Added sugars and micronutrient dilution

Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence

Sugar is widely consumed over the world. Although the mainstream view is that high added or free sugar consumption leads to obesity and related metabolic diseases, controversies exist. This narrative review aims to highlight important findings and identify major limitations and gaps in the current body of evidence in relation to the effect of high sugar intakes on health. Previous animal studies have shown that high sucrose or fructose consumption causes insulin resistance in the liver and skeletal muscle and consequent hyperglycemia, mainly because of fructose-induced de novo hepatic lipogenesis. However, evidence from human observational studies and clinical trials has been inconsistent, where most if not all studies linking high sugar intake to obesity focused on sugar-sweetened beverages (SSBs), and studies focusing on sugars from solid foods yielded null findings. In our opinion, the substantial limitations in the current body of evidence, such as short study durations, use of supraphysiological doses of sugar or fructose alone in animal studies, and a lack of direct comparisons of the effects of solid compared with liquid sugars on health outcomes, as well as the lack of appropriate controls, seriously curtail the translatability of the findings to real-world situations. It is quite possible that "high" sugar consumption at normal dietary doses (e.g., 25% daily energy intake) per se-that is, the unique effect of sugar, especially in the solid form-may indeed not pose a health risk for individuals apart from the potential to reduce the overall dietary nutrient density, although newer evidence suggests "low" sugar intake (<5% daily energy intake) is just as likely to be associated with nutrient dilution. We argue the current public health recommendations to encourage the reduction of both solid and liquid forms of free sugar intake (e.g., sugar reformulation programs) should be revised due to the overextrapolation of results from SSBs studies.

Association between free sugar intake and nutrient dilution among Japanese children and adolescents: the 2016 National Health and Nutrition Survey, Japan

The influence of free sugar intake on nutrient intake remains unclear in Japanese children and adolescents with relatively low free sugar intake. This cross-sectional study aimed to investigate the relationship between free sugar and selected nutrient intakes using data from the 2016 National Health and Nutrition Survey, Japan, based on the WHO recommendations (<5 % or <10 % of energy (%E)) for free sugar intake. A 1-d weighed dietary record was assessed in Japanese children and adolescents (aged 1-19 years; n 2919). Mean intakes for selected nutrients and food groups were compared according to free sugar intake categories (<2·5 %E, 2·5 to <5 %E, 5 to <10 %E and ≥10 %E) with adjustment for sex, age and weight status. Inverse associations were observed between intakes of free sugars and twenty-one of twenty-four micronutrients assessed, except for vitamins A and C and Ca. Significantly reduced intakes were identified for twenty-two and fourteen micronutrients in the ≥10 %E and 5 to <0 %E categories, respectively, compared with the lower categories. Mean micronutrient intakes at the <2·5 %E category did not differ from those at the 2·5 to <5 %E category. Free sugar intake had positive associations with intakes of sugars and jams, confectioneries, fruit and vegetable juices, and soft drinks and negative associations with intakes of pulses and nuts and vegetables. This study showed that nutrient dilution was associated with higher free sugar intake among Japanese children and adolescents. The findings suggest that the WHO recommendations might help prevent nutrient dilution in Japanese children and adolescents.

Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy

Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.

Objective Biomarkers for Total Added Sugar Intake - Are We on a Wild Goose Chase?

Misreporting of added sugar intake has been the major criticism of studies linking high added sugar consumption to adverse health outcomes. Despite the advancement in dietary assessment methodologies, the bias introduced by self-reporting can never be completely eliminated. The search for an objective biomarker for total added sugar intake has therefore been a topic of interest. In this article, the reasons this search may be a wild goose chase will be outlined and discussed. The limitations and inability of the 2 candidate biomarkers, namely urinary sucrose and fructose and δ¹³C isotope, which are based on the 2 only possible ways (i.e., difference in metabolism and plant sources) to identify added sugar based on current knowledge in human physiology and food and nutritional sciences, are discussed in detail. Validation studies have shown that these 2 candidate biomarkers are unlikely to be suitable for use as a predictive or calibration biomarker for total added sugar intake. Unless advancement in our understanding in human physiology and food and nutritional sciences leads to new potential ways to distinguish between naturally occurring and added sugars, it is extremely unlikely that any accurate objective added sugar biomarker could be found. It may be time to stop the futile effort in searching for such a biomarker, and resources may be better spent on further improving and innovating dietary assessment methods to minimize the bias introduced by self-reporting.

