Added Sugars and Low- and No-Calorie Sweeteners in a Representative Sample of Food Products Consumed by the Spanish ANIBES Study Population (Part 3 of 5)

  1. Results

Abstract: Low- and no-calorie sweeteners (LNCS), intensely sweet compounds that virtually contain no calories, are used to replace added sugars in food and drinks. Knowledge about different LNCS data in Spanish foods and added sugar sources in Spain is limited, therefore our aim was to identify and compare their presence across main food groups consumed. Food and beverage products (n = 434) were obtained from the ANIBES Study (anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles), a cross-sectional study of a representative sample of the Spanish population (9–75 years old; n = 2009) carried out in 2013. Food records were obtained from a three-day dietary record using a tablet device. Label data from 1,164 products of different brands were collected and reviewed for content of added sugars and LNCS. LNCS were present in diet soft drinks (100%), “other sweets” (89%), soya drinks (45%), and yogurt and fermented milks (18%). Added sugars were present mainly in sugar soft drinks (100%), energy drinks (96%), sports drinks (96%), bakery and pastry (100%), chocolates (100%), ice cream (100%), breakfast cereals/bars (96%) and jams (89%). Main LNCS were acesulfame K, aspartame, cyclamate and sucralose. Sucrose, dextrose, glucose-fructose syrup, caramel and honey were the main added sugars. Our results show the diversity of foods groups including these ingredients. These data are not compiled in food composition databases, which should be periodically updated to include LNCS and added sugars to facilitate their assessment and monitoring in nutritional surveys.

 

The statistical description of the ANIBES sample population sample is included in Table 1. A total of 434 products were identified from consumption of participants of the ANIBES Study, and by including different brands (traditional vs. distribution), we compiled 1164 foods and beverages (3037 photographs).

 

 

Table 1. Statistical description of the sample ANIBES (Modified from Nissensohn et al., 2016 [27]).

Table 1. Statistical description of the sample ANIBES (Modified from Nissensohn et al., 2016 [27]).

  Total % Male % Female %
2007 100 1011 50.4 996 49.6
Age Group 9–12 100 5 62 6.1 38 3.8
13–17 123 6.1 84 8.3 39 3.9
18–39 777 38.7 387 38.3 390 39.2
40–64 810 40.4 385 38.1 425 42.7
65–75 197 9.8 93 9.2 104 10.4
Level of education Primary or less 743 37 378 37.4 365 36.6
Secondary 858 42.8 434 42.9 424 42.6
Tertiary or University 406 20.2 199 19.7 207 20.8
Economical level 1000 € or less 397 19.8 191 18.9 206 20.7
From 1000 to 2000 € 795 39.6 393 38.9 402 40.4
Over 2000 € 320 15.9 163 16.1 157 15.8
No income 7 0.3 4 0.4 3 0.3
No answer 488 24.3 260 25.7 228 22.9
Geographical distribution Northwest 152 7.6 77 7.6 75 7.5
North Central 161 8 79 7.8 82 8.2

 

 

From analyzed brands, 42% of products included some type of added sugars and 10% contained LNCS in their composition. Only 5.1% of the products had added sugars and LNCS declared on their labels. Table 2 shows the distribution of presence (%) of added sugars and LNCS in each of the food groups consumed.

 

 

Table 2. Presence of added sugars and low- and no-calorie sweeteners (LNCS) across the food groups consumed in the ANIBES Study.

 

Table 2. Presence of added sugars and low- and no-calorie sweeteners (LNCS) across the food groups consumed in the ANIBES Study.

