An investigation of the sources and patterns of free sugars intake by younger people in India and Australia

Abstract

There are no reliable data on individual dietary behaviours and none on free sugars intake despite the triple nutrition burden in young Indian populations. The original research project aimed to quantify sugars intake and determine the sources and pattern of free sugars intake in 11-13-year-olds in Delhi and qualitatively study the barriers and facilitators to sugars reduction. Travel restrictions and school closures due to the pandemic affected this plan; qualitative study was abandoned. A secondary analysis of the data sourced from the Australian Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE) cohort was included to gain experience in the methods of analysis of dietary data. The aim was to identify intake, sources and determinants of free sugars by 5-year-old children. Results showed that 5-year-olds in the SMILE cohort obtained an average of 60% free sugars from three food groups - Cakes, Biscuits and Cereal Bars, Sweetened Yoghurts and Desserts. Experience gained in food group analysis, validation of energy intake and statistical methods (e.g. Multinomial logistic regression) were then applied to the primary doctoral study on sugars intake in India. Subsequent to ethics approval, a statistician external to the research team generated a random sample of 150 private schools stratified by 11 Delhi districts. Recruitment continued until 10 schools had consented. Teachers shared study information with parents who were invited to complete an online consent form; child assent was obtained before data collection. Participants recorded all food and drink consumed over three consecutive days, including one weekend day, in a food diary. Information recorded was entered into an online dietary assessment tool, Intake24 (South Asia Locale) during a researcher-participant interview; portion size was ascertained with reference to the Intake24 integrated food photographs. Intake24 converted food and drink reported into nutrient intake through integrated food compositional tables. A total of 514 pupils provided consent and 393 participants (76.5%) (169 Girls, 224 boys) completed the study. The median energy (E) intake was 11.6 (9.9- 14.1) MJ/day; percent E from fat was above the recommended range in nearly 75% participants with saturated fat contributing a median 16.3 (13.9 - 18.5) % E. Less than 40% girls achieved the India Estimated Average Requirement for iron intake. The median daily intake of free and total sugars were 48.0 (31.1 – 72.9) g and 98.0 (75.6 - 129.1) g respectively, contributing 7.1 (IQR 4.8-10.1) % and 14.9 (IQR 11.4-18.1) % E. The WHO recommended threshold to limit free sugars intake to <5% E was achieved by 27.2%. Sugar, Preserves and Syrups, Cakes and Biscuits and Desserts were the principal sources. More free sugars was consumed as snacks compared with meals (P<0.001) and intake was significantly lower on weekdays (P=0.01). The intake of free sugars as well as saturated fat was above the recommended thresholds, implying that this population is at risk of obesity and other diet-related conditions. These results are expected to underpin the next stages of research to address risk of unhealthy diet in young adolescents living in urban areas in India. Based on the findings, the forthcoming plans include research on a whole of school approach to reduce exposure of young adolescents to unhealthy diet, including restricting the sale of foods containing high-saturated fat, added salt and free sugars around schools.