Relationship of added sugars intakes with physiologic parameters in adults: an analysis of national health and nutrition examination survey 2001-2012

INTRODUCTION

Consumption of added sugars (AS) has been associated with increased risk for liver disease and risk factors for cardiovascular disease. The objective of this study was to further understand the relationship of AS intake with liver enzymes and risk factors for cardiovascular disease in adults (n = 29,687) participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2012.

METHODS

Individual usual intake (IUI) of AS was estimated using the Markov Chain Monte Carlo ratio method using two days of 24-hour dietary recalls gathered using standardized protocols. Subjects were separated into six consumption groups: 0 to <5%, 5 to <10%, 10 to <15%, 15 to <20%, 20 to <25% and ≥25% of energy as added sugars. Linear and group trends were determined using regression analyses for liver enzymes, cardiovascular risk factors, weight parameters, glucose, metabolic syndrome, and C-reactive protein. Logistic regression calculated odds ratios for these biomarkers above established risk levels (p < 0.01).

RESULTS

There was an inverse group trend association with AS IUI for lower body mass index (beta = -0.12 kg/m2 across AS intake groups); % overweight/obese or % obese also showed inverse group trend (-1.44, -0.77, % units across AS intake groups, respectively). Liver enzymes did not show a significant association with AS IUI. Mean plasma glucose levels (mg/dL) showed an inverse linear (beta = -0.13 mg/dL per AS intake); and group association with energy from AS IUI (beta = -0.71mg/d L across AS intake groups). There was no association of AS intake with the risk of elevated uric acid levels; however, the odds of reduced uric acid levels was 17% lower with increasing intake of energy from AS IUI in group trend analysis only (0.83; 0.72-0.95 [99th CI]).

CONCLUSION

Although it is sensible to consume AS in moderation, results suggested that higher intakes of AS were not consistently associated with physiologic parameters. Since the data were cross-sectional, they cannot be used to assess cause and effect. Thus, additional studies are warranted to confirm these findings with more rigorous study designs.

Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009-2014

There is inconsistent evidence regarding the impact of added sugars consumption on micronutrient dilution of the diet. We examined the associations between added sugars intake deciles and nutrient adequacy for 17 micronutrients in U.S. adults 19+ (n = 13,949), 19–50 (n = 7424), and 51+ y (n = 6525) using two days of 24 hour dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014 and regression analysis. Added sugars intake deciles ranged from <3.8 to >23.3% of calories among adults 19+ y, with a median intake of 11.0% of calories. Significant associations (p ≤ 0.01) between added sugars intake deciles and percentage of the population below the Estimated Average Requirement (EAR) were found for magnesium, vitamin C, vitamin D, and vitamin E; only the association with magnesium remained significant after dropping the two highest and lowest deciles of intake, suggesting a threshold effect. Intakes below approximately 18% of calories from added sugars were generally not associated with micronutrient inadequacy. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these four micronutrients, suggesting that adequate intakes are difficult to achieve regardless of added sugars intake.

Association between free sugars intake and nutrient dilution among Japanese adults: the 2016 National Health and Nutrition Survey, Japan

PURPOSE

The association between free sugars and nutrient intake is unclear in Japanese adults with relatively low free sugars intake. This cross-sectional study aimed to elucidate this relationship using data from the 2016 National Health and Nutrition Survey, Japan, and according to the current World Health Organization (WHO) guidelines for the prevention of nutrient dilution [< 5% or < 10% of energy (%E)].

