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

  1. Conclusions

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 present work shows that currently there is a widespread presence of LNCS and added sugars in many food and beverage groups commercialized in Spain. LNCS were present in diet soft drinks (100%), “other sweets” (89%), soya drinks (45%), and yogurt and fermented milks (18%). Added sugars were present 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.

It is relevant to identify LNCS in food and beverage products as the European regulation establishes that their consumption should be monitored and quantified in different population groups. Moreover, added sugars contents should be reduced to meet public health guidelines and key products that contain them could be monitored for reformulation as well. This is the first work conducted in Spain to identify, examine and describe the presence of added sugars and LNCS in main food groups consumed by a representative sample of our population. This information should be compiled in food composition databases to assess their consumption in nutritional surveys and monitor reformulation.

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.

 

References

1.Popkin, B.M.; Hawkes, C. Sweetening of the global diet, particularly beverages: Patterns, trends, and policy responses. Lancet Diabetes Endocrinol. 2016, 4, 174–186. [Google Scholar] [CrossRef]

2.Guideline, W. Sugars Intake for Adults and Children; World Health Organization: Geneva, Switzerland, 2015. [Google Scholar]

3.Ruiz, E.; Rodriguez, P.; Valero, T.; Ávila, J.; Aranceta-Bartrina, J.; Gil, Á.; González-Gross, M.; Ortega, R.; Serra-Majem, L.; Varela-Moreiras, G. Dietary Intake of Individual (Free and Intrinsic) Sugars and Food Sources in the Spanish Population: Findings from the ANIBES Study. Nutrients 2017, 9, 275. [Google Scholar] [CrossRef] [PubMed]

4.Consultation, J.W.F.E. Diet, nutrition and the prevention of chronic diseases. World Health Organ. Tech. Rep. Ser. 2003, 916, 54–55. [Google Scholar]

5.Latasa, P.; Louzada, M.L.D.C.; Martinez Steele, E.; Monteiro, C.A. Added sugars and ultra-processed foods in Spanish households (1990–2010). Eur. J. Clin. Nutr. 2017. [Google Scholar] [CrossRef] [PubMed]

6.Ruiz, E.; Ávila, J.; Castillo, A.; Valero, T.; del Pozo, S.; Rodriguez, P.; Bartrina, J.; Gil, Á.; González-Gross, M.; Ortega, R.; et al. The ANIBES Study on Energy Balance in Spain: Design, Protocol and Methodology. Nutrients 2015, 7, 970–998. [Google Scholar] [CrossRef] [PubMed]

7.Dunford, E.; Taillie, L.; Miles, D.; Eyles, H.; Tolentino-Mayo, L.; Ng, S. Non-Nutritive Sweeteners in the Packaged Food Supply—An Assessment across 4 Countries. Nutrients 2018, 10, 257. [Google Scholar] [CrossRef] [PubMed]

8.Ministerio de Sanidad, Servicios Sociales e Igualdad. Agencia Española de Consumo, Seguridad Alimentaria y Nutrición. Plan de Colaboración Para la Mejora de la Composición de los Alimentos y Bebidas y Otras Medidas 2017–2020. 2018. Available online: http://www.aecosan.msssi.gob.es/AECOSAN/docs/documentos/nutricion/PLAN_COLABORACION_2017-2020.pdf (accessed on 10 April 2018). [Google Scholar]

9.Sylvetsky, A.C.; Rother, K.I. Trends in the consumption of low-calorie sweeteners. Physiol. Behav. 2016, 164, 446–450. [Google Scholar] [CrossRef] [PubMed]

10.Pérez-Rodrigo, C.; Gil, Á.; González-Gross, M.; Ortega, R.M.; Serra-Majem, L.; Varela-Moreiras, G.; Aranceta-Bartrina, J. Clustering of dietary patterns, lifestyles, and overweight among Spanish children and adolescents in the ANIBES study. Nutrients 2016, 8, 11. [Google Scholar] [CrossRef] [PubMed]

11.Nissensohn, M.; Sánchez-Villegas, A.; Serra-Majem, L. Beverage consumption habits amongst the Spanish population: Association with total water and energy intake. Findings of the ANIBES study. Nutr. Hosp. 2015, 32, 10325. [Google Scholar] [PubMed]

