 

  3. Bo S, De Carli L, Venco E, Fanzola I, Maiandi M, De Michieli F et al. Impact of snacking pattern on overweight and obesity risk in a cohort of 11- to 13-year-old adolescents. J Pediatr Gastroenterol Nutr 2014; 59: 465–471.

    Article  Google Scholar 

  4. DeBoer MD, Scharf RJ, Demmer RT . Sugar-sweetened beverages and weight gain in 2- to 5-year-old children. Pediatrics 2013; 132: 413–420.

    Article  Google Scholar 

  5. Malik VS, Pan A, Willett WC, Hu FB . Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 2013; 98: 1084–1102.

    Article  CAS  Google Scholar 

  6. Millar L, Rowland B, Nichols M, Swinburn B, Bennett C, Skouteris H et al. Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children. Obesity (Silver Spring) 2014; 22: E96–E103.

    Article  Google Scholar 

  7. Te Morenga L, Mallard S, Mann J . Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2013; 346: e7492.

    Article  Google Scholar 

  8. Nicklas TA, O’Neil CE, Kleinman R . Association between 100% juice consumption and nutrient intake and weight of children aged 2 to 11 years. Archiv Pediatr Adolesc Med 2008; 162: 557–565.

    Article  Google Scholar 

  9. Sigman-Grant M, Morita J . Defining and interpreting intakes of sugars. Am J Clin Nutr 2003; 78: 815S–826SS.

    Article  CAS  Google Scholar 

  10. World Health Organisation (WHO). Guideline: Sugars Intake for Adults and Children, 2015:

  11. Trumbo P, Schlicker S, Yates AA, Poos M Food, Nutrition Board of the Institute of Medicine TNA. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002; 102: 1621–1630.

    Article  Google Scholar 

  12. Hess J, Latulippe ME, Ayoob K, Slavin J . The confusing world of dietary sugars: definitions, intakes, food sources and international dietary recommendations. Food Funct 2012; 3: 477–486.

    Article  CAS  Google Scholar 

  13. European Food Safety Authority (EFSA). Scientific Opinion on Dietary Reference Values for Carbohydrates and Dietary Fibre. EFSA J 2010; 8: 1462–1539.

    Google Scholar 

  14. Sheiham A, James WP . A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption. Public Health Nutr 2014; 17: 2176–2184.

    Article  Google Scholar 

  15. Koletzko B, von Kries R, Closa R, Escribano J, Scaglioni S, Giovannini M et al. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr 2009; 89: 1836–1845.

    Article  CAS  Google Scholar 

  16. Verwied-Jorky S, Schiess S, Luque V, Grote V, Scaglioni S, Vecchi F et al. Methodology for longitudinal assessment of nutrient intake and dietary habits in early childhood in a transnational multicenter study. J Pediatr Gastroenterol Nutr 2011; 52: 96–102.

    Article  Google Scholar 

  17. Langlois K, Garriguet D . Sugar consumption among Canadians of all ages. Health Rep 2011; 22: 23–27.

    PubMed  Google Scholar 

  18. Morgan KJ, Zabik ME . Amount and food sources of total sugar intake by children ages 5 to 12 years. Am J Clin Nutr 1981; 34: 404–413.

    Article  CAS  Google Scholar 

  19. Svensson A, Larsson C, Eiben G, Lanfer A, Pala V, Hebestreit A et al. European children’s sugar intake on weekdays versus weekends: the IDEFICS study. Eur J Clin Nutr 2014; 68: 822–828.

    Article  CAS  Google Scholar 

  20. Elmadfa I, Meyer A, Nowak V, Hasenegger V, Putz P, Verstraeten R et al. European Nutrition and Health Report 2009. Ann Nutr Metab 2009; 55 (Suppl 2), 1–40.

    PubMed  Google Scholar 

  21. Newens KJ, Walton J . A review of sugar consumption from nationally representative dietary surveys across the world. J Hum Nutr Diet 2016; 29: 225–240.

    Article  CAS  Google Scholar 

  22. Elliott CD . Sweet and salty: nutritional content and analysis of baby and toddler foods. J Public Health (Oxf) 2011; 33: 63–70.

    Article  Google Scholar 

  23. Kersting M, Alexy U, Kroke A, Lentze MJ . [Nutrition of children and adolescents. Results of the DONALD Study]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2004; 47: 213–218.

    Article  CAS  Google Scholar 

  24. Hendricks K, Briefel R, Novak T, Ziegler P . Maternal and child characteristics associated with infant and toddler feeding practices. J Am Diet Assoc 2006; 106 (Suppl 1), S135–S148.

    Article  Google Scholar 

  25. Karp SM, Lutenbacher M . Infant feeding practices of young mothers. MCN Am J Matern Child Nurs 2011; 36: 98–103.

    Article  Google Scholar 

  26. Pearson N, Biddle SJ, Gorely T . Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr 2009; 12: 267–283.

    Article  Google Scholar 

  27. Fein SB, Labiner-Wolfe J, Scanlon KS, Grummer-Strawn LM . Selected complementary feeding practices and their association with maternal education. Pediatrics 2008; 122 (Suppl 2), S91–S97.

    Article  Google Scholar 

  28. Fewtrell MS, Kennedy K, Singhal A, Martin RM, Ness A, Hadders-Algra M et al. How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? Arch Dis Child 2008; 93: 458–461.

    Article  Google Scholar 

  29. Perrin EM, Rothman RL, Sanders LM, Skinner AC, Eden SK, Shintani A, Throop EM, Yin HS . Racial and ethnic differences associated with feeding- and activity related behaviors in infants. Pediatrics 2014; 133: e857–e867.

    Article  Google Scholar 

  30. Burnier D, Dubois L, Girard M . Exclusive breastfeeding duration and later intake of vegetables in preschool children. Eur J Clin Nutr 2011; 65: 196–202.

    Article  CAS  Google Scholar 

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The studies reported herein have been carried out with partial financial support from the Commission of the European Community, specific RTD Programme ‘Quality of Life and Management of Living Resources’, within the 5th Framework Programme, research grants no. QLRT-2001-00389 and QLK1-CT-2002-30582, and the 6th Framework Programme, contract no. 007036 and the European Union’s Seventh Framework Programme (FP7/2007–2013), project EarlyNutrition under grant agreement no. 289346.


This manuscript does not necessarily reflect the views of the Commission and in no way anticipates the future policy in this area.

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Correspondence to B Koletzko.

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Pawellek, I., Grote, V., Theurich, M. et al. Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age. Eur J Clin Nutr 71, 25–32 (2017).

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