METHODS

Dietary intake of Japanese adults (aged ≥ 20 years; n = 16,652) was assessed using a 1-day weighed dietary record. Mean intakes for selected nutrients and food groups were compared among categories of free sugars intake (i.e., < 2.5%E, 2.5 to < 5%E, 5 to < 10%E, and ≥ 10%E) by adjusting for sex, age, weight status, smoking status, habitual drinking, and occupation.

RESULTS

Free sugars intake was inversely associated with the intake of 16 of 24 micronutrients investigated. Compared to its lower categories of free sugars intake, significant reductions in intake were identified for almost all micronutrients at ≥ 10%E, whereas ten micronutrients were reduced at 5 to < 10%E. The intake of dietary fibre, sodium, potassium, calcium, and iron was lower at < 2.5%E than at 2.5 to < 5%E and/or 5 to < 10%E. Free sugars intake was also positively associated with sugars and jams, confectionaries, fruit and vegetable juices, and soft drinks and inversely with pulses and nuts and vegetables.

CONCLUSIONS

This study identified nutrient dilution among Japanese adults with higher free sugars intake and confirmed the significance of the WHO guidelines for preventing nutrient dilution in Japanese.

Association of Added Sugars Intake with Micronutrient Adequacy in US Children and Adolescents: NHANES 2009-2014

BACKGROUND

A concern about the excessive consumption of added sugars is the potential for micronutrient dilution, particularly in children and adolescents; however, the evidence is inconsistent.

OBJECTIVE

We examined the associations between added sugars intake and micronutrient adequacy in US children and adolescents using data from NHANES 2009-2014.

METHODS

Children and adolescents aged 2-18 (n = 7754), 2-8 (n = 3423), and 9-18 y (n = 4331) were assigned to deciles of added sugars intake based on the average of 2 d of dietary recall. Usual intake of micronutrients was determined using 2 dietary recalls and the National Cancer Institute method. Within each age group, regression analyses were used to assess the relationship between added sugars intake decile and percentage of the population below the estimated average requirements (EARs) for 17 micronutrients.

RESULTS

Deciles of added sugars intake (percentage of calories) ranged from <6.4 to >22.8 among children and adolescents aged 2-18 y, with a median intake of 13.3% of calories. Significant positive associations (P < 0.01) between added sugars intake and percentage of the population (aged 2-18 y) below the EAR were found only for calcium, magnesium, and vitamin D. These associations virtually disappeared after dropping the 2 highest and lowest deciles of intake, suggesting a threshold effect; intakes below approximately 19% of calories from added sugars were generally not associated with micronutrient inadequacy.

CONCLUSIONS

As added sugars intake increased, there was a threshold above which an increase in the prevalence of inadequate intakes for calcium, magnesium, and vitamin D among US children and adolescents was observed. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these nutrients, suggesting that adequate intakes of these nutrients are difficult to achieve independent of added sugars intake.

Prospective association between added sugars and frailty in older adults

Background

Sugar-sweetened beverages and added sugars (monosaccharides and disaccharides) in the diet are associated with obesity, diabetes, and cardiovascular disease, which are all risk factors for decline in physical function among older adults.

Objective

The aim of this study was to examine the association between added sugars in the diet and incidence of frailty in older people.

Design

Data were taken from 1973 Spanish adults ≥60 y old from the Seniors-ENRICA cohort. In 2008-2010 (baseline), consumption of added sugars (including those in fruit juices) was obtained using a validated diet history. Study participants were followed up until 2012-2013 to assess frailty based on Fried's criteria. Statistical analyses were performed with logistic regression adjusted for age, sex, education, smoking status, body mass index, energy intake, self-reported comorbidities, Mediterranean Diet Adherence Score (excluding sweetened drinks and pastries), TV watching time, and leisure-time physical activity.

Results

Compared with participants consuming <15 g/d added sugars (lowest tertile), those consuming ≥36 g/d (highest tertile) were more likely to develop frailty (OR: 2.27; 95% CI: 1.34, 3.90; P-trend = 0.003). The frailty components "low physical activity" and "unintentional weight loss" increased dose dependently with added sugars. Association with frailty was strongest for sugars added during food production. Intake of sugars naturally appearing in foods was not associated with frailty.