12.Kroger, M.; Meister, K.; Kava, R. Low-calorie Sweeteners and Other Sugar Substitutes: A Review of the Safety Issues. Compr. Rev. Food Sci. Food Saf. 2006, 5, 35–47. [Google Scholar] [CrossRef]

13.Piernas, C.; Ng, S.W.; Popkin, B. Trends in purchases and intake of foods and beverages containing caloric and low-calorie sweeteners over the last decade in the U.S. Pediatr. Obes. 2013, 8, 294–306. [Google Scholar] [CrossRef] [PubMed]

14.Poti, J.M.; Yoon, E.; Hollingsworth, B.; Ostrowski, J.; Wandell, J.; Miles, D.R.; Popkin, B.M. Development of a food composition database to monitor changes in packaged foods and beverages. J. Food Compos. Anal. 2017, 64, 18–26. [Google Scholar] [CrossRef] [PubMed]

15.Bellisle, F.; Drewnowski, A. Intense sweeteners, energy intake and the control of body weight. Eur. J. Clin. Nutr. 2007, 61, 691. [Google Scholar] [CrossRef] [PubMed]

16.Swithers, S.E. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends Endocrinol. Metab. 2013, 24, 431–441. [Google Scholar] [CrossRef] [PubMed]

17.Nichol, A.D.; Holle, M.J.; An, R. Glycemic impact of non-nutritive sweeteners: A systematic review and meta-analysis of randomized controlled trials. Eur. J. Clin. Nutr. 2018, 72, 796–804. [Google Scholar] [CrossRef] [PubMed]

18.Sylvetsky, A.C.; Rother, K.I. Nonnutritive Sweeteners in Weight Management and Chronic Disease: A Review. Obesity 2018, 26, 635–640. [Google Scholar] [CrossRef] [PubMed]

19.Bernstein, J.T.; Schermel, A.; Mills, C.M.; L’Abbé, M.R. Total and Free Sugar Content of Canadian Prepackaged Foods and Beverages. Nutrients 2016, 8, 582. [Google Scholar] [CrossRef] [PubMed]

20.Gardner, C.; Wylie-Rosett, J.; Gidding, S.S.; Steffen, L.M.; Johnson, R.K.; Reader, D.; Lichtenstein, A.H. Nonnutritive sweeteners: Current use and health perspectives: A scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2012, 126, 509–519. [Google Scholar] [CrossRef] [PubMed]

21.Martyn, D.; Darch, M.; Roberts, A.; Lee, H.; Yaqiong Tian, T.; Kaburagi, N.; Belmar, P. Low-/No-Calorie Sweeteners: A Review of Global Intakes. Nutrients 2018, 10, 357. [Google Scholar] [CrossRef] [PubMed]

22.Mortensen, A. Sweeteners permitted in the European Union: Safety aspects. Scand. J. Food Nutr. 2006, 50, 104–116. [Google Scholar] [CrossRef]

23.Aranceta Bartrina, J.; Pérez Rodrigo, C.; Alberdi Aresti, G.; Varela Moreiras, G.; Serra-Majem, L. Controversies about population, clinical or basic research studies related with food, nutrition, physical activity and lifestyle. Nutr. Hosp. 2015, 3, 15–21. [Google Scholar]

24.Serra-Majem, L.; Serván, P.R.; Cortés, S.B.; Navarro, A.A.; Bartrina, J.A.; Vargas, E.F.; García-Closas, R.; Gómez-Candela, C.; Sancho, E.H.; La Vecchia, C. Chinchón declaration; decalogue on low-and no-calorie sweeteners (LNCS). Nutr. Hosp. 2014, 29, 719–734. [Google Scholar] [PubMed]

25.Serra-Majem, L.; Raposo, A.; Aranceta-Bartrina, J.; Varela-Moreiras, G.; Logue, C.; Laviada, H.; Socolovsky, S.; Pérez-Rodrigo, C.; Aldrete-Velasco, J.; Meneses Sierra, E.; et al. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages. Nutrients 2018, 10, 818. [Google Scholar] [CrossRef] [PubMed]