Food Groups Presence of Added Sugars Presence of LNCS Presence of Added Sugars and LNCS
No Yes No Yes  
Appetizers (n = 19) n = 15; 79% n = 4; 21% n = 18; 95% n = 1; 5% n = 1; 5%
Sugars and sweets (n = 75) n = 12; 16% n = 63; 84% n = 64; 85% n = 11; 15% n = 1; 1%
Low alcohol content beverages (n = 52) n = 22; 71% n = 9; 29% n = 27; 87% n = 4; 13% n = 2; 6%
Non-alcoholic beverages (n = 148) n = 94; 64% n = 54; 36% n = 90; 61% n = 58; 39% n = 22; 15%
Meat and meat products (n = 92) n = 52; 57% n = 40; 43% n = 89; 97% n = 3; 3% n = 3; 3%
Cereals/grains (n = 241) n = 87; 36% n = 154; 64% n = 230; 95% n = 11; 5% n = 11; 5%
Fruits (n = 83) n = 79; 95% n = 4; 5% n = 83; 100% n = 0; 0% n = 0; 0%
Eggs (n = 8) n = 8; 100% n = 0; 0% n = 8; 100% n = 0; 0% n = 0; 0%
Milk and dairy products (n = 299) n = 135; 45% n = 164; 55% n = 262; 88% n = 37; 12% n = 24; 8%
Pulses (n = 23) n = 20; 87% n = 3; 13% n = 23; 100% n = 0; 0% n = 0; 0%
Fish and shellfish (n = 96) n = 95; 99% n = 1; 1% n = 96; 100% n = 0; 0% n = 0; 0%
Ready-to-eat meals (n = 65) n = 28; 43% n = 37; 57% n = 65; 100% n = 0; 0% n = 0; 0%
Sauces and condiments (n = 49) n = 76; 69% n = 34; 31% n = 110; 100% n = 0; 0% n = 0; 0%
Vegetables (n = 76) n = 73; 96% n = 3; 4% n = 76; 100% n = 0; 0% n = 0; 0%

 

 

In the following figures, the presence of added sugars in different food subgroups is shown on the left hand side (independent of their LNCS content), while, on the right hand side, the presence of LNCS independently of sugar content for each food subgroup is presented. Figure 2 shows added sugar and LNCS content of non-alcoholic beverages. Water, coffee and infusions, and natural fruit juices had no added sugars or LNCS. Soya drinks included LNCS in 45% of assessed products. Diet soft drinks contained LNCS in 100% of assessed products, followed by “other drinks” (68%, alcohol-free biter, alcohol-free beer, juice, milk mixes, etc.). Noteworthy, 70% of the last group had added sugars. In turn, 100% of sugar soft drinks had added sugars and 24% LNCS, followed by energy drinks in which 96% of assessed products added sugars and 34% contained LNCS. Additionally, in the sports drinks category, 96% had added sugars but only 4% LNCS. Of all the juices and nectars assessed, 32% contained LNCS, whereas 12% contained added sugars. Finally, only 4% of the low alcohol content beverages present in the survey had added sugars (beers, bitter, sangria, cider and combined low-graded), whereas 2% contained only LNCS. Combined low alcohol content beverages presented LNCS in 76.7% of the assessed and 60% added sugars (data not shown). The major forms of added sugars in these groups were sucrose, glucose, fructose, glucose-fructose syrup and caramel. Main LNCS were acesulfame-k (E-950), aspartame (E-951), cyclamic acid or cyclamate (E-952), saccharine (E-954), sucralose (E-955) and neosperidine DC (E-959). Data from alcoholic beverages were not assessed, as ingredient information was unavailable on most product labels.

Figure 2. Presence of added sugar and low- and no-calorie sweeteners in beverages consumed by the Spanish ANIBES Study.

 

Within the “grains” group, all recorded bakery and pastry products had added sugars (Figure 3). These were mainly sugar, dextrose, glucose-fructose syrup, glucose syrup, inverted sugars, trehalose and caramel. However, only 17% of products contained LNCS such as sorbitol (E-420) (e.g., muffins, strudel and cakes) used at quantum satis level as a humectant.

 

Figure 3. Presence of added sugars and low- and no-calorie sweeteners in grains consumed by the Spanish ANIBES population.

 

Added sugars were present in 96% of breakfast cereals and cereal bars products, namely sugar, dextrose, glucose-fructose syrup, glucose syrup, inverted sugars, trehalose, corn glucose and fructose syrup and caramel. About only 4% from this group contained LNCS: mainly cereal bars, regular and whole, being E-420 the unique LNCS used at quantum satis levels for purpose other than sweetening.

 

Bread and bread products (derivatives) presented added sugars in 81% of assessed products (sugar, glucose-fructose syrup, inverted sugars and lactose). Interestingly, no LNCS were reported in this subgroup.

