Total,Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007–2010

A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7–69 years) from the Dutch National Food Consumption Survey 2007–2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE), free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake <10 %TE was 5% in boys and girls (7–18 years), 29% in women, and 33% in men. Overall diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of <5 %TE and <10 %TE was generally low in the Netherlands, particularly in children. Adherence to the added and free sugar guidelines was not strongly associated with higher diet quality in adults.     

Association of Dietary Sugars and Sugar-Sweetened Beverage Intake with Obesity in Korean Children and Adolescents

Few studies have examined the association between dietary sugar intake and obesity in Asian children and adolescents. We evaluated the association of dietary sugar intake and its food source with obesity in Korean children and adolescents. In this cross-sectional analysis, data were obtained from five studies conducted between 2002 and 2011. The study included 2599 children and adolescents who had completed more than three days of dietary records and had anthropometric data. Total sugar intake was higher in girls than in boys (54.3 g for girls and 46.6 g for boys, p < 0.0001). Sugar intake from milk and fruits was inversely associated with overweight or obesity in girls only (OR for overweight, 0.52; 95% CI, 0.32–0.84; p for trend = 0.0246 and OR for obesity, 0.42; 95% CI, 0.23–0.79; p for trend = 0.0113). Sugar-sweetened beverage (SSB) consumption was not associated with obesity in girls, while boys had lower odds ratios for obesity (OR for obesity, 0.52; 95% CI, 0.26–1.05; p for trend = 0.0310). These results suggest that total sugars and SSB intake in Asian children and adolescents remains relatively low and sugar intake from milk and fruits is associated with a decreased risk of overweight or obesity, especially in girls.     

Perception of sugar reduction,nutrition education,and frequency of snacking in children by the self-perceived sweet dietary habits of mothers in Busan

BACKGROUND/OBJECTIVESThe aim of this study was to investigate the perception of sugar reduction, nutrition education, and frequency of snacking in children according to the self-perceived dietary preferences for sweet taste by mothers in Busan.SUBJECTS/METHODSA total of 277 mothers were surveyed, and their perceptions of sugar reduction and the frequency of snacking in children were assessed using a questionnaire. The subjects were classified into either a sweet (n = 91) or an unsweet (n = 186) group according to their self-perceived preferences for a sweet taste.RESULTSIn the sweet group, the results for sweet products were sweetened ice (86.8%), confectionery (74.7%), processed milk (73.6%), carbonated beverages (71.4%), and fermented milk (53.9%). In the unsweet group, the results were sweetened ice (88.7%), carbonated beverages (78.5%), processed milk (75.8%), confectionery (69.4%), and fermented milk (50.5%). The necessity of sugar intake reduction was high in both groups (sweet = 89.0%, unsweet = 82.8%). Beverage purchases after identifying the nutrition labeling was significantly lower in the sweet group than in the unsweet group (P < 0.05). The reasons for the beverage purchases instead of water were "habitually" (50.5%) and "like sweet taste" (25.3%) in the sweet group (P < 0.01). Snacking in children was significantly higher in the sweet group based on the increased frequencies of carbonated drinks (P < 0.01), fast food (P < 0.001), candy and chocolate (P < 0.05), crackers (P < 0.01), ramen (P < 0.01), and fish paste/hotdogs (P < 0.01). The frequency of purchase education after identifying the nutrition labeling was significantly lower in the sweet group than in the unsweet group (P < 0.01).CONCLUSIONSThese findings suggest that a perception of sugar reduction and practical nutrition education aimed at reducing the sugar intake are necessary to improve dietary habits.     

Total,Added, and Free Sugars: Are Restrictive Guidelines Science-Based or Achievable?