26.European Union. Regulation (EU) 1169/2011 of the European parliament and of the Council of 25 October 2011 on the provision of food information to consumers, amending Regulations (EC) No 1924/2006 and(EC) No 1925/2006 of the European Parliament and of the Council, and repealing Commission Directive 87/250/EEC, Council Directive 90/496/EEC, Commission Directive 1999/10/EC, Directive 2000/13/EC of the European Parliament and of the Council, Commission Directives 2002/67/EC and 2008/5/EC and Commission Regulation (EC) No 608/2004 (Text with EEA relevance). Off. J. Eur. Union 2011, L304, 18–63. Available online: https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A32011R1169 (accessed on 13 June 2018). [Google Scholar]

27.Nissensohn, M.; Sánchez-Villegas, A.; Ortega, R.; Aranceta-Bartrina, J.; Gil, Á.; González-Gross, M.; Varela-Moreiras, G.; Serra-Majem, L. Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study. Nutrients 2016, 8, 232. [Google Scholar] [CrossRef] [PubMed]

28.Husøy, T.; Mangschou, B.; Fotland, T.Ø.; Kolset, S.O.; Nøtvik Jakobsen, H.; Tømmerberg, I.; Bergsten, C.; Alexander, J.; Frost Andersen, L. Reducing added sugar intake in Norway by replacing sugar sweetened beverages with beverages containing intense sweeteners—A risk benefit assessment. Food Chem. Toxicol. 2008, 46, 3099–3105. [Google Scholar] [CrossRef] [PubMed]

29.Buffini, M.; Goscinny, S.; Van Loco, J.; Nugent, A.P.; Walton, J.; Flynn, A.; Gibney, M.J.; McNulty, B.A. Dietary intakes of six intense sweeteners by Irish adults. Food Addit. Contam. Part A 2018, 35, 425–438. [Google Scholar] [CrossRef] [PubMed]

30.Le Donne, C.; Mistura, L.; Goscinny, S.; Janvier, S.; Cuypers, K.; D’Addezio, L.; Sette, S.; Catasta, G.; Ferrari, M.; Piccinelli, R. Assessment of dietary intake of 10 intense sweeteners by the Italian population. Food Chem. Toxicol. 2017, 102, 186–197. [Google Scholar] [CrossRef] [PubMed]

31.Acton, R.B.; Vanderlee, L.; Hobin, E.P.; Hammond, D. Added sugar in the packaged foods and beverages available at a major Canadian retailer in 2015: A descriptive analysis. CMAJ Open 2017, 5, E1–E6. [Google Scholar] [CrossRef] [PubMed]

32.Ng, S.W.; Slining, M.M.; Popkin, B.M. Use of Caloric and Noncaloric Sweeteners in US Consumer Packaged Foods, 2005–2009. J. Acad. Nutr. Diet. 2012, 112, 1828–1834. [Google Scholar] [CrossRef] [PubMed]

33.Probst, Y.C.; Dengate, A.; Jacobs, J.; Louie, J.C.Y.; Dunford, E.K. The major types of added sugars and non-nutritive sweeteners in a sample of Australian packaged foods. Public Health Nutr. 2017, 20, 3228–3233. [Google Scholar] [CrossRef] [PubMed]

34.Zupanič, N.; Miklavec, K.; Kušar, A.; Žmitek, K.; Fidler Mis, N.; Pravst, I. Total and Free Sugar Content of Pre-Packaged Foods and Non-Alcoholic Beverages in Slovenia. Nutrients 2018, 10, 151. [Google Scholar] [CrossRef] [PubMed]

35.Biro, G.; Hulshof, K.; Ovesen, L.; Cruz, J.A. Selection of methodology to assess food intake. Eur. J. Clin. Nutr. 2002, 56, S25. [Google Scholar] [CrossRef] [PubMed]

36.Lieffers, J.R.; Hanning, R.M. Dietary assessment and self-monitoring: With nutrition applications for mobile devices. Can. J. Diet. Pract. Res. 2012, 73, e253–e260. [Google Scholar] [CrossRef] [PubMed]

© 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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