Estado de las Políticas de regulación para el consumo de azúcar y para la comida chatarra en 3 países de América Latina

Introducción: El consumo de bebidas azucaradas y alimentos no saludables es un problema de Salud Pública y de las Políticas Públicas que buscan reducir el impacto de las Enfermedades No Trasmisibles (ENT) en América Latina. Objetivo: identificar las Políticas Públicas generadas en Colombia, Argentina y Chile para la regulación del consumo de azúcar y comida chatarra. Materiales y Métodos: Análisis exploratorio a través de una revisión de literatura y revisión de documentos normativos. Resultados: Colombia en el año 2021 sancionó la Ley 2120 denominada "Ley de Comida Chatarra", que promueve el acceso a información necesaria para fomentar entornos alimentarios saludables y prevenir las ENT, que incluye nuevas normas para el etiquetado de alimentos y describir sus características al consumidor y así limitar el consumo de alimentos procesados y ultraprocesados. Chile fue pionero en el desarrollo de los sellos de advertencia y desde el año 2014, aplica un impuesto adicional a las bebidas no alcohólicas. Argentina en 2021, sancionó la ley que obliga a la industria de alimentos a disponer de etiquetas en los envases que alerten al consumidor sobre los excesos de azúcares, grasas y sodio Conclusiones: Los tres países investigados cuentan con políticas de etiquetado de alimentos procesados, y en Chile existen impuestos a las bebidas azucaradas. Es importante estudiar el impacto de dichas políticas en la prevalencia y severidad de las ENT y de la caries.

Abstract: The consumption of sugar-sweetened beverages and unhealthy foods is a public health problem that has become a regulatory issue for the public policies aimed at reducing the impact of Non Communicable Diseases (NCDs) in Latin America. Objective: to identify the Public Policies in Colombia, Argentina and Chile for the regulation of the consumption of sugar and junk food. Materials and methods. Exploratory analysis through a literature and policy documents review. Results: In 2021, Colombia approved the Law 2120 called "Junk Food Law" promoting public access to information for a healthy food environment to prevent NCDs. It includes food labeling for overweight and obesity prevention and establishes a specific labeling regulation for processed and ultra-processed food and sweet drink products. Chile was pioneer in the development of warning stamps on food packages and since 2014 also taxes sweet non-alcoholic beverages. In 2021, Argentina approved a law to add labels on food packages to alert consumers about excess of sugars, fats and sodium. Conclusions: The three investigated countries have labeling policies for processed food, and Chile puts taxes on sugary drinks. It is important to study the impact of these policies on NCD prevalence, severity and on dental caries.

Trends in beverage consumption and contribution to total energy intake in the Philippines: 2008-2019

Background@#Unhealthy diet, including high consumption of beverages with added sugars, has been attributed to the increasing trend of overweight and obesity. @*Objectives@#This study explored the trend in beverage consumption and estimated the percent energy contribution of beverages to the total energy intake of selected population groups in the Philippines from 2008 to 2019. @*Methodology@#The proportions, mean intakes, and percentile distributions of energy intake from beverages of selected population groups in 2008, 2013, and 2018-2019 used in this study were estimated using the National Nutrition Surveys by the Food and Nutrition Research Institute. Two analyses were done for the energy intake from beverages: (1) beverages excluding milk and dairy products, and (2) all beverages. The energy intake from sugars and syrups was also noted. @*Results@#Results showed that the mean energy intake for beverages increased from 2008 to 2018-2019 for all age groups. The mean contribution of beverages to total energy intake, excluding milk and dairy products, was generally low but increased from 2008 to 2018-2019 with ranges from 2.3-3.7% and 2.8%-5.2%, respectively. However, high beverage consumers or those consuming ≥120 kcal per day, even excluding milk and dairy products, were observed in 6.3% of children 6 months to 5 years, 10.3% of children 6-12 years old, 16.1% of adolescents, 23.5% of adults, and 13.0% of pregnant women in 2018-2019. @*Conclusion@#Behavior change communication strategies are needed to prevent obesity and other lifestyle-related diseases, particularly in the population groups with a high consumption of caloric beverages.

