Added Sugars Consumption Decreased Iron and Zinc Intake among Children Aged 24-59 Months in Central Java
Konsumsi Gula Tambahan Menurunkan Asupan Zat Besi dan Seng pada Anak Usia 24-59 Bulan di Jawa Tengah
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Background: High sugar consumption was found among children in Indonesia. Excessive intake of added sugars was predicted to cause micronutrient dilution, a negative potential effect compromising micronutrient intake such as iron and zinc.
Objectives: This study examined the association between added sugar consumption and iron and zinc intake among children aged 24-59 months.
Methods: This study was a secondary data analysis of the 2014 Total Diet Study in Central Java Province. The subjects were 394 children aged 24-59 months. Dietary intake and sociodemographic data were assessed using the 24-hour food recall and household questionnaire. Added sugars consumption was classified into six cut-offs based on its contribution to daily energy (%E), namely: C1 (<5%E), C2 (5%E - <10%E), C3 (10%E - <15%E), C4 (15%E - <20%E), C5 (20%E - 25%E), and C6 (>25%E).
Results: 48% of subjects had added sugar intake exceeding the WHO recommendation. Subjects with iron and zinc intake below the Estimated Average Requirement (EAR) were 15.2% and 24.1%, respectively. As the added sugar consumption increased, iron and zinc intake decreased significantly (p<0.05). This study found a significant decrease in the intake of iron occurred at added sugar consumption ≥20%E (C5 and above) while decreasing the intake of zinc at added sugar consumption ≥15%E (C4 and above) (p<0,05).
Conclusions: Added sugar consumption had an inverse association with iron and zinc intake among children aged 24-59 months, which showed the occurrence of micronutrient dilution.
Kementerian Kesehatan RI. Laporan Nasional Riset Kesehatan Dasar Tahun 2018. (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2018).
Jati, I. R. A. P., Vadivel, V., Nohr, D. & Biesalski, H. K. Dietary Formulation to Overcome Micronutrient Deficiency Status in Indonesia. Nutr Food Sci 42, 362–370 (2012).
UNICEF. Improving Child Nutrition: The Achievable Imperative for Global Progress. Division of Communication, UNICEF (UNICEF, 2013). doi:978-92-806-4686-3.
Bailey, R. L., West Jr., K. P. & Black, R. E. The Epidemiology of Global Micronutrient Deficiencies. Ann Nutr Metab 66, 22–33 (2015).
Blaney, S., Februhartanty, J. & Sukotjo, S. Feeding Practices Among Indonesian Children Above Six Months of Age: A Literature Review on Their Magnitude and Quality (Part 1). Asia Pac J Clin Nutr 24, 16–27 (2015).
Kementerian PPN/Bappenas. Kajian Sektor Kesehatan Pembangunan Gizi di Indonesia. Kementerian PPN/Bappenas (Kementerian PPN/Bappenas, 2019).
Denney, L. et al. Nutrient Intakes and Food Sources of Filipino Infants, Toddlers and Young Children are Inadequate: Findings from the National Nutrition Survey 2013. Nutrients 10, 1730 (2018).
Medise, B. E. The Role of Iron for Supporting Children's Growth and Development. World Nutrition Journal 5, 16–21 (2021).
Berawi, K. N. et al. Decreasing Zinc Levels in Stunting Toddlers in Lampung Province, Indonesia. Biomedical and Pharmacology Journal 12, 239–243 (2019).
Brown, J. E. et al. Nutrition through the Life Cycle. (Wadsworth Cengage Learning, 2011).
Jati, I. R. A. P., Vadivel, V., Nöhr, D. & Biesalski, H. K. Nutrient density score of typical Indonesian foods and dietary formulation using linear programming. Public Health Nutr 15, (2012).
Usfar, A. A. & Fahmida, U. Do Indonesians follow its Dietary Guidelines? - evidence related to food consumption, healthy lifestyle, and nutritional status within the period 2000-2010. Asia Pac J Clin Nutr 20, 484–494 (2011).
Prawirohartono, E. P., Lestari, S. K., Nurani, N. & Sitaresmi, M. N. Difference in Nutrient Biomarkers Concentration by Habitual Intake of Milk among Preschool Children in an Urban Area of Indonesia. J Hum Nutr Food Sci 3, 1055 (2015).
Mok, A., Ahmad, R., Rangan, A. & Louie, J. C. Y. Intake of Free Sugars and Micronutrient Dilution in Australian Adults. Am J Clin Nutr 107, 94–104 (2018).
World Health Organization (WHO). Guideline: Sugars Intake for Adults and Children. (World Health Organization, 2015).
Drewnowski, A. & Fulgoni III, V. L. Nutrient Density: Principles and Evaluation Tools. Am J Clin Nutr 99, 1223S-1228S (2014).
Fujiwara, A., Okada, E., Okada, C., Matsumoto, M. & Takimoto, H. Association Between Free Sugar Intake and Nutrient Dilution Among Japanese Children and Adolescents: the 2016 National Health and Nutrition Survey, Japan. British Journal of Nutrition 125, 1394–1404 (2021).
Wong, T. H. T., Mok, A., Ahmad, R., Rangan, A. & Louie, J. C. Y. Intake of Free Sugar and Micronutrient Dilution in Australian Children and Adolescents. Eur J Nutr 58, 2485–2495 (2019).
Louie, J. C. Y. & Tapsell, L. C. Association Between Intake of Total vs Added Sugar on Diet Quality: A Systematic Review. Nutr Rev 73, 837–857 (2015).