Conclusions

The consumption of added sugars in the diet of older people was associated with frailty, mainly when present in processed foods. The frailty components that were most closely associated with added sugars were low level of physical activity and unintentional weight loss. Future research should determine whether there is a causal relation between added sugars and frailty.

Relation between sugar-sweetened beverage consumption and micronutrient intake in a prospective study

Micronutrient dilution following sugar-sweetened beverage (SSB) consumption can lead to a qualitative impoverishment of a dietary pattern. The aim of this prospective study was to investigate the relation between SSB consumption and micronutrients. A total 562 adults were tested in 2002 and 2012 for the same anthropometric, lifestyle and nutritional intake activity parameters. Calcium, iron and magnesium intake decreased with increasing baseline SSB intake, and with increasing SSB consumption during the 10 years. A 100 ml increase in SSB consumption was associated with a 22 mg lower intake of calcium, 0.4 mg of iron and 9 mg of magnesium. There was no relation between vitamins and SSB consumption. In conclusion, there was limited evidence in our study, which suggests SSB have minimal dilutional effect on dietary micronutrient consumption. A major limitation of the present study is that of the original 1569 participants in 2002, 36% returned for participation in 2012.

High Intake of Nonmilk Extrinsic Sugars Is Associated With Protein and Micronutrient Dilution in Home-Dwelling and Institutionalized Older People

BACKGROUND

High dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations.

DESIGN AND PARTICIPANTS

This cross-sectional study combined five Finnish data sets covering home-dwelling (n = 526) and institutionalized (n = 374) older people. Their nutritional status was assessed using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1- to 3-day food records. The participants were divided into quartiles corresponding to the proportions of energy received from NMES. Energy, nutrient, and fiber intakes were classified according to the NMES quartiles, and the participants were divided according to their places of residence (home, institution).

RESULTS

High NMES intakes were associated with older age, female sex, poor cognition, low MNA scores, immobility, and institutionalization. In all, 90% of the participants in the highest NMES quartile (Q4) were institutionalized. In the institutionalized individuals, low protein and micronutrient intakes were observed in both those with low energy intake (Q1) and in those with very high NMES intakes (Q4). In home-dwelling individuals, the nutrient intakes tended to decline linearly with increasing NMES intakes in protein and most micronutrients.

CONCLUSIONS

Institutionalized older people consumed diets high in NMES, compared with those living at home, and their low energy and high NMES intakes were associated with low protein and micronutrient intakes.

Naturally occurring and added sugar in relation to macronutrient intake and food consumption: results from a population-based study in adults

Associations between sugar intake and the remaining diet are poorly described in modern food environments. We aimed at exploring associations of high naturally occurring and added sugar intakes with sociodemographic characteristics, intake of macronutrients, fibre and selected food groups. Our data comprised 4842 Finnish adults aged 25-74 years, who participated in the population-based DIetary, Lifestyle and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) study. Diet was assessed by a validated 131-item FFQ. The food item disaggregation approach was used to estimate sucrose and fructose intakes from natural sources (naturally occurring sugar) and all other sources (added sugar). Sex-specific trends in macronutrient, fibre and food group intakes across sugar type quartiles were determined with general linear modelling adjusting for age, energy intake, leisure-time physical activity, smoking, education and BMI. Overall, results were similar across sexes. Young age was found to be a determinant of higher added sugar and lower naturally occurring sugar intakes (P < 0·0001). High added sugar intake was associated with low fibre intake (P < 0·0001) accompanied with lower fruit (P < 0·0001 women; P = 0·022 men) and vegetable consumption (P < 0·0001) and higher wheat consumption (P = 0·0003 women; P < 0·0001 men). Opposite results were found for naturally occurring sugar. Butter consumption increased by 28-32 % (P < 0·0001) when shifting from the lowest to the highest added sugar intake quartile, while a decrease of 26-38 % (P < 0·0001) was found for naturally occurring sugar. Therefore, the associations of sugar types with dietary carbohydrate and fat quality seem opposing. Proper adjustments with dietary variables are needed when studying independent relationships between sugar and health.

