Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years—Results from the EsNuPI Study

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One “Spanish Reference Sample” (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk and fortified and enriched milks, here called “Adapted Milk Consumers Sample” (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.

[1]  S. Stanner,et al.  Public health rationale for reducing sugar: Strategies and challenges , 2020 .

[2]  R. Leis,et al.  Energy Intake, Macronutrient Profile and Food Sources of Spanish Children Aged One to <10 Years—Results from the EsNuPI Study † , 2020, Nutrients.

[3]  M. Casas,et al.  Time Trends and Sociodemographic Factors Associated With Overweight and Obesity in Children and Adolescents in Spain , 2020, JAMA network open.

[4]  B. Amoutzopoulos,et al.  Free and Added Sugar Consumption and Adherence to Guidelines: The UK National Diet and Nutrition Survey (2014/15–2015/16) , 2020, Nutrients.

[5]  R. Leis,et al.  Dietary and Lifestyle Patterns in the Spanish Pediatric Population (One to <10 Years Old): Design, Protocol, and Methodology of the EsNuPI Study † , 2019, Nutrients.

[6]  C. Ogden,et al.  Added Sugars Intake among US Infants and Toddlers. , 2019, Journal of the Academy of Nutrition and Dietetics.

[7]  M. Severo,et al.  Total, added and free sugar intakes, dietary sources and determinants of consumption in Portugal: the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015–2016) , 2019, Public Health Nutrition.

[8]  S. Henauw,et al.  Dietary sources of free sugars in the diet of European children: the IDEFICS Study , 2019, European Journal of Nutrition.

[9]  R. Kruse,et al.  Socioeconomic Status and Other Factors Associated with Childhood Obesity , 2018, The Journal of the American Board of Family Medicine.

[10]  R. Ortega,et al.  Adequacy of usual macronutrient intake and macronutrient distribution in children and adolescents in Spain: A National Dietary Survey on the Child and Adolescent Population, ENALIA 2013–2014 , 2018, European Journal of Nutrition.

[11]  C. Mølgaard,et al.  Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition , 2017, Journal of pediatric gastroenterology and nutrition.

[12]  L. Serra-Majem,et al.  Dietary Intake of Individual (Free and Intrinsic) Sugars and Food Sources in the Spanish Population: Findings from the ANIBES Study , 2017, Nutrients.

[13]  L. Moreno,et al.  A review of total & added sugar intakes and dietary sources in Europe , 2017, Nutrition Journal.

[14]  E. Feskens,et al.  Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007–2010 , 2016, Nutrients.

[15]  V. Flood,et al.  Dietary intake and food sources of added sugar in the Australian population , 2016, British Journal of Nutrition.

[16]  J. Walton,et al.  A review of sugar consumption from nationally representative dietary surveys across the world , 2015, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[17]  W. Willett,et al.  Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. , 2013, The American journal of clinical nutrition.

[18]  E. Trolle,et al.  PANCAKE – Pilot study for the Assessment of Nutrient intake and food Consumption Among Kids in Europe , 2012 .

[19]  Efsa Panel on Dietetic Products Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre , 2010 .

[20]  R. Uauy,et al.  Obesity in children and young people: a crisis in public health. , 2004, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[21]  AE Black,et al.  Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations , 2000, International Journal of Obesity.

[22]  S A Jebb,et al.  Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. , 1991, European journal of clinical nutrition.

[23]  R. Marchelli,et al.  Enfamil® Premium and visual development - Scientific substantiation of a health claim related to Enfamil® Premium and visual development pursuant to Article14 of Regulation (EC) No 1924/2006[1]: Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies , 2009 .