Fulgoni III, V. L., Gaine, P. C., Scott, M. O., Ricciuto, L. & Difrancesco, L. Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009–2014. Nutrients 12, (2020).
Kant, A. K. Reported Consumption of Low-Nutrient-Density Foods by American Children and Adolescents. Arch Pediatr Adolesc Med 157, 789 (2003).
Webb, K. L. et al. Consumption of ‘extra' foods (energy-dense, nutrient-poor) among children aged 16-24 months from western Sydney, Australia. Public Health Nutr 9, 1035–1044 (2006).
Maunder, E. M. W., Nel, J. H., Steyn, N. P., Kruger, H. S. & Labadarios, D. Added Sugar, Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context. PLoS One 10, e0142059 (2015).
Overby, N. C., Lillegaard, I. T., Johansson, L. & Andersen, L. F. High Intake of Added Sugar Among Norwegian Children and Adolescents. Public Health Nutr 7, 285–293 (2004).
Ruottinen, S. et al. High Sucrose Intake is Associated with Poor Quality of Diet and Growth Between 13 Months and 9 Years of Age: The Special Turku Coronary Risk Factor Intervention Project. Pediatrics 121, (2008).
Gibson, S., Francis, L., Newens, K. & Livingstone, B. Associations Between Free Sugars and Nutrient Intakes Among Children and Adolescents in the UK. British Journal of Nutrition 116, 1265–1274 (2016).
Fujiwara, A., Okada, E., Okada, C., Matsumoto, M. & Takimoto, H. Association Between Free Sugars Intake and Nutrient Dilution Among Japanese Adults: the 2016 National Health and Nutrition Survey, Japan. Eur J Nutr 59, 3827–3839 (2020).
Livingstone, M. B. E. & Rennie, K. L. Added Sugars and Micronutrient Dilution. Obesity Reviews 10, 34–40 (2009).
Kementerian Kesehatan RI. Studi Diet Total: Survei Konsumsi Makanan Individu Indonesia 2014. (Lembaga Penerbitan Badang Litbangkes Kementerian Kesehatan RI, 2014).
Louie, J. C. Y. et al. A Systematic Methodology to Estimate Added Sugar Content of Foods. Eur J Clin Nutr 69, 154–161 (2015).
Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) (The National Academies Press, 2005). doi:10.17226/10490.
Drewnowski, A. Concept of a Nutritious Food: Toward a Nutrient Density Score. Am J Clin Nutr 82, 721–732 (2005).
Murphy, S. P. & Poos, M. I. Dietary Reference Intakes: Summary of Applications in Dietary Assessment. Public Health Nutr 5, 843–849 (2002).
Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (National Academies Press (US), 2001). doi:10.17226/10026.
Safitri, A., Jahari, A. B. & Ernawati, F. Konsumsi Makanan Penduduk Indonesia Ditinjau Dari Norma Gizi Seimbang (Food Consumption in Term of the Norm of Balanced Nutrition). Penelitian Gizi dan Makanan (The Journal of Nutrition and Food Research) 39, 87–94 (2017).
Atmarita et al. Consumption and Sources of Added Sugar in Indonesia: A Review. Asia Pac J Clin Nutr 27, 47–64 (2018).
Hawkes, C., Harris, J. & Gillespie, S. Changing Diets: Urbanization and the Nutrition Transition. in 2017 Global Food Policy Report 34–41 (International Food Policy Research Institute (IFPRI), 2017). doi:10.2499/9780896292529_04.
Nurwanti, E. et al. Rural-Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10-18-Year-Old Indonesian Children and Adolescents. Nutrients 11, (2019).
Low, Y. Q., Lacy, K. & Keast, R. The Role of Sweet Taste in Satiation and Satiety. Nutrients 6, 3431–3450 (2014).
de Macedo, I. C., de Freitas, J. S. & da Silva Torres, I. L. The Influence of Palatable Diets in Reward System Activation: A Mini Review. Adv Pharmacol Sci 2016, (2016).
Han, P., Bagenna, B. & Fu, M. The Sweet Taste Signalling Pathways in The Oral Cavity and The Gastrointestinal Tract Affect Human Appetite and Food Intake: A Review. Int J Food Sci Nutr 70, 125–135 (2019).
Almiron-Roig, E., Chen, Y. & Drewnowski, A. Liquid Calories and The Failure of Satiety: How Good is The Evidence? Obesity Reviews 4, 201–212 (2003).
Popkin, B. M. & Hawkes, C. The Sweetening of The Global Diet, Particularly Beverages: Patterns, Trends and Policy Responses for Diabetes Prevention. Lancet Diabetes Endocrinol 4, 174 (2016).
Rennie, K. L. & Livingstone, M. B. E. Associations Between Dietary Added Sugar Intake and Micronutrient Intake: A Systematic Review. British Journal of Nutrition 97, 832–841 (2007).
Gibson, S. A. Dietary Sugars Intake and Micronutrient Adequacy: A Systematic Review of The Evidence. Nutr Res Rev 20, 121–131 (2007).
Alexy, U., Sichert-Hellert, W. & Kersting, M. Fortification Masks Nutrient Dilution due to Added Sugars in the Diet of Children and Adolescents. J Nutr 132, 2785–2791 (2002).
Magriplis, E. et al. Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents " . Children 8, 1–14 (2021).
Mahan, L. K. & Raymond, J. L. Krause's Food & The Nutrition Care Process. Krause's Food & The Nutrition Care Process (Elsevier, 2017).
Biesalski, H. K. & Jana, T. Micronutrients in The Life Cycle: Requirements and Sufficient Supply. NFS Journal 11, 1–11 (2018).
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