Sugar consumption, especially added sugars, is under attack. Various government and health authorities have suggested new sugar recommendations and guidelines as low as 5% of total calories from free sugars. Definitions for total sugars, free sugars, and added sugars are not standardized, nor are there accepted nutrient databases for this information. Our objective was to measure total sugars and added sugars in sample meal plans created by the United States Department of Agriculture (USDA) and the Academy of Nutrition and Dietetics (AND). Utilizing the Nutrition Data System for Research (NDSR) nutritional database, results found that plans created by the USDA and AND averaged 5.1% and 3.1% calories from added sugar, 8.7% and 3.1% from free sugar, and 23.3% and 21.1% as total sugars respectively. Compliance with proposed added sugar recommendations would require strict dietary compliance and may not be sustainable for many Americans. Without an accepted definition and equation for calculating added sugar, added sugar recommendations are arbitrary and may reduce intakes of nutrient-rich, recommended foods, such as yogurt, whole grains, and tart fruits including cranberries, cherries, and grapefruit. Added sugars are one part of excess calorie intake; however, compliance with low added sugar recommendations may not be achievable for the general public.     

Laboratory Determined Sugar Content and Composition of Commercial Infant Formulas,Baby Foods and Common Grocery Items Targeted to Children

Excess added sugar consumption is tied to poor health outcomes in children. The sugar content of beverages and foods children are exposed to is mostly unknown, yet this information is imperative for understanding potential risks from overconsumption of sugars in early life. We determined actual sugar content by conducting a blinded laboratory analysis in infant formulas, breakfast cereals, packaged baked goods and yogurts. One hundred samples were sent to an independent laboratory for analysis via gas chromatography. Sugar content and composition was determined and total sugar was compared against nutrition labels. Of the 100 samples analyzed, 74% contained ≥20% of total calories per serving from added sugars. Nutrient label data underestimated or overestimated actual sugars and ~25% of all samples had actual total sugar values that were either <10% or >10% of labeled total sugar. Many products that are frequently marketed to and consumed by infants and young children contain sugars in amounts that differ from nutrition labels and often in excess of recommended daily levels. These findings provide further support for adding more comprehensive sugar labeling to food and beverage products, specifically those marketed to, or commonly consumed by, children.     

Dietary sugar intake and dietary behaviors in Korea: a pooled study of 2,599 children and adolescents aged 9-14 years

BACKGROUND/OBJECTIVESDietary sugar intake, particularly added sugar and sugar-sweetened beverages, has received worldwide attention recently. Investigation of dietary behaviors may facilitate understanding of dietary sugar intakes of children and adolescents. However, the relationship between dietary sugar intake and dietary behaviors in the Korean population has not been investigated. Thus, this study aimed to estimate dietary sugar intake and food sources according to sex as well as examine the relationship of dietary sugar intake with frequent snacking and dietary patterns among Korean children and adolescents.SUBJECTS/METHODSWe pooled data from five studies involving Korean children and adolescents conducted from 2002 to 2011. A total of 2,599 subjects aged 9-14 years were included in this study. Each subject completed more than 3 days of dietary records.RESULTSMean daily total sugar intake was 46.6 g for boys and 54.3 g for girls. Compared with boys, girls showed higher sugar intakes from fruits (7.5 g for boys and 8.8 g for girls; P = 0.0081) and processed foods (27.9 g for boys and 34.9 g for girls; P < 0.0001). On average, 95.4% of boys and 98.8% of girls consumed snacks during the study period, and total sugar intake showed a significantly increasing trend with increasing energy intake from snacks (P < 0.0001 for both sexes). Two dietary patterns were identified by cluster analysis: Traditional and Westernized patterns. Total sugar intake was higher in the Westernized pattern (56.2 g for boys and 57.2 g for girls) than in the Traditional pattern (46.5 g for boys and 46.3 g for girls).CONCLUSIONSThese results suggest that multilateral and practical development of a nutrition education and intervention program that considers dietary behaviors as well as absolute sugar intake is required to prevent excessive sugar intake in Korean children and adolescents.     

