The Association Between Added Sugars Intake and the Healthy Eating Food Index 2019 Among Canadians: Analyses from the 2015 Canadian Community Health Survey—Nutrition Public Use Microdata File
Background/Objectives: There is continuing debate regarding the association between added sugars (AS) consumption and overall diet quality, which remains a research gap within the Canadian population. This study aimed to assess the association between intakes of added sugars and the Healthy Eating Food Index (HEFI) 2019 that measures adherence to Canada’s Food Guide as an indicator of diet quality. Methods: The first 24 h dietary recalls of Canadians 2 years and older (n = 19,532) from the 2015 Canadian Community Health Survey—Nutrition were used. Added sugars intakes were calculated based on a systematic 10-step algorithm. Descriptive statistics were obtained for total HEFI and component scores across different AS intake categories. The association between AS categories and HEFI scores was tested using a generalized linear model adjusted for age, sex, education level, type of smoker, and misreporting status. Results: The association between continuous AS intake and HEFI scores was non-linear. In the categorical model, AS intake categories were inversely associated with HEFI scores among Canadians (R2 = 0.32, p < 0.001). Large overlaps in HEFI scores were observed among individuals with similar AS intakes for the whole population and each age group. Among high AS consumers (>15% EI), lower HEFI scores were largely due to higher proportions of sweetened beverages (i.e., low beverage scores) and lower intakes of vegetables and fruit and plant-based proteins. Scores for protein food and whole grains were low across all AS intake categories. Conclusions: Large variations in overall HEFI scores were observed amongst those with similar AS intakes, suggesting that added sugars alone may not fully capture overall diet quality or adherence to Canada’s Food Guide.