DOI QR코드

DOI QR Code

Ultra-processed foods and total sugars intake in Korea: evidence from the Korea National Health and Nutrition Examination Survey 2016-2018

  • Shim, Jee-Seon (Department of Preventive Medicine, Yonsei University College of Medicine)
  • Received : 2021.10.29
  • Accepted : 2021.12.13
  • Published : 2022.08.01

Abstract

BACKGROUND/OBJECTIVES: Dietary sugars intake worldwide is stable or decreasing, but overall sugars intake remains above the recommended level. Some studies suggest that ultra-processed foods (UPFs) drive excessive sugars intake. However, UPF consumption in Korea and its association with sugars intake have not yet been studied. This study aimed to estimate the contribution of UPF consumption to total sugars intake and to investigate the association between UPF consumption and total sugars intake in Koreans. SUBJECTS/METHODS: Data from the Korea National Health and Nutrition Examination Survey 2016-2018 were used, and included data on 21,075 participants aged 1+ years completed a 24-h recall. Food items reported in the 24-h recall were classified according to the NOVA system as UPFs, processed foods, processed culinary ingredients, or unprocessed or minimally processed foods. RESULTS: The average daily energy intake was 1,996 kcal, and UPFs accounted for 26.2% of the total energy intake (% TE). The average total sugars intake was 63.1 g (13.0% TE), and 44.9% of total sugars intake came from UPFs. Among the entire population, 15.8% exceeded the recommended limit for total sugars within 20% TE, and excessive total sugars intake was more prevalent among females (19.5%) and children (21.1%). The prevalence of excessive total sugars intake showed a significantly increasing tendency across the quartiles of UPF energy contribution, ranging from 11.9% in the lowest quartile to 23.2% in the highest quartile. Even after adjustment for sociodemographic variables, UPF consumption was positively associated with the prevalence of excessive total sugars intake (P for trend < 0.001). This association was similar in subgroup analyses by sex and age. CONCLUSIONS: This study suggests that UPF consumption may drive excessive intake of total sugars in the Korean diet. Our findings conclusively establish that restricting UPF consumption may be an efficient way to reduce sugars intake in Korean population.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2020R1I1A1A01064904).