A Comparison of the Effects of Young-Child Formulas and Cow’s Milk on Nutrient Intakes in Polish Children Aged 13–24 Months

Adequately balanced daily food rations that provide the body with sufficient amounts of energy and nutrients, including minerals, are particularly important in early childhood when rapid physical, intellectual and motor development takes place. Cow’s milk (CM) and young-child formulas (YCFs) are introduced to a child’s diet past the first year of age. The main aim of the present study was to perform a qualitative and a quantitative analysis of daily food rations of young children based on the recommendations of the daily food ration model. An attempt was also made to determine whether the type of consumed milk (YCF or CM) adequately meets young children’s energy demands and contributes to the incorporation of different food groups into a balanced and healthy diet for children aged 13–24 months. A total of 714 parents between October 2019 and March 2020 filled out a food frequency questionnaire. In the second stage of the study, the parents participated in a dietary recall and were asked to keep diaries of all meals and foods consumed by children over a period of three days. The mean daily intake of CM/YCF and fermented milks was determined at 360 mL ± 128 mL, and it accounted for 55.4% of the guideline values. Flavored dairy products were consumed more frequently than fermented milks without added sugar or flavoring (94 ± 17 g vs. 56 ± 26 g, p < 0.05). Diets incorporating CM were significantly more abundant in protein than YCF diets (29.3 g vs. 21.9 g; p < 0.01). Liquid intake was somewhat higher in children fed YCFs (1280.8 mL vs. 1120.1; p < 0.05), mainly due to the higher consumption of fruit juice, nectars and sweetened hot beverages (246 ± 35 mL in the YCF group vs. 201 ± 56 mL in the CM group; p < 0.05). Children fed YCF consumed significantly larger amounts of sweetened beverages such as tea sweetened with sugar or honey, sweetened hot chocolate or instant teas (OR = 2.54; Cl: 1.32–3.26; p < 0.001), than children receiving CM. This group was also characterized by higher consumption of sweetened dairy products, mainly cream cheese desserts, fruit yogurt and yogurt with cereal (OR = 1.87; Cl: 1.36–2.54; p < 0.01), as well as a lower daily intake of plain fermented milks (OR = 0.56; Cl: 0.21–0.79; p < 0.001). The daily food intake and the quality of the diets administered to children aged 13–24 months were evaluated and compared with the model food ration. It was found that milk type influenced children’s eating habits and preference for sweet-tasting foods. The study also demonstrated that Polish parents and caregivers only have limited knowledge of nutritional guidelines for toddlers.     

Added Sugars in School Meals and the Diets of School-Age Children

Research is limited on added sugars in school meals and children’s dietary intakes after the 2015–2020 Dietary Guidelines for Americans (DGA) recommended that added sugars be limited to less than 10% of total calories. This analysis uses data from the School Nutrition and Meal Cost Study (SNMCS) to examine levels of added sugars in: (1) school meals and (2) children’s dietary intakes at breakfast, lunch, and over 24 h on school days. SNMCS data were collected in the 2014–2015 school year after updated nutrition standards for school meals were implemented. Most schools exceeded the DGA limit for added sugars at breakfast (92%), while 69% exceeded the limit at lunch. The leading source of added sugars in school meals (both breakfasts and lunches) was flavored skim milk. More than 62% of children consumed breakfasts that exceeded the DGA limit, and almost half (47%) consumed lunches that exceeded the limit. Leading sources of added sugars in the breakfasts consumed by children were sweetened cold cereals and condiments and toppings; leading sources of added sugars in children’s lunches were flavored skim milk and cake. Over 24 h, 63% of children exceeded the DGA limit. These findings show that school meals and children’s dietary intakes are high in added sugars relative to the DGA limit and provide insights into the types of foods that should be targeted in order to decrease levels of added sugars.     

