Spanish children consume more than twice as much added sugar per day as recommended by the World Health Organization (WHO): 55,7 grams/day, well above the maximum of 25 grams/day recommended by the WHO. This is clear from an observational study carried out by researchers from the Biosanitary Research Institute of Granada (ibs.GRANADA) and the 'José Mataix Verdú' Institute of Nutrition and Food Technology, of the University of Granada, which has been published in the american magazine Nutrients and whose results have been presented this morning.
Thus, the work "Consumption of added sugar in Spanish children (7-12 years) and nutrient density of foods that contribute to said consumption: an observational study" concludes that it is necessary to review the diet of minors to favor the presence of foods with greater nutritional density and less contribution of added sugars, as well as persevering in the strategy of reformulation of products by the food industry.
This observational study has had the participation of 1775 parents with children between 7 and 12 years old through a survey distributed online and has been led by Jesús Francisco Rodríguez Huertas, professor of Physiology at the UGR. Also participating in it were María Dolores Mesa-García, professor at the Department of Biochemistry and Molecular Biology of the UGR, member of the Biosanitary Research Institute of Granada (ibs.GRANADA) and member of the Ricors Network of the Carlos III Health Institute Red SAMID (Maternal and Child Health and Development), and Marta Palma Morales, researcher at the 'José Mataix Verdú' Institute of Nutrition and Food Technology and the Biomedical Research Center of the University of Granada.
The figures for childhood obesity continue to increase year after year worldwide, with a prevalence of overweight and obesity in the child population of 23,3% and 17% respectively. A diet rich in free sugars is associated with an increased risk of obesity, metabolic syndrome, and cardiovascular disease.
The authors built an index to assess the nutritional value of the foods under study, reflecting the nutrient density present in each serving of each food (NDIS), and a daily nutrient intake index (DNII), calculated based on the daily amount consumed of each food.
65% of added sugar comes from foods with low nutritional density
According to the results, 65% of the added sugars consumed daily by Spanish children come from foods and/or products with low nutritional density: white sugar, jams, sauces, sweets, cocoa powder, soft drinks, ice cream, cookies , fruit nectars, industrial pastries and pastries, chocolate bars, biscuits and homemade pastries, energy and/or sports drinks.
The other 35% of the added sugars consumed daily by Spanish children comes, on the contrary, from foods and/or products with a higher nutritional density. Medium density, dairy desserts, vegetable drinks and sweetened or flavored yogurts; and high-density, packaged shakes with at least 90% milk, breakfast cereals, and fortified infant formulas.
According to the data from the study and the NDIS index, milk is the food most consumed by Spanish children and has a very high nutritional density – only bettered by enriched infant milk, which is the food with the highest contribution of essential nutrients per serving. -. Milk provides proteins of high biological value, calcium, phosphorus, magnesium, potassium, zinc, vitamin A, riboflavin and niacin, essential nutrients for their stage of development and growth.
In the case of breakfast cereals, they obtain a high nutritional value and contribute 5,9% of the added sugars consumed each day (3,3 g/day). The same occurs with shakes with at least 90% milk, which also provide these nutrients in similar amounts with the difference that they contain added sugars -they provide 6% of the added sugars consumed each day (3,4 g / day)-, so they could be maintained in the diet, since they have a high nutritional density index, as long as there is a global consumption of added sugars below the recommendations established by the WHO.
On the contrary, cookies and cocoa powder, which contain more than 10,3g/serving and 7,3g/serving of added sugars respectively, are consumed very frequently (between 4 and 6 times a week) and, Consequently, they are the two foods that contribute the greatest amount of added sugar each day to the diet of Spanish children. However, both foods do not contribute significantly to the supply of essential nutrients due to their low nutritional density.
Parental misperceptions
The study reveals that not all parents have a clear vision of the nutritional profile of the food their children consume. In fact, it is significant that products that provide a high amount of added sugar per serving (above 15 g / serving) and that have low nutritional density (<1,5 on the NDIS index), in the case of energy or sports drinks , chocolate bars, fruit nectars, cocoa powder or ice cream, are perceived by parents as having a normal nutritional quality, equivalent to that given to other foods with a low content of added sugars and high nutritional density, such as fortified infant formulas, vegetable drinks, breakfast cereals or shakes with at least 90% milk.
The case of biscuits and homemade pastries is particularly striking, which parents value as having a good nutritional profile, equivalent to that of fortified infant milk or vegetable drinks, when they provide 17 g of added sugar per serving and have a low index. nutritional density. Or that of cookies, widely consumed by the majority of children, which are perceived positively, despite providing more than 10 g of added sugar per serving.
Enriched infant milks are the category with the highest nutritional density of those analyzed -double that of basic milk in the nutrient contribution rate-, providing a low amount of added sugars (<5 g per serving), therefore they represent an opportunity potential for improving the dietary pattern of children, considering the intake deficits of some essential nutrients, which have been revealed by recent studies such as ESNUPI.
