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

Abstract

ObjectiveThe 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.MethodsSecondary 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.ResultsAdded 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].ConclusionAlthough 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.

Dietary Inadequacies in HIV‐infected and Uninfected School‐aged Children in Johannesburg, South Africa

“…In addition, the low mean diet diversity score similar to other studies of South African Children (20, 25) further suggests an increased risk for nutritional deficiencies. As recommended, a large proportion of the HIV-infected group was taking multivitamins but the micronutrient composition of the multivitamins was unknown and we were unable to factor this into the analysis (31).…”

“…Although the reported macronutrient composition fell within the AMDRs for more than half of the sample, many children in both groups fell below the recommended ranges for carbohydrates, protein, or fat. In comparison to a study of South African children ages 1–8 years, our estimate of protein as a percentage of energy was similar, but we observed a lower percentage of energy intake from carbohydrates and higher percentage of energy intake from fat (25). For the HIV-infected group, we found a lower percentage of energy intake coming from protein and carbohydrate, but a higher percentage of energy intake from fat as compared to Brazilian HIV-infected adolescents (24).…”

Snack food and beverage consumption and young child nutrition in low‐ and middle‐income countries: A systematic review

“…Among Australian 16‐ to 24‐month‐olds, Webb et al () noted reduced intakes of many nutrients, including calcium, zinc, and vitamin A, among the highest consumers of snack foods/SSB, with these foods contributing 27% TEI on average. Among South African 1‐ to 3‐year‐olds, those in the highest quartile of added sugar consumption (based on % TEI) had lower intakes of calcium, iron, and zinc, as compared with toddlers with lower % TEI from added sugar (Maunder, Nel, Steyn, Kruger, & Labadarios, ). Five studies in this review (Anderson et al, ; Jeharsae et al, ; Karnopp et al, ; Lander et al, ; Rodríguez‐Ramírez et al, ) noted % TEI from snack foods/SSB of approximately 20% or higher among children below 23 months of age, suggesting levels of consumption that could contribute to micronutrient dilution.…”

Introduction of "Sugar Tax" in South Africa: Placebo or panacea to curb the onset of cardio-metabolic diseases?

“…(2) Dietary sugars are derived from a range of foodstuffs, but sugar-sweetened beverages (SSBs) that include sodas, fruit juices, energy drinks and sweetened milk drinks provide a significant proportion of added sugars. (1,3) This perspective article will briefly consider trends in SSB consumption, its association with the onset of obesity, diabetes and heart diseases and the potential of a "sugar tax" to curb the pandemic of cardio-metabolic diseases. tions.…”