Added sugar intake by adolescents: A population-based study

Braz, Marici; Assumpção, Daniela de; Barros, Marilisa Berti de Azevedo; Barros, Antonio de Azevedo

doi:10.1590/1413-81232018249.24692017

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ARTICLE • Ciênc. saúde coletiva 24 (9) • Sept 2019 • https://doi.org/10.1590/1413-81232018249.24692017 copy

Added sugar intake by adolescents: A population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of the present study was to estimate the prevalence of added sugar intake within the maximum limit of 5% of the total energy of the diet and test associations with demographic/socioeconomic characteristics, health-related behaviors and nutritional status in adolescents. A population-based, cross-sectional study was conducted with two-stage cluster sampling. The amount of free sugar in the diet was estimated using a 24-hour dietary recall. Among the 924 adolescents evaluated, only 20.1% (95% CI: 16.8-23.9) met the recommendation of not exceeding 5% of total calories with added sugar. Higher prevalence rates of adherence to the recommendation were found among males (22.0%), adolescents aged 15 to 19 years (24.3%), those born outside the state of São Paulo (30.4%), those with less screen time (27.5%), those with a lower number of household appliances (0-7: 29.5%; 8-15: 20.3%) and those with higher diet quality scores (2nd tertile: 17.7%; 3rd tertile: 37.2%). The findings demonstrate factors associated with added sugar intake from an epidemiological perspective, revealing the simultaneity of inappropriate behaviors, that is, the adolescents who consume more sugar also have longer screen time and worse overall diet quality.

Key words
Sugar; Food consumption; Adolescent; Health surveys

Variables and categories	n	%	95% CI^* ***** CI: confidence interval.
Sex
Male	466	51.0	47.6 - 54.2
Female	458	49.0	45.7 - 52.4
Total	924	100.0
Age group (in years)
10-14	508	55.0	51.2 - 58.7
15-19	416	45.0	41.3 - 48.8
Place of birth
Campinas	701	75.8	67.7 - 83.8
Other municipality in state of São Paulo	104	11.4	7.7 - 15.0
Other state	119	12.8	7.6 - 18.0
Schooling of head of household (years)
0-7	387	41.5	31.7 - 51.3
8-11	313	33.8	27.3 - 40.3
12 or more	213	24.7	16.0 - 33.2
Income per capita (in minimum wages)
< 0.5	292	31.3	24.2 - 38.4
≥ 0.5-1	300	32.0	25.6 - 38.3
> 1	332	36.7	28.6 - 44.7
Attends school
No	144	15.4	12.0 - 18.8
Yes, public	617	65.7	57.4 - 74.0
Yes, private	162	18.9	10.1 - 27.6
Physical activity during recreation
Inactive / insufficiently active	733	79.0	74.0 - 84.1
Active	191	21.0	15.9 - 26.0
Screen time (hours/day)
≤ 3	198	21.8	16.3 - 27.3
> 3	707	78.2	72.7 - 83.7
BMI (kg/m2)
Underweight / eutrophic	603	73.6	70.7 - 76.5
Overweight / obese	216	26.4	23.5 - 29.3

Variables and categories	n^* * n: number of individuals in unweighted sample;	Prevalence (95% CI)	PR (95% CI)^ CI: confidence interval; **PR: prevalence ratio;	PR _adjusted^* ***** PR adjusted for sex and/or age group; p: p-value of chi-squared test. (95% CI)
Sex		p = 0.179
Male	466	22.0 (17.3-27.4)	1	1
Female	458	18.2 (14.5-22.5)	0.83 (0.62-1.09)	0.82 (0.62-1.08)
Total	924	20.1 (16.8-23.9)
Age group (in years)		p = 0.003
10-14	508	16.6 (13.2-20.8)	1	1
15-19	416	24.3 (19.7-29.5)	1.46 (1.14-1.86)	1.46 (1.14-1.87)
Place of birth		p = 0.010
Campinas	701	18.2 (14.8-22.1)	1	1
Other municipality in state of São Paulo	104	21.2 (15.1-28.9)	1.17 (0.79-1.71)	1.15 (0.78-1.70)
Other state	119	30.4 (21.1-41.7)	1.67 (1.20-2.34)	1.58 (1.13-2.21)
Schooling of head of household (years)		p = 0.036
0-7	387	21.8 (16.3-28.4)	1	1
8-11	313	23.2 (18.5-28.6)	1.06 (0.75-1.51)	1.07 (0.76-1.51)
12 or more	213	13.2 (9.0-18.8)	0.60 (0.38-0.95)	0.59 (0.38-0.92)
Income per capita (in minimum wages)		p = 0.046
< 0.5	292	25.5 (19.7-32.3)	1	1
≥ 0.5-1	300	20.4 (15.0-27.0)	0.80 (0.56-1.13)	0.81 (0.57-1.14)
> 1	332	15.2 (10.7-21.3)	0.60 (0.39-0.91)	0.57 (0.38-0.87)
Number of appliances in home		p < 0.001
0-7	190	29.5 (21.7-38.7)	2.17 (1.40-3.38)	2.24 (1.45-3.44)
8-15	468	20.3 (16.8-24.2)	1.49 (1.05-2.12)	1.55 (1.10-2.19)
16 or more	265	13.6 (9.7-18.7)	1	1
Private health insurance		p = 0.008
Yes	310	14.4 (10.1-19.9)	1	1
No	609	23.2 (19.1-27.8)	1.61 (1.12-2.31)	1.67 (1.17-2.39)
Attends school		p = 0.012
No	144	27.8 (20.5-36.4)	2.12 (1.25-3.61)	1.87 (1.08-3.23)
Yes, public	617	20.3 (16.6-24.7)	1.55 (0.96-2.52)	1.64 (1.03-2.61)
Yes, private	162	13.1 (8.2-20.3)	1	1