Mobile application-based dietary sugar intake reduction intervention study according to the stages of behavior change in female college students / 한국영양학회지

PURPOSE: This study examined the effects of a mobile app-based program to reduce the dietary sugar intake according to the stages of the behavioral change in dietary sugar reduction in female college students. METHODS: The program used in this study can monitor the dietary sugar intake after recording the dietary intake and provide education message for the reduction of dietary sugar intake. In an eight-week pre-post intervention study, 68 female college students were instructed to record all the food they consumed daily and received weekly education information. At pre-post intervention, the subjects were asked to answer the questionnaire about sugar-related nutrition knowledge, sugar-intake behavior, and sugar-intake frequency. For statistical analysis, ANOVA and a paired t-test were used for comparative analysis according Precontemplation (PC), Contemplation ·Preparation (C ·P), and A ·M (Action ·Maintenance) stage. RESULTS: Significant differences were observed in the frequency of snacking, experience of nutrition education, and preference for sweetness according to the stages of behavior change in dietary sugar reduction. After finishing an intervention, the sugar-related nutrition knowledge score was increased significantly in the stages of Precontemplation (PC) and Contemplation ·Preparation (C ·P). The score of the sugar intake behavior increased significantly in all stages. The intake frequency of chocolate, muffins or cakes, and drinking yogurt decreased significantly in the PC stage and the intake frequency of biscuits, carbonated beverages, and fruit juice decreased significantly in the C ·P stage. Subjects in the PC and C ·P stages had an undesirable propensity in nutrition knowledge, sugar-intake behavior, and sugar-intake frequency compared to the A ·M stage, but this intervention improved significantly their nutrition knowledge, sugar-intake behavior, and sugar-intake frequency. CONCLUSION: This program can be an effective educational tool in the stages of PC and C ·P, and is expected to further increase the usability and sustainability of mobile application if supplemented appropriately to a health platform program.

Nutrition education discouraging sugar intake results in higher nutrient density in diets of pre-school children

BACKGROUND/OBJECTIVES: The intake of sugar has increased worldwide, and it is well established that childhood experiences and food preferences affect lifelong eating habits. To discourage sugar intake, nutrition education was imparted, and the effectiveness of the nutrition education program was investigated by considering the nutrient density and major dietary sources of sugar intake. SUBJECTS/METHODS: Twenty four-hour dietary recall and sugar intake frequency of 96 pre-school children (educated n = 47; non-educated n = 49) were collected on 3 consecutive days (1 weekend day, 2 weekdays) after 11 weeks of imparting nutrition education. Dietary intake of nutrients and total sugar were analyzed, and the intake frequency of sugar source foods were identified. All nutrition education programs were focused on a hands-on education program, and consisted of cooking lab, play, activity, animation, and visual materials. The difference between the two groups was verified by the Chi-square test or t-test. All statistical analysis was performed with significance level at P < 0.05. RESULTS: Compared to the non-educated group, the intakes of protein (P < 0.001), fiber (P < 0.01), potassium (P < 0.05), iron (P < 0.05), zinc (P < 0.05), and iodine (P < 0.001) were significantly higher, and the intakes of carbohydrate (P < 0.01) and total sugar (P < 0.05) were significantly lower in the educated group. The cumulative percent of sugar intake of top 20 sugar source foods in the educated group (82.80%) was lower than that of the non-educated group (85.75%). The contribution of beverages on total sugar intake was lower in the educated group. The average frequency of consuming sugary foods was significantly lower in the educated group (P < 0.05). CONCLUSIONS: Our results indicate that nutrition education on discouraging sugar intake is effective in reducing the amount of total sugar consumed, resulting higher nutrient density in the diets of pre-school children.

