Micronutrient dilution associated with added sugar intake in elderly black South African women

Abstract

Objectives: To investigate the association between added sugar and macronutrient and micronutrient intakes, and to assess whether added sugar intake is related to biochemical indices of nutritional status, Mini-Nutritional Assessment (MNA) score, body mass index (BMI) and performance on physical function tests. Design: A cross-sectional, analytical study. Setting and subjects: Convenient sample of 285 institutionalised and community-dwelling black South African men and women aged 60 þ y. Methods: An interviewer-administered 24-h dietary recall and MNA were performed. Serum albumin, vitamin B 12 , ferritin, cholesterol, haemoglobin, red blood cell (RBC) folate and plasma vitamin C were measured. Handgrip strength, BMI, 'sit-tostand' and 'get-up-and-go' tests were measured. Outcome variables were analysed according to tertiles of added sugar, in grams and as a percentage of total energy (% E). Results: In each tertile of sugar intake, mean MNA score fell in the 'at-risk' classification. In women, energy, protein, % E protein, fibre, thiamin, riboflavin, niacin, vitamin B6, folate, pantothenic acid, biotin, vitamin C, calcium, iron, magnesium, phosphorus, zinc, copper and selenium intake were significantly lowest in subjects in the highest % E sugar tertile. In men, no differences were found for micronutrient intake according to tertiles of total added sugar or % E added sugar. Physical function declined with increasing sugar intake, and suboptimal RBC folate and plasma ascorbic acid status was associated with increasing sugar intake (in women). No relationship was found between added sugar intake and the very high prevalence (65%) of obesity in women. Conclusion: A nutrient-diluting effect of added sugars intake was demonstrated in elderly black South African women. Further studies in this population are required in order to develop food-based dietary guidelines, which include messages on added sugar intake.

Measuring micronutrient intakes at different levels of sugar consumption in a population in transition: the Transition and Health during Urbanisation in South Africa (THUSA) study

“…[3][4][5] However, from the systematic reviews of Gibson 8 and Rennie and Livingstone 30 on the results of both observational and intervention studies, it appeared that the results were not necessarily linear or consistent across nutrients, populations and age groups; that quantification was hampered by differences in cut-offs to define categories of added sugar intake, ways of expressing sugar intake and methods of analyses.…”

“…These results concur with other studies that have investigated absolute intakes. [3][4][5] However, reported total energy intake is an important indicator of micronutrient intake, and in general, is significantly positively associated with micronutrient intakes. 24 Using the second approach to determine the dilution effect of added sugar (micronutrient intake per 4.18 MJ), a slight but significant nutrient dilution was found for thiamine, riboflavin, niacin, vitamin B 6 , magnesium, phosphorus and zinc in the men who consumed the most added sugar.…”

“…5 Although high sugar intake worsened the dietary quality of the women, energy intake was the factor that was most predictive of micronutrient intake. 5 It has been confirmed by other authors that energy intake is the major determinant of micronutrient adequacy. 6,7 The evidence to support the assumption that high added sugar intakes cause micronutrient dilution is inconclusive.…”

Added sugars: consumption and associated factors among adults and the elderly. São Paulo, Brazil

“…Of those investigating adults and elderly individuals, a study by Charlton et al 19 evaluating the diet of 285 African elderly individuals using a 24-hour food recall is noteworthy. These authors reported that the added sugar contribution to EI was 9.3% among men and 9.9% among women, which corroborates the findings in the present study.…”

Carbohydrate intake and obesity

“…Studies in children, adolescents and adults have reported that a high energy percentage of the diet as free sugars is associated with lower intakes of various micronutrients (Alexy et al, 2003;Charlton et al, 2005;Kranz et al, 2005). In addition, a high free-sugar content of the diet has been associated with lower intakes of fiber (Kranz et al, 2005) and fruit and vegetables (Charlton et al, 2005). Regular consumption of foods high in free sugars does not have to be associated with micronutrient deficiencies (Ruxton, 2003).…”