Zinc Intake and Its Dietary Sources: Results of the 2007 Australian National Children's Nutrition and Physical Activity Survey

The current Australian Nutrient Reference Values (NRV) use different Estimated Average Requirements (EAR) for zinc for adolescent boys and girls compared to the previous recommendations. The adequacy of zinc intakes of 2-16 years old children (n = 4834) was examined in the 2007 Australian National Children's Nutrition and Physical Activity Survey. Zinc intakes were estimated from two 24-h recalls and compared with age- and gender-specific NRV. Food sources of zinc were assessed and compared with those of the 1995 National Nutrition Survey. The mean (SD) zinc intake was 10.2 (3.0) mg/day for all children. Nearly all children met the EAR for zinc except for 14-16 years old boys (29% did not meet EAR). Children (2-3 years) were at highest risk of excessive zinc intakes with 79% exceeding the Upper Level of Intake. Meat and poultry; milk products; and cereals and cereal products contributed 68% of total zinc intake. The contribution of cereals to total zinc intake has increased significantly since 1995, due to the greater market-availability of zinc-fortified breakfast cereals. We conclude that sub-groups of Australian children are at-risk of inadequate (boys 14-16 years) or excessive (children 2-3 years) zinc intakes, and monitoring of zinc status is required.     

Mediterranean Diet Adherence in a Sample of Italian Adolescents Attending Secondary School—The “#facciamoComunicAzione” Project

Our aim was to assess adherence to the Mediterranean diet in a group of 726 secondary school students (336 girls, 390 boys) who completed the web-based Medi-Lite questionnaire simultaneously, during school hours, at the “Istituto Professionale per l’Enogastronomia e l’Ospitalità Alberghiera Marco Polo” in Genoa, Italy. The mean adherence score was 9.28 ± 2.29, with significantly (p = 0.017) higher values in girls (9.5 ± 2.2) than boys (9.1 ± 2.4). As to the individual food components of the Medi-Lite score, 84% of students reported non-optimal consumption (i.e., the choice that yielded ≤ 1 point) of meat and meat products, and over 50% reported non-optimal consumption of vegetables, legumes, dairy products, and fish. Significant differences between girls and boys were observed for fruit (p = 0.003), cereals (p < 0.001), meat and meat products (p < 0.001), and dairy products (p = 0.003). By conducting a principal component analysis, we observed that Medi-Lite items on the consumption of some animal products (meat and meat products and dairy products) and some plant products (fruit, vegetables, and legumes) generated contrasting patterns of responses, denoting excessive consumption in the first case and underconsumption in the second. This result suggests the need for effective actions to promote healthy eating habits in young people.     

Foods, nutrients and portions consumed by a sample of Australian children aged 16–24 months

Aim:  To describe the diet of a sample of Australian children aged 16–24 months with regard to the amounts of foods and nutrients consumed.
Methods:  Cross-sectional data collected from participants in a five-year randomised trial of the primary prevention of asthma. Pregnant women with a family history of atopy were recruited from six hospital antenatal clinics in western Sydney. At the 18-month assessment, carers of 429 of children completed three-day weighed food records. Three-day average intakes of foods and nutrients and average portions per eating occasion for commonly consumed foods. T -tests for comparing gender differences.
Results:  Diets were characterised by large amounts of milk and non-milk drinks with smaller amounts of cereals, fruits, vegetables and meats. Total energy intake was significantly higher for boys than girls and exceeded estimated energy requirements in both boys and girls. Food groups contributing most to energy included milk and milk products (35%), cereals (15%), cereal-based products (9%) and non-milk drinks (8%). Micronutrient intakes were below the Estimated Average Requirement in more than 5% of the children for vitamin A, calcium, vitamin C and iron. Sodium intakes exceeded the upper level of 1000 mg for 62% of children, while dietary fibre intake was only half the Adequate Intake of 14 g. Relatively few foods were widely consumed and median portion sizes were typically small in relation to commonly used reference portion sizes.
Conclusion:  These data may be useful as a preliminary basis for developing age-specific dietary surveillance tools and dietary guidance for children aged one to two years.     

