Inequalities in the frequency of free sugars intake among Syrian 1-year-old infants: a cross-sectional study

BACKGROUND: High frequency of free sugars intake, during the first year of life is probably the greatest risk factor for early childhood caries. The latter is a global public health challenge. Very little is known about the social determinants of infant’s frequency of free sugars intake, particularly in low-income countries. Thus, the present study aimed to assess the association between the frequency of free sugars intake among 1-year-old Syrian infants and each of parents’ socioeconomic position (SEP), maternal frequency of free sugars intake and knowledge of infant’s oral health behaviour. METHODS: Using a cross-sectional design, 323 1-year-old infants, attending vaccination clinics in 3 maternal and child health centres (MCHCs) in Damascus, Syria, were selected. A systematic random sampling was applied using the MCHCs’ monthly vaccination registries. The 3 MCHCs were located in affluent, moderate and deprived areas. Infants’ mothers completed a structured questionnaire on socio-demographics, infant’s and mother’s frequency of free sugars intake from cariogenic foods and beverages, and mother’s knowledge about infant’s oral health behaviour. Binary and multiple regression analyses were performed. The level of significance was set at 5 %. RESULTS: The response rate was 100 %. Overall, 42.7 % of infants had high frequency of free sugars intake (>4times a day). Infants whose fathers were not working were more likely to have high frequency of free sugars intake. Similarly, infants whose mothers had low level of knowledge about infant’s oral health behaviour, or high frequency of free sugars intake were more likely to have high frequency of free sugars intake. The association between father’s occupation and infant’s frequency of free sugars intake attenuated after adjustment for mother’s knowledge and frequency of free sugars intake (adjusted OR = 1.5, 1.8, 3.2; 95%CI = 0.5–4.8, 1.1–3, 1.4–7.4; respectively). CONCLUSIONS: There are socioeconomic inequalities in the frequency of free sugars intake among Syrian 1-year-old infants. Integrated pre/post-natal interventions, targeting mothers from low SEP and aiming at reducing their free sugars intake and improving their knowledge about infant’s oral health behaviour, will potentially reduce socioeconomic inequalities in infant’s frequency of free sugars intake

Total free sugars, reducing sugars and glucose

Carbohydrates in the tissues of crustaceans exist as free sugars and as bound with proteins (Saravanan, 1979). The free sugars in haemolymph consist of mono, di and oligosaccharides. All monosaccharides, maltose and its oligosaccharides constitute the total reducing sugars. Trehalose constitutes the non-reducing sugar fraction of the total free sugars. The total free sugars are estimated by Anthrone method and reducing sugar by Nelson-Somogyi method. The difference in the values obtained by these two methods indicates total non-reducing sugar value which is primarily trehalose in crustacean blood. The glucose can be determined by Glucose-oxidase method. The difference between values of glucose and reducing sugars would indicate the concentration of non-glucose reducing sugars

Free sugars in spelt wholemeal and flour

Spelt (Triticum aestivum L. ssp. spelta) is experiencing a renaissance in Europe and North America, where it is used for baking, brewing, production of pasta, and self-supplied animal feed. One of the characteristics of spelt is that in comparison to modern wheat it is more resistant to harsh climatic and poor soil conditions. In contrast to wheat the hulls remain on the grain after threshing. Drawbacks are that spelt yields are quite low compared to modern wheat. The subject of the current study was to gain information about the composition of soluble sugars and their concentrations in spelt wholemeal and flour. High performance liquid chromatography (HPLC) was used for analysis. Concentrations of nine free sugars in spelt wholemeal and flour are reported. Flour cumulative free sugar concentrations were 63% lower than in wholemeal. For comparisons, we also analyzed wholemeal of wheat. The cumulative concentration of free sugars was 27% lower than in spelt wholemeal. However, when published data for sugar concentration ranges of wheat are taken into account, the total concentration of free sugar was not different between spelt and modern wheats. Low concentrations of xylose and stachyose were detected in spelt. Higher concentrations of fructans such as 1-kestose and kestotetraose were detected in spelt when compared with wheat. Generally, concentrations of free sugars in spelt were in the range of free sugar levels published for wheat, except for maltose which was higher in spelt

