Dietary sugar intake from complementary foods : a cross-sectional study describing total, free and added sugar intake of infants living in New Zealand : a thesis presented in the partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand
Loading...
Date
2021
DOI
Open Access Location
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Massey University
Rights
The Author
Abstract
Background: Complementary feeding is introduced at around six months of age when breast milk alone is no longer sufficient to meet the nutritional requirements of an infant. Additional foods and liquids are introduced alongside breast milk to bridge the gap and fulfil nutritional requirements. The types of foods introduced during complementary feeding influence the eating habits and behaviours of the infants and thus can play a role in future health outcomes. Excess total, free, and added sugar intake during infancy can increase the risk of dental caries, nutrient displacement, undesirable weight gain and the development of unhealthy eating habits. Infant feeding recommendations advise against added sugars, honey or sweeteners during the complementary feeding stage as they provide no nutritional benefit. Furthermore they may accustom an infant to sweet tasting foods. There are limited studies assessing total, free and added sugar intake of New Zealand infants. The quantity of sugar from various food sources, feeding practices (baby led weaning and traditional spoon feeding), frequency of pouch use and non-commercial/commercial infant food, require further investigation to better understand where, what and how sugar intake occurs in New Zealand infants. Aim: To investigate the quantity of total, free and added sugars in the diets of infants from the First Foods study in New Zealand and explore the food sources, feeding practices and frequency of pouch use contributing to sugar intake during complementary feeding. Methods: An observational cross-sectional study design was used. Two 24hr diet recalls were conducted on non-consecutive days with caregivers of 211 infants (aged between 7 to 10 months) across Auckland and Dunedin. Descriptive analyses were carried out using excel and SPSS to determine, energy and macronutrient intakes, total/free/added sugar intake by food group, feeding practice, pouch use and non-commercial/commercial infant food. Feeding practices included baby led weaning, partial baby led weaning and traditional spoon feeding. Baby led weaning infants were defined as infants who are fed finger foods as opposed to pureed or mashed foods. Inferential analyses were run for feeding practice and pouch use to determine whether there was a difference in sugar intake between the groups. Results: Infants median total, free and added sugar intake from complementary foods was 15.8g/day. 0.5g/day and 0.2g/day, respectively. Total sugar contributed to 18.4% of the total energy intake from all nutrient sources. Infants consumed sugars from 32 defined food groups. Of these food groups, custards (9.87g), sweet pouches (9.71g), yoghurt with fruit (7.76g), fruit (4.98g), and sweetened breakfast (3.56g) contributed the most to total sugar intake. All food groups contributed less than 2g/day of free and added sugar, excluding custards (5.58g) and yoghurt with fruit (2.18g). There was no significant difference in total sugar intake between feeding practices. Free and added sugar were significantly different between feeding practices as determined through the Kruskal-Wallis test (P values= 0.035 and 0.003). Free sugar intake was significantly higher in infants following traditional spoon feeding compared to infants following baby led weaning. Added sugar intake was also significantly higher in infants following traditional spoon feeding and partial baby led weaning compared to infants following baby led weaning. Relationships between sugar intake and feeding practice were identified using the Dunn-Bonferroni post hoc test. The same significance tests were run for frequency of pouch use and sugar intake. Infants categorised as frequent pouch users consumed the highest values of total, free and added sugar (19.89g/d, 1.59g/d and 1.19g/d) and intakes of total, free and added sugar were significantly different between differing pouch use groups (P values= 0.001, 0.0 and 0.018). Non-pouch users had a significantly lower intake of total, free and added sugar compared to frequent pouch users. Non-commercial foods contributed 6.33g/d more total sugar than commercial food; free and added sugar intakes were ≤0.25g for commercial, mixed, and non-commercial foods. Conclusion: The quantity of total, free and added sugars in the diets of infants from the First Foods study was minimal regardless of feeding method, pouch use and food form. The majority of the foods eaten by the infants did not contain free sugar. Intake of added sugar from custard and yoghurt with fruit was over 2g per day. Food groups that contributed the most to total sugar intake were fruit-based. There were no significant relationships between feeding practice (Baby-led weaning, partial baby-led weaning and traditional spoon feeding) and sugar intake. Infants who were categorised as frequent pouch users had the highest intake of total, free and added sugar compared to infants in the moderate and non-pouch user groups. Parents should be encouraged to choose foods for their infants that are low in total, free and added sugar and to expose their infants to bitter-tasting foods. As current practices show that parents are exposing their infants to minimal sugars, there is no need to change the way infants are fed in New Zealand in relation to sugar intake.
Description
Keywords
complementary feeding, sugar intake, food sources, feeding practices, pouch use