Sugar intake and metabolic syndrome among older adults in Peninsular Malaysia

@#Introduction: Sugar is widely consumed and excessive intake has been associated with increased risk of weight gain, diabetes mellitus and cardiovascular diseases, leading to metabolic syndrome (MetSyn). However, the association between sugar intake and MetSyn has seldom been studied among multi-ethnic Malaysian older adults. Methods: A total of 1,057 respondents aged ≥60 years were recruited through multistage random sampling from selected states. Anthropometric parameters, blood pressure, blood test for sugar and lipid profile were determined. Dietary intake was derived using a 7-day dietary history questionnaire (DHQ) and a semi-quantitative food frequency questionnaire (FFQ) for added sugar intake. Results: Prevalence of MetSyn was 39.9%, 30.9% and 42.2% using the harmonised definition, International Diabetes Federation (IDF) and National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII) definitions respectively. Mean total sugar intake was 40.5±32.0 g (8 tsp) and added sugar intake was 33.0±31.0 g (6 tsp). Excessive added sugar consumption at 100th percentile increased risks of high total cholesterol by two-fold (p<0.001) and triglyceride by 1.8 fold (p<0.001). Total sugar intake at 50th percentile increased risk of high blood pressure by 0.68 fold (p<0.05) and total sugar intake at 50th, 75th and 100th percentile increased total cholesterol risk by 1.7 fold (p<0.01), 1.5 fold (p<0.05) and 2.3 fold (p<0.001) respectively. Conclusion: Excessive sugar consumption among older adults showed no association with MetSyn but revealed significant associations with blood pressure and lipid profiles. Effects of long term excessive consumption of sugar on health outcomes in older persons should be investigated.

Study on Sugar Consumption of Adult Workers According to Smoking Status / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to investigate the smoking status among adult workers, and current status of sugar intake. METHODS: The survey included 500 men working in Gyeonggi-do from October to November in 2016. Questionnaire items covered their age, working status, smoking status, eating habits, eating behaviors, snack consumption status, habits and behaviors related to sugar intake. All data were analyzed by SPSS program (Ver. 23) and descriptive statistics was performed; a t-test, χ² test, One-way ANOVA and Scheffe test were used for post-hoc test. RESULTS: The study results showed that eating habits and behaviors of non-smokers were better than those of smokers. The frequency of daily snack consumption was the highest in smokers compared to and non-smokers. The smokers' favorite taste after smoking was ‘Sweet’. The average score of sugar-related nutrition knowledge was higher in non-smokers compared to smokers. Non-smokers had better recognition of ‘sugar reduction’, and smokers were more likely to eat sweet foods, respectively. On the other hand, non-smokers could observe that they were trying to control themselves for health reasons. According to the results of the study, non-smokers showed better eating habits and dietary habits and consumed less sugar. Also, it was found that non-smokers tried to drink more water than beverages and refrain from eating sweets to reduce their sugar intake. Further, the most of the bread, coffee and beverages were also consumed at a lower frequency by non-smokers compared to smokers. CONCLUSIONS: This study results showed that smoking and sugar consumption were closely related. Therefore, adult workers should actively promote and learn so that they can maintain healthy and suitable dietary habits through reduction of sugar consumption.

High School Students' Sugar Intake Behaviors and Consumption of Sugary Processed Food Based on the Level of Sugar-related Nutrition Knowledge in Seoul Area / 대한지역사회영양학회지

OBJECTIVES: The present study aimed to investigate high school students' sugar intake behaviors, the status of consuming sugary processed foods, the awareness of sugar, and the experience and interest in sugar-related education based on the level of sugar-related nutrition knowledge. METHODS: In this study, five high schools were selected in Seoul, Korea, and a survey was conducted in 400 students on the level of sugar-related nutrition knowledge and sugar intake status. A total of 349 questionnaires were used for the final analysis. For statistical analysis, descriptive statistics was performed; a t-test, χ2 test, and Friedman test were used for comparative analysis. RESULTS: The study results showed a positive association between the knowledge level of sugar and the appropriate sugar intake behavior and sugary food choices. The group with more nutrition knowledge on sugar was found to have good eating habits and to eat less sugary food. The main sources of sugar were beverages, confectionary, and bakery goods in the corresponding order, irrespective of the level of nutrition knowledge related to sugar. A significant difference was found in the groups' awareness of the sugar content of the drinks with 89.4% for the higher-knowledge group, and only 81.5% for the lower-knowledge group (p < 0.05). Results also showed that 43.9% of the higher-knowledge group and 36.4% of the lower knowledge group were interested in participating in education on sugar. CONCLUSIONS: This study result indicated the need to help adolescents to avoid excessive sugar intake from only certain favorite foods. Therefore, it is necessary to seek a systematic foundation for participatory education in order for them to maintain a low sugar intake in daily life and lead healthy eating habits by increasing their level of sugar-related information and knowledge.