The estimated daily manganese intake of Korean children aged 11-12

The purpose of this study was to estimate the daily manganese (Mn) intake of Korean children. This study was done using a three-day dietary intake survey of 257 Korean children (boys 123; girls 134). The Mn intake values were calculated based on a database that provides the Mn content of the frequently consumed Korean foods, alongside the food composition table provided by the Korean National Rural Living Science Institute. The average age, height, weight and body mass index of our subjects were 11.9 years, 155.4 cm, 48.9 kg and 20.2 kg/m² in boys and 11.9 years, 154.1 cm, 43.5 kg and 18.3 kg/m² in girls. The average daily energy intakes were 2,249.2 kcal in boys and 2,044.5 kcal in girls. Boys consumed significantly more Mn than girls, based on intake estimates of 4,585.3 µg (117.6% of adequate intake) and 4,029.3 µg (117.1% of adequate intake), respectively (P < 0.001). Boys had a Mn intake of 2,041.1 µg per 1,000 kcal of energy consumption, whereas for girls this was at 1,983.9 µg per 1,000 kcal. Neither group exceeded the tolerable upper intake level for Mn. The major food groups which contributed to Mn intake in our subjects were cereals (50.8%), vegetables (21.0%), seasonings (8.9%), and pulses (7.7%). Notably, boys derived a higher Mn intake through cereals and vegetable than did girls (P < 0.001, P < 0.05). The key food sources of Mn, in descending order, were rice, soybean curd, kimchi, black rice and cereals. We propose that the results of our study may be used as a basis for follow-up studies that examine the Mn intake of children.     

Estimated Intakes and Sources of Total and Added Sugars in the Canadian Diet

National food supply data and dietary surveys are essential to estimate nutrient intakes and monitor trends, yet there are few published studies estimating added sugars consumption. The purpose of this report was to estimate and trend added sugars intakes and their contribution to total energy intake among Canadians by, first, using Canadian Community Health Survey (CCHS) nutrition survey data of intakes of sugars in foods and beverages, and second, using Statistics Canada availability data and adjusting these for wastage to estimate intakes. Added sugars intakes were estimated from CCHS data by categorizing the sugars content of food groups as either added or naturally occurring. Added sugars accounted for approximately half of total sugars consumed. Annual availability data were obtained from Statistics Canada CANSIM database. Estimates for added sugars were obtained by summing the availability of “sugars and syrups” with availability of “soft drinks” (proxy for high fructose corn syrup) and adjusting for waste. Analysis of both survey and availability data suggests that added sugars average 11%–13% of total energy intake. Availability data indicate that added sugars intakes have been stable or modestly declining as a percent of total energy over the past three decades. Although these are best estimates based on available data, this analysis may encourage the development of better databases to help inform public policy recommendations.     

Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus

Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16–41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003–2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: “high refined grains, fats, oils and fruit juice”, “high nuts, seeds, fat and soybean; low milk and cheese”, and “high added sugar and organ meats; low fruits, vegetables and seafood”. GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4–17.0) for “high refined grains, fats, oils and fruit juice” pattern, 7.5 (1.8–32.3) for “high nuts, seeds, fat and soybean; low milk and cheese” pattern, and 22.3 (3.9–127.4) for “high added sugar and organ meats; low fruits, vegetables and seafood” pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.     