Commercial complementary food consumption is prospectively associated with added sugar intake in childhood

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

Added Sugar, Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context

OBJECTIVE

The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1-8.9 years of age in South Africa.

METHODS

Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined.

RESULTS

Added sugar intake varied from 7.5-10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1-3 years) (Q1) to 19.3% in Q4 (4-8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1-3 years), phosphorus, iron (4-8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4-8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2-29.8)% in Q4 compared to 13.0 (8.7-17.3)% in Q1, p = 0.0063].

CONCLUSION

Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4-8 year old children.

Intake of total and added sugars and nutrient dilution in Australian children and adolescents

This analysis aimed to examine the association between intake of sugars (total or added) and nutrient intake with data from a recent Australian national nutrition survey, the 2007 Australian National Children’s Nutrition and Physical Activity Survey (2007ANCNPAS). Data from participants (n 4140; 51 % male) who provided 2×plausible 24-h recalls were included in the analysis. The values on added sugars for foods were estimated using a previously published ten-step systematic methodology. Reported intakes of nutrients and foods defined in the 2007ANCNPAS were analysed by age- and sex-specific quintiles of %energy from added sugars (%EAS) or %energy from total sugars (%ETS) using ANCOVA. Linear trends across the quintiles were examined using multiple linear regression. Logistic regression analysis was used to calculate the OR of not meeting a specified nutrient reference values for Australia and New Zealand per unit in %EAS or %ETS. Analyses were adjusted for age, sex, BMI z-score and total energy intake. Small but significant negative associations were seen between %EAS and the intakes of most nutrient intakes (all P<0·001). For %ETS the associations with nutrient intakes were inconsistent; even then they were smaller than that for %EAS. In general, higher intakes of added sugars were associated with lower intakes of most nutrient-rich, ‘core’ food groups and higher intakes of energy-dense, nutrient-poor ‘extra’ foods. In conclusion, assessing intakes of added sugars may be a better approach for addressing issues of diet quality compared with intakes of total sugars.

Intake and sources of added sugars among Australian children and adolescents

PURPOSE

To examine the intake and sources of added sugars (AS) of Australian children and adolescents, and compare their intake of free sugars (FS) to the recommended limit set by the World Health Organization (<10 % energy from FS).

METHOD

Data of 4140 children and adolescents aged 2-16 years with plausible intakes based on 2 × 24 h recalls from the 2007 Australian National Children Nutrition and Physical Activity Survey were used. AS content of foods was estimated based on a published method. Intakes of AS and FS, as well as food sources of AS, were calculated. One-way ANOVA was used for comparisons between age groups and gender.

RESULTS

The mean (SD) AS intake was 58.9 (35.1) g/day, representing 11.9 (5.6) % of daily energy intake and 46.9 (17.5) % of daily total sugars intake. More than 80 % of the subjects had % energy from FS > 10 %. Significant increasing trends for AS intake, % energy from AS, % energy from FS across age groups were observed. Sugar-sweetened beverages (19.6 %), cakes, biscuits, pastries and batter-based products (14.3 %), and sugar and sweet spreads (10.5 %) were the top three contributors of AS intake in the whole sample. Higher contribution of AS from sugar-sweetened beverages was observed in adolescents (p _trend < 0.001).

CONCLUSIONS

A large proportion of Australian youths are consuming excessive amounts of energy from AS. Since the main sources of AS were energy-dense, nutrient-poor foods, interventions which target the reduction in these foods would reduce energy and AS intake with minimal impact to core nutrient intake.

