The Contribution of Free Sugars to Energy Intake in Mid to Late Childhood: Comparisons Between Nutrient and Food Group Intakes and Antecedents of Diets High and Low in Free Sugars.

High intakes of free sugars may have negative effects on health perhaps associated with their effect on nutrient and food group intakes. The primary aim of the study was to compare nutrient and food group intakes between children with habitual high or low intakes of free sugars to identify which foods could be targeted to improve the diets of children consuming excess free sugars. The secondary aim was to assess antecedents for a child being in the high free sugars group compared with the low to identify the age at which an intervention would be most effective. The Avon Longitudinal Study of Parents and Children collected 3-day food records from children at ages 7, 10, and 13 years. Increments of 5% of energy from free sugars (%E-FS) were calculated. Two groups of children were identified: those consuming ≤15%E-FS each time (Low-FS) and those consuming >20%E-FS each time (High-FS). Their mean daily nutrient and food group intakes were compared at each age using ANOVA. Antecedents of being in these two FS groups were tested using regression models. At each age, 70% of children consumed >15%E-FS with one-third >20%E-FS. Data were available for 4723 children at all three ages, and the diets of the 456 children with Low-FS intakes were compared with 330 children with High-FS intakes at each age. Energy intakes were higher in High-FS than Low-FS at each age, but protein, fat, starch, and fibre intakes were lower. Several micronutrient intakes (e.g., calcium, zinc, selenium, and retinol) were also lower. The High-FS group ate more confectionery and other sweet foods than the Low-FS group as well as six times more sugar-sweetened soft drinks (SSSD) and four times more fruit juice. However, the High-FS group consumed less bread, fat spreads, milk, and vegetables than the Low-FS group. Being in the High-FS group compared with Low-FS group was not associated with maternal education, age, or breastfeeding duration. It was more likely if the child was difficult to feed at 15 months or a picky eater in preschool years and if a dietary pattern low in nutrient-dense core foods and high in nutrient-poor discretionary foods was being consumed at 2 and/or 3 years of age. Children who habitually ate a High-FS diet in mid-late childhood consumed larger amounts of SSSD and fruit juice and less of some core foods than Low-FS consumers. This type of dietary pattern was already evident at 2 years of age and was associated with being a picky eater. To reduce children's intake of free sugars, support for parents to introduce a healthy balanced diet should be provided in the first 2 years of a child's life.