 

Added sugars were present in 2% of milk products (Figure 4), specifically, in condensed milk. Similarly, cheeses contained added sugars in only 3% of reported products. None of these two groups contained LNCS. However, “other dairy products”, a subgroup that comprised milkshakes, dairy desserts and ice cream, reported 82% of products containing added sugars, namely, ice cream contained sugar in 100% of products (sugar, caramel, glucose-fructose syrup, lactose and dextrose). In addition, yogurt and fermented milk products had added sugars in a high proportion of reported products (63%, sucrose, glucose, fructose, lactose and glucose-fructose syrup), while 18% of products in this subgroup had LNCS, mainly acesulfame-k (E-950), aspartame (E-951), cyclamate (E-952) and sucralose (E-955).

 

 

Figure 4. Presence of added sugars and low- and no-calorie sweeteners in milk and dairy products consumed by the Spanish ANIBES population.

In the “sugar” (table sugar) and “chocolates” group, 100% of products only contained added sugars (sucrose, honey, lactose and dextrose) and no LNCS were declared in their labels (Figure 5). Jams and others presented added sugars in 89% of products, namely sucrose and glucose-fructose syrup; conversely, LNCS were present in roughly 10% of this group (sorbitol (E-420), mannitol (E-421), acesulfame-k (E-950), aspartame (E-951), cyclamate (E-952), sucralose (E-955) and stevia (E-960)).

Nutrients 10 01265 g005 550

Figure 5. Presence of added sugars and low- and no-calorie sweeteners in sugar and sweets consumed by the Spanish ANIBES population.

 

Other sweets, including candy, chewing gum, marzipan, licorice and “turron” (a traditional Spanish type of nougat) had added sugars in 13% of assessed products (sucrose, glucose-fructose syrup, honey and inverted sugars) while 89% had LNCS (sorbitol (E-420), mannitol (E-421), acesulfame-k (E-950), aspartame (E-951), cyclamate (E-952), saccharine (E-954), sucralose (E-955) and xylitol (E-967)).

 

In the following group, “meat” and “fish” refers to unprocessed products (only refrigerated or chilled cuts). Sausages and other meat products and fish derivatives encompass those processed products that might contain ingredients other than meat in their composition. Presence of added sugars was observed in 86% of the sausages and other meat products subgroup (i.e., sausages, bacon, chorizo, etc.) and in 14% of fish derivatives (Figure 6), mainly sucrose, dextrose, lactose and glucose and dextrose syrup. LNCS were present in 8.5% of sausages and other meat products (sorbitol, E-420) but not in the second subgroup.

Figure 6. Presence of added sugars and low- and no-calorie sweeteners in meat and fish and derivate products consumed by the Spanish ANIBES population.

 

Canned pulses and fruits presented higher proportions of products containing added sugars, 78% and 63%, respectively, while only 10% of assessed canned vegetables did (Figure 7). As for “ready-to-eat meals”, we observed that 61% of assessed products had added sugars (sucrose, lactose, caramel, and corn dextrose and glucose syrup). Appetizers had added sugars in 8% of products (sucrose, glucose-fructose syrup and glucose syrup) and LNCS in 2% (aspartame, E-951). Finally, amongst sauces and condiments, 57% of assessed products had added sugars such as sucrose, caramel, lactose and glucose-fructose syrup.

 

 

Figure 7. Presence of added sugars and low- and no-calorie sweeteners in other food groups consumed by the Spanish ANIBES population.

 

Table 3 and Table 4 show the prevalence of the different types of added sugars and LNCS found, respectively. Overall, sucrose was the major added sugar ingredient (Table 2). Aspartame (E-951) and acesulfame K (E-950) were the most used LNCS across the different studied food groups, while neosperidine DC (E-959) was employed only in the non-alcoholic beverages category (Table 3).

 

Table 3. Prevalence of type of added sugars declared on food products with added sugar consumed by the ANIBES study population.

 

Table 3. Prevalence of type of added sugars declared on food products with added sugar consumed by the ANIBES study population.

Added Sugars Prevalence
Sugar (sucrose) 50.3%; n = 308
Sugar (sucrose) and glucose-fructose syrup 5.7%; n = 35
Sugar (sucrose) and glucose syrup 4.1%; n = 25
Dextrose 2.8%; n = 17
Fructose 2.8%; n = 17
Lactose 2.6%; n = 16
Sugar (sucrose) and lactose 2.5%; n = 15
Sugar (sucrose) and dextrose 2.3%; n = 14
Sugar (sucrose) and caramel 2.0%; n = 12
Caramel 1.8%; n = 11
Glucose-fructose syrup 1.1%; n = 7

Only those added sugars which contribute to at least 1% of intakes have been included, calculated as percentage of assessed products containing added sugars.