A High-Sugar Diet Consumption,Metabolism and Health Impacts with a Focus on the Development of Substance Use Disorder: A Narrative Review

Carbohydrates are important macronutrients in human and rodent diet patterns that play a key role in crucial metabolic pathways and provide the necessary energy for proper body functioning. Sugar homeostasis and intake require complex hormonal and nervous control to proper body energy balance. Added sugar in processed food results in metabolic, cardiovascular, and nervous disorders. Epidemiological reports have shown enhanced consumption of sweet products in children and adults, especially in reproductive age and in pregnant women, which can lead to the susceptibility of offspring’s health to diseases in early life or in adulthood and proneness to mental disorders. In this review, we discuss the impacts of high-sugar diet (HSD) or sugar intake during the perinatal and/or postnatal periods on neural and behavioural disturbances as well as on the development of substance use disorder (SUD). Since several emotional behavioural disturbances are recognized as predictors of SUD, we also present how HSD enhances impulsive behaviour, stress, anxiety and depression. Apart from the influence of HSD on these mood disturbances, added sugar can render food addiction. Both food and addictive substances change the sensitivity of the brain rewarding neurotransmission signalling. The results of the collected studies could be important in assessing sugar intake, especially via maternal dietary patterns, from the clinical perspective of SUD prevention or pre-existing emotional disorders. Methodology: This narrative review focuses on the roles of a high-sugar diet (HSD) and added sugar in foods and on the impacts of glucose and fructose on the development of substance use disorder (SUD) and on the behavioural predictors of drugs abuse. The literature was reviewed by two authors independently according to the topic of the review. We searched the PubMed and Scopus databases and Multidisciplinary Digital Publishing Institute open access scientific journals using the following keyword search strategy depending on the theme of the chapter: “high-sugar diet” OR “high-carbohydrate diet” OR “sugar” OR “glucose” OR “fructose” OR “added sugar” AND keywords. We excluded inaccessible or pay-walled articles, abstracts, conference papers, editorials, letters, commentary, and short notes. Reviews, experimental studies, and epidemiological data, published since 1990s, were searched and collected depending on the chapter structure. After the search, all duplicates are thrown out and full texts were read, and findings were rescreened. After the selection process, appropriate papers were included to present in this review.     

Sugars and Health Controversies: What Does the Science Say?

The consumption of sugar and its relation to various potential adverse health consequences are the subjects of considerable debate and controversy. This supplement to Advances in Nutrition provides an expanded summary of a symposium held on 26 April 2014 entitled “Sugars and Health Controversies: What Does the Science Say?” as part of the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2014. The articles in the supplement discuss results of current systematic reviews and meta-analyses as well as randomized controlled trials and draw implications for public policy considerations. In addition, future research gaps are identified. Current research trials conducted with commonly consumed sugars [e.g., sucrose and high-fructose corn syrup (HFCS)] do not support a unique relation to obesity, metabolic syndrome, diabetes, risk factors for heart disease, or nonalcoholic fatty liver disease. Neurologic differences in response to studies that used pure fructose compared with pure glucose have not been confirmed using typical sugars that are consumed (i.e., sucrose and HFCS), which contain ∼50% glucose and fructose. We conclude that added sugars consumed in the normal forms in which humans consume them, at amounts typical of the human diet and for the time period studied in randomized controlled trials, do not result in adverse health consequences. Although more research trials are needed in many areas of sugar consumption and health, there is little scientific justification for recommending restricting sugar consumption below the reasonable upper limit recommended by the Dietary Guidelines for Americans, 2010 of no more than 25% of calories.     

Development of the SoFAS (Solid Fats and Added Sugars) Concept: The 2010 Dietary Guidelines for Americans

The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a “calorie” is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to “empty calories” to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010 DGAs. This information will provide practitioners, as well as the public, with valuable information to better understand the evolution of SoFAS over time.     

Neither Incretin or Amino Acid Responses,nor Casein Content,Account for the Equal Insulin Response Following Iso-Lactose Loads of Natural Human and Cow Milk in Healthy Young Adults

