Sugar Content in Processed Foods in Spain and a Comparison of Mandatory Nutrition Labelling and Laboratory Values

Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan

BACKGROUND/OBJECTIVES

Population´s dietary intake of saturated fat, sodium, and sugars is higher than the current recommendations in Spain and most European countries. Nationwide food reformulation strategies have the potential to improve nutritional quality; however, evaluations are only available in a few countries and are difficult to compare. This study shows the degree of compliance with the nutrient reduction objectives included in a 4-year (2016-2020) Spanish food reformulation initiative.

METHODS

In 2016, baseline median nutrient content was established for 57 food subcategories. Agreed reduction (%) expressed as the median content to be reached by 2020 was set as the objective. In 2021, Spanish Food Safety and Nutrition Agency (AESAN) collected mandatory nutritional information from 3118 products belonging to the food subcategories included in the PLAN. Median nutrient content was calculated and compared with baseline data established in 2016 and PLAN objectives.

RESULTS

Median nutrient content reduction was observed in all food subcategories. Relative reductions (%) ranged from 0.6 to 60% for added sugars, 4.8 to 33.3% for salt, 4.5 to 78.3% for saturated fat, and 24.9 to 36% for total fat. PLAN objectives were achieved in all subcategories except for one. The number of products involved, belonging to the highly consumed food categories, shows the potential of national reformulation strategies to improve the nutritional quality of the diet.

CONCLUSION

Compliance with nutrient reduction agreements was 99%; however, the variability of nutrient content within subcategories shows that there is room for further reduction in selected nutrients and food subcategories.

Accuracy of declared nutrient content on labels of commercial complementary food products in Cambodia, Indonesia and Senegal

Commercially produced complementary foods (CPCF) have the potential to fill nutritional gaps in the diets of older infants and young children. This study evaluated the accuracy of nutrient declarations on labels of 43 commonly available CPCF in three peri-urban/urban locations: Khsach Kandal district, Cambodia (n = 11); Bandung, Indonesia (n = 11) and Guédiawaye and Dakar departments, Senegal (n = 21). Label values (LV) from product nutrient declarations were compared to analytical values (AV) derived from laboratory nutrient analysis for macronutrients (carbohydrate, protein and total fat), nutrients of public health concern (saturated fat, total sugar and sodium), and micronutrients of interest (calcium, iron and zinc). European Union guidance for nutrition label accuracy was used to set tolerance ranges for each nutrient LV relative to AV. LV were missing for one or more nutrients in 88.4% (n = 38) of the CPCF products and no CPCF met EU tolerance thresholds for all nine nutrients assessed. Over half of products with LV for key micronutrients (55.6%, n = 10/18) and macronutrients (54.8%, n = 23/42) met tolerances for LV accuracy. Eighty-five percent (n = 11/13) of products with LV for nutrients of public health concern were determined to be accurate. Nutrient content claims for iron appeared on 19 (44.2%) of the 43 products. Of the products which made an iron content claim, 26.3% had inaccurate LV with the majority of these containing less iron than declared. Regulatory action is needed to ensure that CPCF labelling communicates complete and accurate nutrient content information that enables caregivers to make informed decisions for feeding older infants and young children.

Erosive Potential and Sugar Content of Popular Beverages: A Double Whammy for Dentition

Objectives

This study aims to identify the pH level and subsequently the erosive potential of beverages including their sugar content.

Materials and Methods

Beverages were purchased from a local convenience store, and some of the beverages were freshly prepared. The acidity of each beverage was identified using a calibrated pH meter. The pH was obtained in triplicate, and the results were expressed in average values with standard deviations. The pH values were then used to determine their erosive potential and the sugar content was obtained from the packaging and recorded.

Results

A total of 167 beverages were purchased and categorized. The beverages were categorized into 15 groups: milk tea, hawker drinks, instant drinks, fresh fruit juices, milk, energy drinks, designer coffee, soda, canned drinks, cultured milk, vegetable juices, cordials, bottled fruit drinks, tea, and mineral water. The pH value ranges from 2.65 to 7.85. Seven beverages (4.2%) were classified as extremely erosive, 53 beverages (31.1%) were classified as erosive, and 36 beverages (21.6%) were classified as minimally erosive. In total, 57.5% of the beverages were potentially erosive, and most of the soda and energy drinks were erosive. The highest sugar content per 100 g was BOH Teh Tarik Original (71.8 g), whereas the highest sugar content per serving was Carabao energy drink (10.8 g).

