title: Added Sugar, Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context.
abstract: OBJECTIVE
  The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1-8.9 years of age in South Africa.
  
  
  METHODS
  Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined.
  
  
  RESULTS
  Added sugar intake varied from 7.5-10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1-3 years) (Q1) to 19.3% in Q4 (4-8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1-3 years), phosphorus, iron (4-8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4-8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2-29.8)% in Q4 compared to 13.0 (8.7-17.3)% in Q1, p = 0.0063].
  
  
  CONCLUSIONS
  Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4-8 year old children.
authors.affiliation: School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
authors.forename: Eleni M W
authors.initials: EM
authors.lastname: Maunder
authors.affiliation: Department of Logistics, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Nel
authors.affiliation: Division of Human Nutrition, University of Cape Town, Cape Town, South Africa.
authors.forename: Nelia P
authors.initials: NP
authors.lastname: Steyn
authors.affiliation: North West University, Potchefstroom; North West Province, South Africa.
authors.forename: H Salome
authors.initials: HS
authors.lastname: Kruger
authors.affiliation: Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, Western Cape, South Africa.
authors.forename: Demetre
authors.initials: D
authors.lastname: Labadarios
mesh_terms: D000886:Anthropometry; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology*; D002675:Child, Preschool; D004032:Diet; D002149:Energy Intake / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018977:Micronutrients; D009749:Nutrition Surveys; D009752:Nutritional Status; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology*
chemical_list: D018977:Micronutrients