Tolerable upper intake level for dietary sugars

Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy‐related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well‐established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy‐related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50–75% probability), low for non‐alcoholic fatty liver disease and type 2 diabetes (> 15–50% probability) and very low for hypertension (0–15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations

Estimating Free Sugars Intake in New Zealand

Background: Sugar has been implicated as a cause or risk factor in a number of diseases. Recently the focus of research and recommendations have shifted to emphasise the potential importance of free or added sugars on health. In response to the literature which suggests a negative association between free sugars and health (particularly relating to dental caries) the World Health Organisation (WHO) updated their recommendations for intake of free sugars. Monitoring the extent to which populations are achieving these recommendations is difficult, primarily because free sugars are indistinguishable analytically from sugars inherent to a food. Thus, in the New Zealand (NZ) food composition database there is currently no nutrient information for free sugars and as a result, estimates have not been possible for free sugar intakes in NZ. Objective: The first objective of this research project was to update the current New Zealand Food composition database (NZFCD) to include estimates of free sugars for every food. The second objective was to estimate intakes of free sugars in NZ adults using data from the New Zealand Adult Nutrition Survey 2008/09 (NZANS 08/09), with the intention of comparing these intakes with international recommendations for free sugars, such as those set by WHO. Methods: Estimates of free sugars were created for each food record in the NZFCD, using a 10-step protocol. Intakes of free sugars in the NZANS 08/09 were estimated by matching free sugar estimates for each food item to the 24-hour recall data. Survey weighted estimates of free sugars intakes were calculated by age group, sex, and ethnicity. Usual intakes were estimated by adjusting for intra-individual variation using the Multiple Source Method (MSM). Population intakes were compared with the WHO recommendations for free sugars. Results: Free sugars content (g/100g) of 2779 foods were estimated. Estimates for 2543 were calculated by objective measures and the remaining 236 foods from subjective measures. Estimated median intake of free sugars in NZ adults was 57 g/day (57g, 95%CI: 55, 59) which equated to 11.1% of total energy (TE), this was significantly higher than sucrose (48g, 95%CI: 46, 50) and added sugar (49g, 95%CI: 47, 51). Intakes were highest among younger age groups. Young males (15-18 years) had the highest intake (89g/day), and young females had the highest by %TE. An estimated 57.8% of the total population are estimated to be exceeding the WHO recommendation that free sugars intakes should be <10%TE and 90.5% of the population are exceeding the recommendation that free sugars intake should <5% TE. Conclusions: This study offered valuable insight into the consumption of free sugars, improving the understanding of who may be at the greatest risk of poor health outcomes. It found that free sugar consumption of specific population groups (such as younger adults) was high in comparison with WHO recommendations, suggesting that public health strategies to reduce free sugars intakes would be strengthened by targeting younger adults. Updating the NZFCD to include free sugars will enable future research to investigate the relationships between consumption of free sugars and health outcomes, in a New Zealand setting

A review of recent evidence relating to sugars, insulin resistance and diabetes

The potential impact on health of diets rich in free sugars, and particularly fructose, is of major concern. The focus of this review is the impact of these sugars on insulin resistance and obesity, and the associated risk of developing type 2 diabetes. Much of the concern is focussed on specific metabolic effects of fructose, which are argued to lead to increased fat deposition in the liver and skeletal muscle with subsequent insulin resistance and increased risk of diabetes. However, much of the evidence underpinning these arguments is based on animal studies involving very large intakes of the free sugars. Recent human studies, in the past 5 years, provide a rather different picture, with a clear dose response link between fructose intake and metabolic changes. In particular, the most marked effects are observed when a high sugars intake is accompanied by an excess energy intake. This does not mean that a high intake of free sugars does not have any detrimental impact on health, but rather that such an effect seems more likely to be a result of the high sugars intake increasing the chances of an excessive energy intake rather than it leading to a direct detrimental effect on metabolism