Conclusion

High sugar content and low acidic content of beverages could have a negative impact on the dentition. An intervention is required from a public health perspective to regulate the consumption of sweetened and flavored beverages.

Evaluation of Food Labelling the Products with Information Regarding the Level of Sugar: A Preliminary Study

The aim of this article is to explore the reasons for seeking selected information on a food label, with particular emphasis on certain information about sugar. In order to meet the aim, in 2020, a survey was conducted among consumers aged 18–45. Predictive models (Logistic Regression) were developed for noticing “light” products and reading food labels. The results of our study indicate that consumers are mainly discouraged from reading label information by a large amount of information, the lack of time, and a general reluctance to be interested in label information. When it comes to the factors that lead people to read label information, the naturalness of the product, its organic origin, and physical activity are important. Moreover, respondents who declared that they noticed products on the market defined as “light” were those who were interested in the naturalness of the product, but also consumers declaring that they have nutritional knowledge. The results of the study indicate the need to intensify information campaigns in order to emphasize how important it is for consumers to read the information on food labels. The amount and complexity of information currently appearing on the food label may unfortunately discourage consumers from reading it, so it is important to continuously improve this form of communication with the consumer.

Verifying the Use of Food Labeling Data for Compiling Branded Food Databases: A Case Study of Sugars in Beverages

Branded food composition databases are an important tool for research, education, healthcare, and policy making, amongst others. Such databases are typically compiled using food labeling data without chemical analyses of specific products. This study aimed to verify whether the labeled sugar content in sugar-sweetened beverages (SSBs) corresponds to the actual sugar content in these products, thus enabling food monitoring studies to be conducted. A secondary objective was to determine the specific types of sugars in these SSBs. A case study was conducted using market share-driven sampling of these beverages from the Slovenian food supply. On the basis of nationwide yearly sales data, 51 best-selling products were sampled in 2020 and analyzed using high-performance liquid chromatography. This sales-driven approach to sampling has been shown to be very useful for conducting food monitoring studies. With the careful selection of a small proportion of available products, we finished with a manageable sample size, reflecting the composition of a majority (69%) of the national market share volume. The analyzed total sugar content was compared with labeled data, within the context of the European Union's regulatory labeling tolerances. In all samples, the sugar content was within the tolerance levels. The most common (N = 41) deviation was within ±10% of the labeled sugar content. In the subcategories, the differences between the analyzed and labeled median sugar contents were not statistically significant. Sucrose was most commonly (N = 36; 71%) used for sweetening, suggesting that the proportion of fructose in most SSBs was around 50%. A higher fructose content was only observed in beverages with fructose–glucose syrup or a higher content of fruit juice. The study results show that the labeled sugar content information in SSBs is reliable and can be used to compile branded food databases and monitor the nutritional quality of foods in the food supply.

Sugar Content and Sources in Commercial Infant Cereals in Spain

Instant infant cereals reconstituted with infant formula are the first complementary food for most Spanish infants. The main aim is to provide information on sugars in the formulation of infant cereals. Product information was collected from department stores, supermarkets, and pharmacies and completed with data from brand websites. A portion of the samples was selected for total sugars determination using the HPLC and Luff-Schoorl methods. The information regarding a total of 120 milk-free instant infant cereals marketed in Spain from 12 companies was summarized. The mean of total sugars was 23 ± 9 g/100 g (25–42%), providing 24% of the calories. Most of porridges are prepared with partially hydrolyzed flours providing free sugars (glucose and maltose). The most commonly added sugar is sucrose. A total of 43.3% of products contain added sucrose, and 16.7% contain fruits. Infant cereals analyzed with added sugars can have a sugar content similar to that found in products without added sugars. Consistent differences were found in sugars content between assayed methods and this label information. Although the European legislation of infant cereals establishes values for added sugars, the labeling reflects the content of total sugars, but not that of added sugars.