References

  1. Prinz P. The role of dietary sugars in health: molecular composition or just calories? Eur J Clin Nutr 2019;73:1216-23. https://doi.org/10.1038/s41430-019-0407-z
  2. Debras C, Chazelas E, Srour B, Kesse-Guyot E, Julia C, Zelek L, Agaesse C, Druesne-Pecollo N, Galan P, Hercberg S, et al. Total and added sugar intakes, sugar types, and cancer risk: results from the prospective NutriNet-Sante cohort. Am J Clin Nutr 2020;112:1267-79. https://doi.org/10.1093/ajcn/nqaa246
  3. World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization; 2015.
  4. Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian DGlobal Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation 2015;132:639-66. https://doi.org/10.1161/CIRCULATIONAHA.114.010636
  5. Bray GA, Popkin BM. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care 2014;37:950-6. https://doi.org/10.2337/dc13-2085
  6. Sigman-Grant M, Morita J. Defining and interpreting intakes of sugars. Am J Clin Nutr 2003;78:815S-826S. https://doi.org/10.1093/ajcn/78.4.815s
  7. US Government Printing Office. Dietary Guidelines for Americans, 2020. 8th ed. Washington, D.C.: US Government Printing Office; 2020.
  8. Korean Nutrition Society, Ministry of Health and Welfare. Dietary Reference Intakes for Koreans 2020. Sejong: Ministry of Health and Welfare; 2020.
  9. Wittekind A, Walton J. Worldwide trends in dietary sugars intake. Nutr Res Rev 2014;27:330-45. https://doi.org/10.1017/S0954422414000237
  10. Lee HS, Kwon So, Yon M, Kim D, Lee JY, Nam J, Park SJ, Yeon JY, Lee SK, Lee HY, Kwon OS, Kim CI. Dietary total sugar intake of Koreans: based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. J Nutr Health 2014;47:268-76. https://doi.org/10.4163/jnh.2014.47.4.268
  11. Rauber F, Louzada MLDC, Martinez Steele E, Rezende LFM, Millett C, Monteiro CA, Levy RB. Ultraprocessed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open 2019;9:e027546. https://doi.org/10.1136/bmjopen-2018-027546
  12. Martinez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open 2016;6:e009892. https://doi.org/10.1136/bmjopen-2015-009892
  13. Cediel G, Reyes M, da Costa Louzada ML, Martinez Steele E, Monteiro CA, Corvalan C, Uauy R. Ultra-processed foods and added sugars in the Chilean diet (2010). Public Health Nutr 2018;21:125-33. https://doi.org/10.1017/S1368980017001161
  14. Machado PP, Steele EM, Louzada MLDC, Levy RB, Rangan A, Woods J, Gill T, Scrinis G, Monteiro CA. Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia. Eur J Nutr 2020;59:2783-92. https://doi.org/10.1007/s00394-019-02125-y
  15. Latasa P, Louzada MLDC, Martinez Steele E, Monteiro CA. Added sugars and ultra-processed foods in Spanish households (1990-2010). Eur J Clin Nutr 2018;72:1404-12. https://doi.org/10.1038/s41430-017-0039-0
  16. Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr 2019;22:936-41. https://doi.org/10.1017/s1368980018003762
  17. Shim JS, Shim SY, Cha HJ, Kim J, Kim HC. Association between ultra-processed food consumption and dietary intake and diet quality in Korean adults. J Acad Nutr Diet. Forthcoming 2021.
  18. Blanton CA, Moshfegh AJ, Baer DJ, Kretsch MJ. The USDA automated multiple-pass method accurately estimates group total energy and nutrient intake. J Nutr 2006;136:2594-9. https://doi.org/10.1093/jn/136.10.2594
  19. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77. https://doi.org/10.1093/ije/dyt228
  20. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Guidelines for Nutrition Survey: Korea National Health and Nutrition Examination Survey 6th (2013-2015). Cheongju: Korea Centers for Disease Control and Prevention; 2015.
  21. Korea Centers for Disease Control and Prevention. 2016-2018 Guidebook for Using the Data from Korea National Health and Nutrition Examination Survey. Cheongju: Korea Centers for Disease Control and Prevention; 2020.
  22. Yeon SY, Kweon SH, Oh KW. The daily dietary sugar intake in Korea, 2018. Public Health Wkly Rep 2020;13:359-63.
  23. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada ML, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 2018;21:5-17. https://doi.org/10.1017/S1368980017000234
  24. Ricciuto L, Fulgoni VL 3rdGaine PC, Scott MO, DiFrancesco L. Sources of added sugars intake among the U.S. population: analysis by selected sociodemographic factors using the National Health and Nutrition Examination Survey 2011-18. Front Nutr 2021;8:687643. https://doi.org/10.3389/fnut.2021.687643
  25. Fisberg M, Kovalskys I, Gomez G, Rigotti A, Sanabria LYC, Garcia MCY, Torres RGP, Herrera-Cuenca M, Zimberg IZ, Koletzko B, et al. Total and added sugar intake: assessment in eight Latin American Countries. Nutrients 2018;10:389. https://doi.org/10.3390/nu10040389
  26. Shim JS, Kang NH, Lee JS, Kim KN, Chung HK, Chung HR, Kim HJ, Ahn YS, Chang MJ. Socioeconomic burden of sugar-sweetened beverages consumption in Korea. Nutr Res Pract 2019;13:134-40. https://doi.org/10.4162/nrp.2019.13.2.134
  27. Xi B, Huang Y, Reilly KH, Li S, Zheng R, Barrio-Lopez MT, Martinez-Gonzalez MA, Zhou D. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr 2015;113:709-17. https://doi.org/10.1017/S0007114514004383
  28. Wiener RC, Shen C, Findley PA, Sambamoorthi U, Tan X. The association between diabetes mellitus, sugar-sweetened beverages, and tooth loss in adults: evidence from 18 states. J Am Dent Assoc 2017;148:500-509.e4. https://doi.org/10.1016/j.adaj.2017.03.012
  29. Bernabe E, Vehkalahti MM, Sheiham A, Aromaa A, Suominen AL. Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study. J Dent 2014;42:952-8. https://doi.org/10.1016/j.jdent.2014.04.011
  30. Anari R, Amani R, Veissi M. Sugar-sweetened beverages consumption is associated with abdominal obesity risk in diabetic patients. Diabetes Metab Syndr 2017;11 Suppl 2:S675-8. https://doi.org/10.1016/j.dsx.2017.04.024
  31. Malik VS, Hu FB. Fructose and cardiometabolic health: what the evidence from sugar-sweetened beverages tells us. J Am Coll Cardiol 2015;66:1615-24. https://doi.org/10.1016/j.jacc.2015.08.025
  32. Vandevijvere S, Jaacks LM, Monteiro CA, Moubarac JC, Girling-Butcher M, Lee AC, Pan A, Bentham J, Swinburn B. Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories. Obes Rev 2019;20 Suppl 2:10-9. https://doi.org/10.1111/obr.12860
  33. Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, Monteiro C. Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res 2014;75:15-21. https://doi.org/10.3148/75.1.2014.15
  34. Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health 2014;36:e2014009. https://doi.org/10.4178/epih/e2014009
  35. Willett WC. Nutritional Epidemiology. Oxford: Oxford University Press; 2012.