Variables and categories	n^* * n: number of individuals in unweighted sample;	Prevalence (95% CI)	PR (95% CI)^ CI: confidence interval; **PR: prevalence ratio;	PR _adjusted^* ***** PR adjusted for sex and/or age group; (95% CI)
Smoking		p = 0.109
Never smoked	882	19.6 (16.3-23.3)	1	1
Ex-smoker/smoker	42	31.0 (17.4-49.0)	1.58 (0.93-2.70)	1.35 (0.77-2.36)
Use of alcoholic beverage		p = 0.118
Does not drink	773	19.1 (15.8-22.9)	1	1
Drinks	146	25.4 (17.8-34.8)	1.33 (0.93-1.88)	1.11 (0.75-1.63)
Physical activity during recreation		p = 0.126
Inactive / insufficiently active	733	18.8 (15.2-23.0)	0.75 (0.52-1.08)	0.76 (0.51-1.13)
Active	191	25.1 (18.0-33.8)	1	1
Screen time (hours/day)		p = 0.009
≤ 3	198	27.5 (21.2-34.8)	1	1
> 3	707	17.7 (14.1-22.0)	0.64 (0.46-0.88)	0.68 (0.49-0.94)
Diet quality score (tertile#)		p< 0.001
1st tertile	307	5.5 (3.3-9.3)	1	1
2nd tertile	308	17.7 (13.0-23.6)	3.20 (1.92-5.30)	3.24 (1.95-5.38)
3rd tertile	308	37.2 (31.0-43.9)	6.72 (4.03-11.19)	6.86 (4.12-11.43)
BMI (kg/m2)		p = 0.633
Underweight / ideal	603	19.5 (15.7-23.8)	1	1
Overweight / obese	216	20.6 (16.0-26.2)	1.06 (0.83-1.35)	1.13 (0.85-1.49)

Variables and categories	First step PR _adjusted^* * PR: prevalence ratio adjusted for energy (kcal) and demographic/socioeconomic variables. (95% CI)	Second step PR _adjusted^ PR: prevalence ratio adjusted for energy (kcal) and all variables in first step. (95% CI)
Sex
Male	1	1
Female	0.69 (0.52-0.92)	0.73 (0.55-1.00)
Age group (in years)
10-14	1	1
15-19	1.51 (1.18-1.94)	1.59 (1.24-2.03)
Place of birth
Campinas	1	1
Other municipality in state of São Paulo	1.15 (0.77-1.72)	1.14 (0.74-1.76)
Other state	1.41 (1.03-1.93)	1.39(1.03-1.88)
Number of appliances in home
0-7	1.93 (1.28-2.91)	1.39 (0.89-2.17)
8-15	1.46 (1.03-2.07)	1.31 (0.91-1.89)
16 or more	1	1
Screen time (hours/day)
≤ 3		1
> 3		0.74 (0.54-1.00)
Diet quality score (tertile#)
1st tertile		1
2nd tertile		3.05 (1.86-5.01)
3rd tertile		5.72 (3.41-9.58)

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[1] Collaborations

D Assumpção performed the statistical analysis, literature review and writing of the manuscript. M Braz proposed the article and contributed to the discussion section. MBA Barros and AA Barros Filho performed critical reviews of the statistical analysis and writing of the manuscript.