Evaluation of a Nutrition Education Program Designed to Reduce Sugar Intake in Preschool Children

The purpose of this study was to evaluate a nutrition education program designed to reduce sugar intake in preschool children. The nutritional knowledge, dietary attitude, dietary behavior, and food intake with a sweet taste in preschool children were tested before and after 4 weeks of nutrition education from March 8 to April 1, 2016. The preschool children were recruited in Dobong-gu, Seoul. The subjects were divided into two groups; educated (N=59) and non-educated group (N=40). Statistical analyseis were performed using SPSS 22. The nutritional knowledge about sweet tasting food was significantly increased (Psweetened breads>cookies/biscuits>chocolate>cereals>beverages>sweetened milk>sweet spicy chicken>Tteokbokki. Although there are some limitations in this study, due to the short length of the nutrition education and lack of active participation by the parents, the results suggest that effective nutrition education on sweet tasting food can bring about changes in nutritional knowledge as well as dietary attitude.

The Effects of industrial workers' food choice attribute on sugar intake pattern and job satisfaction with Structural Equcation Model

BACKGROUND/OBJECTIVES: This research analyzes the effects of the food choices of industrial workers according to their sugar intake pattern on their job satisfaction through the construction of a model on the relationship between sugar intake pattern and job satisfaction. SUBJECTS/METHODS: Surveys were collected from May to July 2015. A statistical analysis of the 775 surveys from Kyungsangnam-do was conducted using SPSS13.0 for Windows and SEM was performed using the AMOS 5.0 statistics package. RESULTS: The reliability of the data was confirmed by an exploratory factor analysis through a Cronbach's alpha coefficient, and the measurement model was proven to be appropriate by a confirmatory factor analysis in conjunction with AMOS. The results of factor analysis on food choice, sugar intake pattern and job satisfaction were categorized into five categories. The reliability of these findings was supported by a Cronbach's alpha coefficient of 0.6 and higher for all factors except confection (0.516) and dairy products (0.570). The multicollinearity results did not indicate a problem between the variables since the highest correlation coefficient was 0.494 (P < 0.01). In an attempt to study the sugar intake pattern in accordance with the food choices and job satisfaction of industrial workers, a structural equation model was constructed and analyzed. CONCLUSIONS: All tests confirmed that the model satisfied the recommended levels for the goodness of fit index, and thus, the overall research model was proven to be appropriate.

Associations of Obesity and Dyslipidemia with Intake of Sodium, Fat, and Sugar among Koreans: a Qualitative Systematic Review

A qualitative systematic review was performed to identify associations of obesity and dyslipidemia with intake of sodium, fat, and sugar among Koreans. We reviewed 6 Korean research databases (KMbase, KoreaMed, NDSL, DBpia, RISS, KISS) with the keywords “sodium intake,”“fat intake,” and “sugar intake.” Total of 11 studies were investigated in this present study. Of these articles, 7 studies were related to sodium intake, 2 studies had a relation to fat intake, and 2 studies were associated with sugar intake. We indicated general characteristics, concentration of serum lipids, nutrition intake, and statistically significant results. High sodium intake contributed to increased etiology of hypertriglyceridemia, high-density lipoprotein (HDL) hypocholesterolemia, and a risk of being overweight. Fat intake was significantly associated with body fat, low-density lipoprotein (LDL) hypercholesterolemia, and HDL hypocholesterolemia. Sugar intake from coffee drinks and sugar-sweetened beverages contributed to increased HDL hypocholesterolemia and continuous metabolic syndrome score. This qualitative review among Koreans represented that intake of sodium, fat, and sugar has a positive relationship with cause of obesity-related diseases. Especially, this present study has a great significance in terms of considered study that intake of the potentially hazardous nutrients among Koreans has an association with obesity and dyslipidemia. However, further studies such as randomized controlled trials on associations between sodium, fat, and sugar and obesity and dyslipidemia need to be continuously required in order to conduct quantitative systematic reviews and a meta-analysis for Koreans.