 

Table 4. Prevalence of type of Low- and no-calorie sweeteners (LNCS) declared on food products with LNCS consumed by the ANIBES study population.

Table 4. Prevalence of type of Low- and no-calorie sweeteners (LNCS) declared on food products with LNCS consumed by the ANIBES study population.

Low- and No-Calorie Sweeteners Prevalence
Acesulfame K (E-950) 30.5%; n = 80
Sucralose (E-955) 30.2%; n = 79
Aspartame (E-951) 10.7%; n = 28
Cyclamate (E-952) 10.7%; n = 28
Sorbitol (E-420) 7.3%; n = 19
Saccharine and its Sodium (E-954) 6.1%; n = 16
Neohesperidine DC (E-959) 1.5%; n = 4
Mannitol (E-412) 1.1%; n = 3
Steviol glycosides or “stevia” (E-960) 1.1%; n = 3
Thaumatin (E-957) 0.4%; n = 1
Xylitol (E-967) 0.4%; n = 1

 

 

Supplementary Materials

The following are available online at https://www.mdpi.com/2072-6643/10/9/1265/s1, Table S1: Food group classification and included subgroups assessed in the ANIBES Study (Adapted from Pérez-Rodrigo et al. (1)).

 

Author Contributions

M.d.L.S.-V. and E.R. designed and wrote the manuscript. T.P. contributed to the design of the manuscript, and to the interpretation and discussion of the results. J.A.-B., A.G., M.G.-G., R.M.O. and L.S.-M. are members of the Scientific Advisory Board of the ANIBES study. These authors were responsible for the careful review of the study protocol, design and methodology; providing scientific advice to the study; and the interpretation of the results. They also critically reviewed the manuscript. G.V.-M., the Principal Investigator, was responsible for the design, protocol, methodology, and follow-up/checking of the study. G.V.-M. also revised the manuscript. All authors approved the final version of the manuscript.

 

Funding

This research was funded by a grant from Coca-Cola Iberia through an agreement with the Spanish Nutrition Foundation (Fundación Española de la Nutrición (FEN).

 

Acknowledgments

The authors would like to thank Coca-Cola Iberia and IPSOS for its support and technical advice, particularly Rafael Urrialde and Javier Ruiz.

 

Conflicts of Interest

The study was financially supported by a grant from Coca-Cola Iberia through an agreement with the Spanish Nutrition Foundation (Fundación Española de la Nutrición (FEN)). The funding sponsor had no role in the design of the study, the collection, analysis nor interpretation of the data, the writing of the manuscript, nor in the decision to publish the results. The authors declare no conflict of interest.

 

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© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

María de Lourdes Samaniego-Vaesken 1,†, Emma Ruiz 2,†, Teresa Partearroyo 1, Javier Aranceta-Bartrina 3,4,5, Ángel Gil 6,7, Marcela González-Gross 6,8, Rosa M. Ortega 9, Lluis Serra-Majem 4,6,10 and Gregorio Varela-Moreiras 1,2,* 

1 Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain

2 Spanish Nutrition Foundation (FEN), 28010 Madrid, Spain

3 Department of Food Sciences and Physiology, University of Navarra, Pamplona, 31009 Navarra, Spain

4 Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain

5 Department of Physiology, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Vizcaya, Spain

6 CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, 28029 Madrid, Spain

7 Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Sciences, University of Granada, 18010 Granada, Spain

8 ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, 28040 Madrid, Spain

9 Department of Nutrition and Food Science, Faculty of Pharmacy, Madrid Complutense University, 28040 Madrid, Spain

10 Service of Preventive Medicine, Complejo Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canary Health Service, Las Palmas de Gran Canaria, 35016 Las Palmas, Spain*

Correspondence: gvarela@ceu.es; Tel.: +34-91-372-47-26 or +34-91-447-07-59†

These authors contributed equally to this work.

Received: 6 July 2018 / Accepted: 5 September 2018 / Published: 7 September 2018

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