Consumption of sugar during complementary feeding : an observational study describing total sugar intake and food sources of sugar among nine-to eleven-month-old infants in Aotearoa New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand

Abstract

Background: Complementary feeding is a formative step in an infant's life, bridging the gap between milk feeding and family foods, and setting the scene for future health outcomes and eating behaviours. From birth, infants are exposed to sugars and the sweet tastes they provide. Breastmilk and infant formula are high in the intrinsic sugar, lactose, which is an important source of energy for the growing infant. Infants then begin the transition onto complementary foods around six months of age, a stage necessary to provide them with adequate nutrients for growth and development beyond what breastmilk can provide. The first foods and beverages provided to them during this stage are important for predicting future health outcomes. Infant feeding recommendations across the world advise against the introduction of added sugars, honey or sweeteners during the complementary feeding period on the premise that they do not provide any nutritional benefit (other than energy provision). Despite these recommendations, infants are being introduced to foods containing added sugars in their first year of life. The New Zealand Food and Nutrition Guidelines for Healthy Infants and Toddlers currently do not address sugars naturally present in milk/milk products, grains and cereals, or the sweet fruits and vegetables commonly found in many infant foods as there is currently no evidence of the negative effects of consuming these. Few studies have described the total sugar intake from complementary foods consumed by New Zealand infants, or analysed sources contributing to these. Aim: To investigate the quantity of total sugars obtained from complementary foods and beverages and the food and beverage sources contributing to these in the diets of nine- to eleven-month-old infants in Aotearoa-New-Zealand. Methods: A cross-sectional study design was used. Four-day weighed food records (4dWFR) were completed on non-consecutive days by the parents of 95 infants (aged between nine and eleven months) across New Zealand. Descriptive analyses were carried out to determine the energy intake, nutrients (including carbohydrates, total sugars, % energy from sugar) and the foods and beverages contributing to sugar intakes in the infants. Results: The mean ± SD daily total sugar intake from complementary foods and beverages was 23.8 ± 13.7g, which contributed to 22.0% of the total energy intake derived from complementary foods among infants (range 7.0 to 55.0%). Infants consumed sugars from seven food groups (vegetables, fruits, breads and cereals, commercial infant products, dairy and dairy-free alternatives, meat and meat substitutes, and discretionary foods and beverages). The majority of sugar was contributed by fruits (46.2 ± 20.1%) and vegetables (14.6 ± 13.4%) in particular those of the sweeter variety (bananas, apples, pears, kumara, carrots and pumpkin). Sixty percent of infants consumed sugar from commercial infant products, which tend to be fruit based; these contributed to 19.1 ± 20.6% of the infants' total sugar intake from complementary foods. Conclusion: Fruits, vegetables and commercially-available complementary foods are the greatest contributors to total sugars from foods consumed by NZ infants, and are predominantly those that impart an overall sweet taste, rather than vegetables which would expose infants to a more bitter taste experience. Manufacturers of infant foods should be encouraged to reformulate commercially available complementary foods (CACFs) available in New Zealand to shift towards the use of more vegetable and savoury products, rather than fruit-based and sweet foods.