A study of total sugar intake by middle school students in Jeju Province / 한국영양학회지

PURPOSE: The aim of this study was to estimate total sugar intake and sugar intake-related dietary habit and nutrient intake of middle school students. METHODS: Subjects included 1,184 middle school students (476 males and 708 females) residing in Jeju. This research analyzed daily dietary intakes of subjects using the 24 hour recall method and surveyed the dietary habit related to total sugar intake using questionnaires. Descriptive analysis, chi-square test, t-test, and ANOVA, using the SAS program were used for analysis of data. RESULTS: The average daily total sugar intake was 60.3 g (male 50.5 g, female 66.9 g). Total sugar intake per meal was 6.5 g (10.8%) from breakfast, 9.0 g (14.9%) from lunch, 11.8 g (19.6%) from dinner, and 33.0 g (54.7%) from snacks. Food groups that contribute to the majority of total sugar intake were grains and their products (23.0 g), milk (11.0 g), fruits and their products (7.3 g), sugars and sweets (6.1 g), and vegetables and their products (5.8 g). In terms of total sugar intakes by cooking methods, desserts showed a greater amount than main and side dishes, and indicated in order of amount as follows: bread and cookies (11.5 g), dairy products (7.5 g), ice cakes (6.2 g), beverages (5.3 g), and fruits (4.5 g). Total sugar consumption was high for rice and side dishes such as noodles (10.2 g), fried foods (2.9 g), stir-fried foods (2.0 g), and cooked rice with seasoning (1.7 g). The daily intake of natural sugar, added sugar, and natural and added sugar was 18.3 g, 35.8 g, and 6.2 g, respectively. The high sugar intake group, which was over 20% of the energy from total sugar intakes, consumed significantly less Fe, Zn, vitamin B6, niacin, and vitamin E than the low sugar intake group, which was below 20%. CONCLUSION: Total sugar intake of second graders of middle schools on Jeju Island was 60.3 g/day, mostly obtained from snacks (54.7%). Therefore, nutritional education for proper selection of better snacks and for reduction of dietary sugar intake is needed for middle school students.

A study of dietary intake of total sugars by elementary students in Jeju province / 한국영양학회지

PURPOSE: The aim of this study was to estimate total sugar intake and sugar intake-related dietary habit and nutrient intake of elementary school students. METHODS: Subjects included 701 elementary school students (351 boys and 350 girls) residing in Jeju. The research analyzed a sample and was carried out using the 24 hour recall method and one day consumption of total sugar. RESULTS: The average daily total sugar intake was 55.3 g (male 53.1 g, female 57.6 g). Total sugar intake per meal was 6.3 g (11.4%) from breakfast, 6.9 g (12.5%) from lunch, and 7.2 g (13.0%) from dinner, 34.9 g (63.1%). Major food groups of total sugar were milks (17.04 g), grains and their products (12.79 g), fruits and their products (9.40 g), and sugars and sweets (7.30 g). In analysis of the amount of total sugar consumption from several recipes, much was taken in from dessert and snacks such as dairy products (15.08 g), bread and snacks (6.4 g), beverages (5.5 g), fruits (5.1 g), and ice cakes (4.8 g). Total sugar consumption was high for rices and side dishes such as noodles (5.1 g), stir-fried foods (2.3 g), fried foods (1.4 g), cooked rice with seasoning (1.4 g), and hard-boiled foods (1.1 g). In comparison of total sugar consumption for sugar sources, daily intake of natural sugar, added sugar, and natural and added sugar were 25.8 g, 23.3 g, and 6.2 g, respectively. High sugar intake group, which was over 20% of the energy from total sugar intakes, consumed significantly less Fe, Zn, and niacin than the low sugar intake group, which was below 20%. CONCLUSION: Total sugar intake of fifth graders of elementary schools on Jeju Island was 55.4 g/day, and it was usually intake from snacks. Therefore, elementary school students need nutritional education for proper selection of better snacks and for reduction of dietary sugar intake.