Ecological momentary assessment of environmental and personal factors and snack food intake in African American women

This study examined contributions of environmental and personal factors (specifically, food availability and expense, daily hassles, self-efficacy, positive and negative affect) to within-person and between-person variations in snack food intake in 100 African American women. Participants were signaled at random five times daily for seven days to complete a survey on a study-provided smartphone. Women reported consuming snack foods at 35.2% of signals. Easier food availability accounting for one's usual level was associated with higher snack food intake. Being near outlets that predominately sell snacks (e.g., convenience stores), while accounting for one's usual proximity to them, was associated with higher snack food intake. Accounting for one's usual daily hassle level, we found that on days with more frequent daily hassles snack food intake was higher. The positive association between within-person daily hassles frequency and snack food intake was stronger when foods were easily available. Public and private policies to curb ubiquitous food availability and mobile health interventions that take into account time-varying influences on food choices and provide real-time assistance in dealing with easy food availability and coping with stressors may be beneficial in improving African American women's day to day food choices.

High proportions of foods recommended for consumption by United States Dietary Guidance contain solid fats and added sugar: results from the National Health and Nutrition Examination Survey (2007-2008)

BACKGROUND

The 2010 Dietary Guidelines for Americans (DGA) recommend that individuals age two years and older reduce intakes of solid fats (SoF) and added sugars (AS; together SoFAS). MyPlate illustrates the proportions of five major food groups to promote healthy eating (Vegetables, Grains, Protein Foods, Fruits and Dairy).

METHODS

To assess if the foods currently consumed by Americans are in concordance with the DGA, food consumption data from What We Eat In America, National Health and Nutrition Examination Survey (WWEIA-NHANES) 2007-2008 (n = 8 527) was used to estimate the proportion of foods that contained SoFAS and to report them by food group. Weighted analysis was conducted to be nationally representative.

RESULTS

The Dairy group contained the highest proportion (93%) of either SoF or AS, followed by Grains (70% SoF; 70% AS; 50% both). Fruits contained the least SoFAS (7%).

CONCLUSIONS

Results suggest that the high proportion of SoFAS in each recommended food group makes it challenging for Americans to reduce their intake of SoFAS.

The Association Between Body Metrics and Breakfast Food Choice in Children

Purpose. Ready-to-eat cereal (RTEC) consumption has been associated with better nutrient intakes and anthropometric end points compared with breakfast skipping and other breakfasts. Our objective was to evaluate RTEC breakfast type (presweetened and nonpresweetened) on physiological end points. Methods. National Health and Nutrition Examination Survey 2003-2006 data were analyzed using SUDAAN. Participants (n = 6729; 2-17 years) were separated into groups based on breakfast habits as follows: presweetened RTEC (PS-RTEC); nonpresweetened RTEC (NPS-RTEC); breakfast skippers (SKs); other breakfasts (OBs). Presweetened was defined as ≥9 g of added sugars per serving. Results. No differences were found for weight, BMI, waist circumference, blood pressure, or lipids in children consuming PS-RTECs or NPS-RTECs. In children 12 to 17 years old, BMI and percentage of children overweight or obese were lower for consumers of PS-RTECs at breakfast compared with SK or OB groups. Skinfolds were significantly lower in PS-RTEC versus SK or OB groups. SK and OB children (12-17 years old) were nearly twice as likely to be overweight or obese as compared with children consuming PS-RTECs (odds ratio of 1.87 and 2.12, respectively). Conclusion. Consumption of breakfast cereal with higher or lower added sugar was not associated with unhealthy physiological end points in children. The study confirms the association between RTEC consumption and healthier body weights compared with children and adolescents skipping or consuming a non-RTEC breakfast.

The confusing world of dietary sugars: definitions, intakes, food sources and international dietary recommendations

Government and health organizations worldwide have issued dietary guidelines for sugars. These guidelines vary considerably in the recommended or suggested intakes and the types of sugars specified. Despite access to the same published literature, recommendations vary greatly and create confusion for nutrition practitioners who offer dietary guidance. Some of the confusion in this field is linked to differences in definitions for sugar and methods to measure total sugars. Additionally, although dietary guidance typically recommends foods high in sugar, fruits and dairy products, other advice suggests strict limits on intake of "added sugar". Added sugar cannot be analytically determined and must be calculated so nutrient databases generally contain values for total sugar and do not differentiate between sugars naturally occurring in foods and those added in processing. This review defines sugars, provides the sugar content of major food sources, summarizes health concerns about dietary sugars, and compiles dietary guidelines for sugars issued by various organizations. Dietary recommendations from various health organizations are based on different means of assessment, and thus vary considerably. In general, the use of added sugars is cautioned, especially when it contributes to calories in excess of needs for an individual.