Human milk contains <50% less protein (casein) than cow milk, but is equally effective in insulin secretion despite lower postingestion hyperaminoacidemia. Such potency of human milk might be modulated either by incretins (glucagon-like polypeptide-1,GLP-1); glucose-inhibitory-polypeptide, GIP), and/or by milk casein content. Healthy volunteers of both sexes were fed iso-lactose loads of two low-protein milks, i.e., human [Hum] (n = 8) and casein-deprived cow milk (Cow [↓Cas]) (n = 10), as well as loads of two high-protein milks, i.e., cow (n = 7), and casein-added human-milk (Hum [↑Cas]) (n = 7). Plasma glucose, insulin, C-peptide, incretins and amino acid concentrations were measured for 240′. All milks induced the same transient hyperglycemia. The early [20′–30′] insulin and C-peptide responses were comparable among all milk types apart from the low-protein (Cow [↓Cas]) milk, where they were reduced by <50% (p < 0.05 vs. others). When comparing the two high-protein milks, GLP-1 and GIP [5’–20’] responses with the (Hum [↑Cas]) milk were lower (by ≈2–3 fold, p < 0.007 and p < 0.03 respectively) than those with cow milk, whereas incretin secretion was substantially similar. Plasma amino acid increments largely reflected the milk protein content. Thus, neither casein milk content, nor incretin or amino acid concentrations, can account for the specific potency of human milk on insulin secretion, which remains as yet unresolved.     

A Priori and a Posteriori Dietary Patterns during Pregnancy and Gestational Weight Gain: The Generation R Study

Abnormal gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We examined whether dietary patterns are associated with GWG. Participants included 3374 pregnant women from a population-based cohort in the Netherlands. Dietary intake during pregnancy was assessed with food-frequency questionnaires. Three a posteriori-derived dietary patterns were identified using principal component analysis: a “Vegetable, oil and fish”, a “Nuts, high-fiber cereals and soy”, and a “Margarine, sugar and snacks” pattern. The a priori-defined dietary pattern was based on national dietary recommendations. Weight was repeatedly measured around 13, 20 and 30 weeks of pregnancy; pre-pregnancy and maximum weight were self-reported. Normal weight women with high adherence to the “Vegetable, oil and fish” pattern had higher early-pregnancy GWG than those with low adherence (43 g/week (95% CI 16; 69) for highest vs. lowest quartile (Q)). Adherence to the “Margarine, sugar and snacks” pattern was associated with a higher prevalence of excessive GWG (OR 1.45 (95% CI 1.06; 1.99) Q4 vs. Q1). Normal weight women with higher scores on the “Nuts, high-fiber cereals and soy” pattern had more moderate GWG than women with lower scores (−0.01 (95% CI −0.02; −0.00) per SD). The a priori-defined pattern was not associated with GWG. To conclude, specific dietary patterns may play a role in early pregnancy but are not consistently associated with GWG.     

Energy,Sugars, Iron,and Vitamin B12 Content of Commercial Infant Food Pouches and Other Commercial Infant Foods on the New Zealand Market

There has been an important shift in the New Zealand infant food market over the past decade, with the majority of complementary foods now sold in “pouches”. Along with the increasing market share of commercial infant food pouches internationally, there have been growing concerns about their nutritional quality. However, research examining the nutritional quality of these pouches compared to other forms of commercial infant foods in New Zealand has not been undertaken. Nor have any studies reported the free sugars or added sugars content of these foods. To address this knowledge gap, a cross-sectional survey of infant foods sold in New Zealand supermarkets was conducted in 2019–2020. Recipes and nutrient lines were developed for the 266 foods identified (133 food pouches). The energy, iron, vitamin B12, total sugars, free sugars, and added sugars content of infant food pouches and other forms of commercial infant foods per 100 g were compared, both within food groups and by age group. Infant food pouches contained similar median amounts of energy, iron, and vitamin B12 to other forms of commercial infant foods but contained considerably more total sugars (8.4 g/100 g vs. 2.3 g/100 g). However, median free sugars and added sugars content was very low across all food groups except for “dairy” and “sweet snacks”. All “dry cereals” were fortified with iron whereas none of the infant food pouches were. Therefore, consuming food pouches to the exclusion of other commercial infant foods may place infants at risk of iron deficiency if they do not receive sufficient iron from other sources.