Dietary total sugar intake of Koreans: Based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011 / 한국영양학회지

PURPOSE: The aim of this study is to estimate total sugar intake and identify major food sources of total sugar intake in the diet of the Korean population. METHODS: Dietary intake data of 33,745 subjects aged one year and over from the KNHANES 2008-2011 were used in the analysis. Information on dietary intake was obtained by one day 24-hour recall method in KNHANES. A database for total sugar content of foods reported in the KNHANES was established using Release 25 of the U.S. Department of Agriculture National Nutrient Database for Standard Reference, a total sugar database from the Ministry of Food and Drug Safety, and information from nutrition labeling of processed foods. With this database, total sugar intake of each subject was estimated from dietary intake data using SAS. RESULTS: Mean total sugar intake of Koreans was 61.4 g/person/day, corresponding to 12.8% of total daily energy intake. More than half of this amount (35.0 g/day, 7.1% of daily energy intake) was from processed foods. The top five processed food sources of total sugar intake for Koreans were granulated sugar, carbonated beverages, coffee, breads, and fruit and vegetable drinks. Compared to other age groups, total sugar intake of adolescents and young adults was much higher (12 to 18 yrs, 69.6 g/day and 19 to 29 yrs, 68.4 g/day) with higher beverage intake that beverage-driven sugar amounted up to 25% of total sugar intake. CONCLUSION: This study revealed that more elaborated and customized measures are needed for control of sugar intake of different subpopulation groups, even though current total sugar intake of Koreans was within the range (10-20% of daily energy intake) recommended by Dietary Reference Intakes for Koreans. In addition, development of a more reliable database on total sugar and added sugar content of foods commonly consumed by Koreans is warranted.

Studies Examining Whether Sugar Added to Foods Changes Body Weight: Is a Sweet Solution Out There.

This review re-examines the studies relating sugar consumption to development of overweight or obesity as identified for the recent revision of the Australian Dietary Guidelines. All studies identified for the initial evidence review that examined sugars added to foods (one systematic review, three randomised controlled trials, one retrospective cohort study) were re-examined for biases, methodological flaws, and potential confounders that may have affected outcome or quality rating. While the initial evidence review itself followed rigorous methods, methodological issues were evident among primary studies, including short duration of interventions, difficulties with estimating total sugar intake and distinguishing natural versus added sugars, overlooking effects of the food matrix and metabolic differences between glucose and fructose. Few studies examined isocaloric interventions and some introduced concurrent interventions confounding the effect of sugar. Most (71%) of the included studies were funded by the food industry. More high quality, well-controlled longitudinal studies are yet required to support public health messages relating to sugar added to foods and the risk of weight gain.

Relationship between Total Sugar Intake and Obesity Indices in Female Collegians

This study investigated the relationship between total sugar intake and obesity indices in 362 female university students. This study was conducted using an anthropometric checkup and 3-day dietary records. Subjects were categorized according to the total sugar intake as or = 83.8 g (group IV, n = 90). No significant differences in age, weight, height, body mass index (BMI), or the percentage of body fat were observed among the four groups. Based on BMI, 20.2% were overweight, and the percentage of body fat was > 30% in 67.1% of all students sampled. Energy intake in each groups was 1,164.7 kcal, 1,488.6 kcal, 1,590.0 kcal, and 1795.8 kcal, respectively (p < 0.001). Total sugar intake in the groups was 20.5 g, 44.6 g, 68.3 g, and 111.8 g, respectively (p < 0.001). Carbonated beverages were identified as the most significant food source for total sugar intake in female university students. The next major foods were ice cream, milk, coffee, fruit, sugar, cookies, bread, chocolate, corn syrup, rice, onion, maple syrup, pickle, and sweet potato. As intake of total sugar increased, intake of energy also increased significantly. Mean daily intakes of fat and calcium/1,000 kcal were significantly higher in group IV than those in the other groups. Mean daily intakes of vitamin C and vitamin E/1,000 kcal were significantly higher in group III than those in the other groups. The percentage of subjects who consumed nutrients below the estimated average requirement was less in the higher total sugar intake group than that in the lower intake group. The obesity indices (weight, BMI, % body fat) were not associated with total sugar intake in the subjects. We conclude that total sugar intake does not seem to influence obesity indices in female university students.