Intake of added sugars is not associated with weight measures in children 6 to 18 years: National Health and Nutrition Examination Surveys 2003-2006

Studies examining an association between consumption of added sugars (AS) and weight measures in children are inconclusive. This study examined the association between intake of AS and 5 measures of weight or adiposity using a nationally recent representative sample of children. National Health and Nutrition Examination Surveys 2003-2006 24-hour recall data from children 6 to 18 years (n = 3136) were used. United States Department of Agriculture's definition of AS and MyPyramid Equivalents Database were used to estimate daily intake. Multiple linear regression and squared partial correlation coefficients were used to estimate the strength of association between weight, body mass index (BMI), BMI Z scores, waist circumference, and triceps and subscapular skinfolds as dependent variables with AS as the independent variable. Covariates were age, sex, race/ethnicity, poverty income ratio, total energy intake (kJ), and physical activity. Mean intake of AS was 23 ± 0.55 teaspoons (tsp) (21 tsp for 6-11 years and 25 tsp for 12-18 years) accounting for 17% of total energy intake for both groups. The percent variance explained in BMI Z scores was 3.9% in children 6 to 11 years, with AS contributing only 0.03%. In children 12 to 18 years, the percent variance explained in the BMI Z scores was 6.5% with 0.18% coming from AS. No significant associations were observed between intake of AS and weight or adiposity measures. Consumption of AS did not contribute significantly to BMI Z scores in children 6 to 18 years. Longitudinal studies using more robust and precise measures of dietary intake are needed to further investigate the role of AS and weight in children.

Association of candy consumption with body weight measures, other health risk factors for cardiovascular disease, and diet quality in US children and adolescents: NHANES 1999-2004

OBJECTIVE

The purpose of this study was to determine the effects of total, chocolate, or sugar candy consumption on intakes of total energy, fat, and added sugars; diet quality; weight/adiposity parameters; and risk factors for cardiovascular disease in children 2-13 years of age (n=7,049) and adolescents 14-18 years (n=4,132) participating in the 1999-2004 National Health and Nutrition Examination Survey.

METHODS

Twenty-four hour dietary recalls were used to determine intake. Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). Covariate-adjusted means, standard errors, and prevalence rates were determined for each candy consumption group. Odds ratios were used to determine the likelihood of associations with weight status and diet quality.

RESULTS

In younger children, total, chocolate, and sugar candy consumption was 11.4 g±1.61, 4.8 g±0.35, and 6.6 g±0.46, respectively. In adolescents, total, chocolate, and sugar candy consumption was 13.0 g±0.87, 7.0 g±0.56, and 5.9 g±0.56, respectively. Total candy consumers had higher intakes of total energy (2248.9 kcals±26.8 vs 1993.1 kcals±15.1, p<0.0001) and added sugars (27.7 g±0.44 vs 23.4 g±0.38, p<0.0001) than non-consumers. Mean HEI-2005 score was not different in total candy and sugar candy consumers as compared to non-consumers, but was significantly lower in chocolate candy consumers (46.7±0.8 vs 48.3±0.4, p=0.0337). Weight, body mass index (BMI), waist circumference, percentiles/z-score for weight-for-age and BMI-for-age were lower for candy consumers as compared to non-consumers. Candy consumers were 22 and 26%, respectively, less likely to be overweight and obese than non-candy consumers. Blood pressure, blood lipid levels, and cardiovascular risk factors were not different between total, chocolate, and sugar candy consumers and non-consumers (except that sugar candy consumers had lower C-reactive protein levels than non-consumers).

CONCLUSION

This study suggests that candy consumption did not adversely affect health risk markers in children and adolescents.