Diet Quality and Sociodemographic, Lifestyle, and Health-Related Determinants among People with Depression in Spain: New Evidence from a Cross-Sectional Population-Based Study (2011-2017)

The role of diet quality in depression is an emerging research area and it appears that diet quality could be an important modifying factor. The aims of this study were to report the prevalence of diet quality among individuals with and without a self-reported diagnosis of depression aged from 16 to 64 years old in Spain, to analyze the time trends of the frequency of food consumption and diet quality from 2011 to 2017 in individuals with a self-reported diagnosis of depression, and to explore the associations between poor/improvable diet quality and sociodemographic, lifestyle, and health-related factors. A nationwide cross-sectional study was conducted in 42,280 participants with and without a self-reported diagnosis of depression who had participated in the 2011/2012 and 2017 Spanish National Health Surveys and the 2014 European Health Survey in Spain. A logistic regression analysis was performed to identify the variables associated with diet quality. The overall prevalence of diet quality among depressive and non-depressive individuals revealed 65.71% and 70.27% were in need of improvement, respectively. Moreover, having a poor or improvable diet quality is associated with male gender, people aged 16-24 years old and 25-44 years old, separated or divorced, and also in smokers.

Evaluation of the Accurateness of the Nutritional Labels of Processed and Ultra-Processed Products Available in Supermarkets of Ecuador

Nutrition labeling is a public health tool that allows consumers to choose healthier foods and beverages. For this reason, there are protocols in place to monitor the food environment. The purpose of this study was to evaluate the consistency of nutrition labeling on packages for processed and ultra-processed products (UPPs) found at the main supermarkets in Cuenca, Ecuador. We conducted a descriptive cross-sectional study in which we identified label components on the packages of 1725 foods and beverages—including the nutrition table, statement on sweeteners, ingredient list, and the traffic light (TL) label—and determined the degree of consistency between the indicators reported on the traffic light label and those obtained from the information in the nutrition table. We found that 24% of products had inconsistencies in the traffic light label, and 10.9% of products had inconsistencies in the indicator for sugar specifically. The majority of inconsistencies were in the medium indicators for sugar (K = 0.68) and fat (0.75). The products with a medium indicator for sugar had a 1.98 (p < 0.05, 95% CI 1.15, 3.39) times higher chance of having inconsistencies in comparison with the low indicator. Health authorities must create new guidelines to allow for continued monitoring of the nutrition and traffic light labels on products accessible to consumers.

Carbohydrates, Starch, Total Sugar, Fiber Intakes and Food Sources in Spanish Children Aged One to <10 Years-Results from the EsNuPI Study

Diet quality is a modifiable factor that may contribute to the onset of diet-related chronic diseases. Currently, in Spain there are no studies that examine the intakes and sources for total carbohydrates, starch, total sugar, and fiber by both children consuming all kind of milks and children regularly consuming adapted milk formulas. Our goal was to evaluate the contribution of different food groups to total carbohydrates, starch, total sugar, and fiber consumption within the EsNuPI study participants by assessing their usual intakes by applying two 24 h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707) and another cohort which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk, fortified and enriched milks, here called Adapted Milk Consumers Cohort” (AMS) (n = 741). Estimation of the usual intake showed that nutrient intake increased with age for all nutrients except for fiber. The percentage of children by age and gender who met the reference intake (RI) range for total carbohydrates, was in all groups more than 50% of individuals, except for girls aged 6 to <10 years from the reference cohort in which only 46.9% complied the RI. Median fiber intake, both in the SRS and the AMS, was well below the adequate intake (AI) for children between 3 and 10 years. Main total carbohydrates sources were cereals, followed by milk and dairy products, fruits, bakery and pastry, vegetables and sugars and sweets. The highest contributors to starch intakes were cereals, bakery and pastry, vegetables, and fruits. Major sources of total sugar intakes were milk and dairy products, fruits, bakery and pastry, sugars and sweets, vegetables, and cereals. Nonetheless, milk and dairy products, and fruits, mainly provided lactose and fructose, respectively, which are not considered free sugars. Higher contribution to fiber intakes was provided by fruits, cereals, vegetables and bakery and pastry. There were no significant differences in relation with the total sugar intake according to the body mass index (BMI) between SRS and AMS. The present study suggests a high proportion of children had total carbohydrates intakes in line with recommendations by public health authorities, but still a significant number presented insufficient total carbohydrate and fiber intakes, while total sugar consumption was high, with no major differences between SRS and AMS cohorts.