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The more sugar the less vitamins study shows

The more sugar we eat, the lower intake of vitamins and minerals we have, show new findings from Lund University Diabetes Centre.

Esther González-Pradilla
Esther González-Padilla Photo: Sara Liedholm

High sugar intake has been associated with numerous diseases and conditions such as dental caries, obesity, diabetes, and cardiovascular disease. In this study the researcher have examined the effect of added sugar - that is sugar added to food and beverages during processing, not the sugar that comes naturally in for exemple fruit, vegetables or milk - in relation to micronutrient (vitamins and minerals) intake.

Recommendations varies

The recommended upper limit of added sugar intake varies in different countries and from different institutions. The Nordic Nutrition Recommendations - the dietary guidelines tailored for the Nordic populations - suggest that added sugar should be limited to 10% of energy intake (%E); however, the European Food Safety Authority (EFSA) concluded that there are insufficient scientific data to define an upper limit. As a result, EFSA is reassessing the existing sugar intake recommendations by looking at the evidence behind them.
-    The selection of added sugar as opposed to other types of sugar, was done with the purpose of looking at the overall effect of the quality of diet. Added sugar is not part of foods and beverages naturally, it is added to foods and beverages during processing, manufacturing or at the table for different purposes, and is therefore not strictly necessary in our diets, says Esther González-Padilla.

Studies the Swedish population

Even though previous studies have found significant associations between the intake of added sugar and the displacement of nutrient-rich foods (high content of vitamins and minerals) by the consumption of energy-dense foods (high in sugar and fat) in various populations, studies in the adult population in Nordic countries are missing. The aim of this study was therefore to examine whether there was an association between the intake of added sugar and the intake of micronutrients in the adult Swedish population by examining two large population-based studies; the National Swedish Food Survey and the Malmö Diet and Cancer Study (see below).

Six groups

Added sugar intake was estimated for each individual by totaling the intake of simple sugars (mainly glucose, fructose and sucrose) from the whole diet and then subtracting the amount of sugars from fruits and berries, fruit juice, and vegetables (the main sources of naturally occurring sugars). The energy intake for added sugar were calculated and the populations were stratified into six groups according to their added sugar intake as follows: less than 5%E, 5–7.5%E, 7.5–10%E, 10–15%E, 15–20%E, and greater than 20%E from added sugar.
-    These cut-off points were selected with the intention of comparing our results with already existing added sugar intake recommendations all over the world, explains Esther González-Padilla.

Inverse association

Next they compared with the intake of nine micronutrients; calcium, folate, iron, magnesium, potassium, selenium, vitamin C, vitamin D, and zinc. The researchers observed an inverse association between the intake of added sugar and the daily intake of all nine micronutrients in both studies. The more added sugar the participants consumed, the lower was the intake of vitamins and minerals.
-    However, to be able to ascertain a clear limit of added sugar intake the decrease in micronutrient intake needs to be remarkably enlarged which we did not observe in our study. Even though this study alone is not sufficient to change recommendations it adds valuable evidence to the scientific pool of information to adjust recommendations in the future, says Esther González-Padilla.

The study was published in the journal Nutrition & Metabolism.

Link to the publication:
Association between added sugar intake and micronutrient dilution: a cross-sectional study in two adult Swedish populations



About the study

In the National Swedish Food Survey (Riksmaten Adults), 1797 men and women between 18 and 80 years old who resided in Sweden participated between May 2010 and July 2011. The Malmö Diet and Cancer Study is a population-based prospective cohort study consisting of all men born between 1923 and 1945 and women born between 1923 and 1950, altogether 12238 participants, who resided in Malmö (in the south of Sweden) during the data collection period (March 1991 – October 1996). Together, these two cohorts present information about dietary habits in the Swedish adult population that covers over two decades.