Proposals to reduce the consumption of added sugars
One of the main conclusions of this work is that the nutritional value of a food should not be evaluated only based on the sugar it contains, but the rest of the nutrients that it can contribute to the diet must be considered, that is, its nutritional density. “The population must be made aware to reduce the consumption of all products that contain added sugars, primarily those with low nutritional quality. In the context of a healthy and nutritionally adequate diet, occasional consumption (1-2 servings/week) of products with low nutritional quality could be maintained, as long as the added sugar content is low or moderate", says Jesús Francisco Rodríguez Huertas. , studio manager. On the other hand, he adds, "a lower presence in the diet of products that are providing significant amounts of added sugars should be encouraged in favor of other similar or equivalent ones without added sugars, for example natural yogurt instead of sweetened or flavored yogurt ; the reformulation of products that provide added sugars and that are highly consumed; and the improvement of nutritional labeling, which should offer more information on the real contribution of added sugars and minimize confusion with naturally present sugars”.
On the other hand, according to the authors of the study, the reality of the nutritional value of food does not correspond to the perception of parents since when choosing a product they focus above all on its sugar content. Thus, "nutritional education campaigns aimed at both parents and children are necessary to make them aware that the quality of a food should not be evaluated only by the sugar it contains, but that other basic nutrients that contribute to promoting a healthy diet should also be considered." and balanced”, explains Rodríguez Huertas.
Similarity with previous results
The results of this study have revealed that Spanish children consume a high amount of added sugars, 55,7 g/day. In the ESNUPI study, the total consumption of added sugars in Spanish children between 6 and 10 years old was 41,4 g/day for boys and 35,9 g/day for girls. The ANIBES study reported an intake of 48,6 g/day of added sugars in Spanish children from 9 to 12 years of age. Although these studies differ in the methodology used to quantify sugar intake, the age of the children, and the formula used to calculate the amount of added sugars in foods, the results consistently show that children's added sugar intake Spanish is above the recommendations and highlights the need for sugar reduction strategies.
Regarding the main sources of added sugars, this study shows cookies, cocoa powder, sweetened yoghurts and dairy desserts as the foods that contribute the most to intake. These results are in line with those recently published from the ESNUPI study, where added sugars to children's diets (1-9 years) came mainly from yoghurts, pastries/pastry and sugars/sweets. Five years earlier, the ANIBES study also showed that chocolates, soft drinks, pastries/pastries, flavored yogurts, and other sweetened dairy products were the main sources of added sugars in the diet of Spanish children aged 9 to 12 years.
Methodology: Indices that evaluate the nutritional density of foods and their impact on the diet
The study, which included a sample of 1.775 adults with children between the ages of 7 and 12, had the objective of estimating the intake of added sugars and analyzing the nutritional density of the foods that these sugars contribute to the diet of minors. The results have made it possible to know the pattern of consumption of foods with added sugars in children, through a questionnaire on frequency of food consumption and perception of nutritional quality addressed to parents. An estimate of the usual portions was made using the photographic guide of food portions consumed in Spain and to determine the composition of the food, the Spanish Food Composition Database (BEDCA) was used. To estimate the added sugar content, data reported by various companies, nutritional labeling data and even analysis results from certified laboratories were used.
The authors built an index to assess the nutritional quality of the foods under study, reflecting the nutrient density present in each serving of each food (NDIS), and a daily nutrient intake index (DNII), calculated based on the daily amount consumed of each food. The NDIS index of each product was calculated by adding the ratios between the content of each nutrient per serving and the reference values established by the European Food Safety Authority (EFSA) for the pediatric population. The DNII was calculated by adding the ratios between the average daily intake of each nutrient and the reference values established by EFSA for the pediatric population.
The reference values for children that have been taken into account are: the established mean values of energy requirement (RA) for total energy; the reference intake (RI) ranges for carbohydrates, fiber, and fat; recommended dietary intakes for protein; the population reference intakes for vitamins and minerals, folate, niacin, riboflavin, thiamine, vitamin A, vitamin B6, vitamin C, calcium, iron, and zinc; and adequate intakes (AIs) for α-tocopherol, vitamin B12, and vitamin D, and the minerals magnesium, phosphorus, potassium, and selenium.
To classify foods according to their NDIS, the authors considered milk as a reference quality food, with a calculated NDIS of 3, since it provides a significant amount of nutrients without containing added sugars. Therefore, foods with an NDIS close to that of milk (NDIS > 2,5) were considered to be of high nutritional value. Foods with an NDIS between 1,5 and 2,5 were considered medium nutrient dense, and foods with an NDIS less than 1,5 were considered low nutrient dense.
Regarding the content of added sugars, products with a low added sugar content were considered those with less than 5 g per serving, moderate content of added sugars those with 5-10 g per serving, high content of added sugars those with 10-15 g per serving, and those with more than 15 g per serving have a very high added sugar content.
The previously described indices were also calculated, which evaluate the quality of food, such as the SAIN (Score of Nutritional Adequacy of Individual Foods) which considers the content of protein, fiber, iron, calcium and vitamin C, and the LIM (Nutrient to be limited) which considers unhealthy nutrients: sodium, added sugars and saturated fatty acids. A food with a SAIN index > 5 is considered to have good nutritional density. A food with a LIM index >7,50 is considered rich in nutrients that are harmful to health.
Bibliographic reference:
Added Sugar Consumption in Spanish Children (7–12 y) and Nutrient Density of Foods Contributing to Such Consumption: An Observational Study
Marta Palma-Morales, María Dolores Mesa-García and Jesús R. Huertas
Nutrients 2023, 15(3), 560
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