Importance of food composition data to nutrition and public health

INTRODUCTION

Adequate nutrition is one of the pillars of public health. Before developing and implementing effective intervention programmes to improve nutrition at the population level, it is important to know the nutritional situation of the target group.

ASSESSMENT OF ENERGY AND NUTRIENT INTAKE

The estimation of nutrient intake from food consumption requires reliable data on food composition. These data are also the fundamentals of food-based dietary guidelines for healthy nutrition, containing the necessary information on food sources for different nutrients. Furthermore, food composition tables can provide information on chemical forms of nutrients and the presence and amounts of interacting components, and thus provide information on their bioavailability. For some nutrients such as vitamin A, vitamin E and niacin, the concept of equivalence has been introduced to account for differences in the availability and biological activity of different chemical forms. NON-NUTRITIVE FOOD COMPONENTS: Although most food composition tables focus on energy, macro- and micronutrients, interest in non-nutritive components is increasing. Considering the beneficial effects of biologically active secondary plant cell compounds such as polyphenols and carotenoids, more data on these are needed. On the other hand, there are a number of naturally occurring or 'man-made' non-nutritive substances with negative effects, and to control exposure, the main dietary sources must be known. Another aspect is contaminants, which could have detrimental effects on consumers' health. Among these are agrochemicals, industrial pollutants reaching the food chain and substances formed during food preparation. A valid risk assessment requires data on exposure, and thus on the contents of contaminants in foods. However, these data are highly variable and may significantly differ even within narrowly confined regions. CURRENT FOOD COMPOSITION DATABASES ARE FAR FROM COMPLETE: The fact that composition tables generally do not provide information about the origin of substances found in food can also influence their usability. For example, the German Nutrient Data base does not discriminate between naturally occurring and added sucrose impeding the estimation of added sucrose intake that should be limited. Points of focus: Considering the increasing number of persons relying on community nutrition and catering, healthy menu lines can improve the consumers' diets and contribute to nutrient supply. The development and implementation of appropriate guidelines also need food composition databases (FCBs) to compose meals. The ever-increasing number of new food preparations and manufactured products has resulted in a need for procedures for regularly updated data. Moreover, there is a lack of data particularly for essential trace elements such as copper, chromium or molybdenum and also vitamin K, as well as the already mentioned non-nutritive components. Limited comparability between countries is another issue. Regional differences arise especially from the use of local varieties, different soil quality or meteorological aspects. This variability is further increased with composite meals because of variation in recipes.

CONCLUSION

Information about food composition is necessary for the assessment of diet quality and the development and application of food-based dietary guidelines, providing a useful tool for the field of public health nutrition. In this regard, more attention should be paid to the preparation, extension and maintenance of FCBs.

On the role and fate of sugars in human nutrition and health. Introduction

The recently implemented European Regulation (EC) No. 1924/2006 on nutrition and health claims made on foods is fuelling scientific research efforts in the food and health arena. Essentially, it is now established that only claims that are scientifically substantiated will be allowed. Because this new legislation covers the idea that foods with health or nutritional claims might be perceived by consumers as having a health advantage over products without claims, it introduces a further requirement (enclosing the new concept of 'nutrient profile') to avoid a situation where claims could mislead consumers when trying to make healthy choices in the context of a balanced diet. Thus, only those foods having an appropriate nutrition profile (composition of different nutrients such as sugars and other substances with particularly relevant nutritional or physiological effects) will be allowed to bear claims. A scientific expert workshop was organized to critically review the available evidence behind current intake recommendations for sugars, focusing on the strength/gaps of the scientific evidence available and the identification of those fields where further research is needed. Work was distributed in the following topics covering potential effects of dietary sugars on (i) body weight control; (ii) diabetes-insulin resistance; (iii) dental health and (iv) micronutrient dilution. New approaches, including intervention studies and the application of nutrigenomic technologies, should be undertaken and interpreted bearing in mind that foods, food components and their combinations can have both positive and negative effects on health, thus requiring benefit-risk analysis.