nutrition survey Amount nd food sources of totl sugr intke by children ges 5 to 12 yers1-3 Kren J. Morgn, Ph.D. nd Mry E. Zbik, Ph.D. ABSTRAT Averge dily consumption of sugrs by children 5 to 12 yr ws investigted by nlyses of 7-dy food diries of cross-sectionl smple of Americn children. The verge dily totl sugr consumption for the totl smple ws 134.3 g with the food group of milk contributing, on the verge, the gretest number of grms of sugrs. Other food groups mking significnt contributions to the children s totl sugr consumption were ckes, cookies. pies, nd other desserts: sweetened beverges: fruits: nd fruit juices. Spline distributions of totl sugr intke reveled few children were consuming over 28 g of sugrs per verge dy while some consumed less thn 44 g of sugrs. Spline distributions, lso indicted tht the food groups most likely to be consumed t levels resulting in excessive mounts of sugrs intke by prticulr children were sweetened beverges; ckes, cookies, pies, nd other desserts; nd fruit juices. Am. J. lin. Nutr. 34: 44-413, 1981. KEY TERMS Totl sugr consumption. children. food sources of sugrs Introduction Recently much ttention hs focused on the reltionship between children s dietry ptterns nd dentl cries. Although considerble reserch (1-4) hs concentrted on the development nd composition of dentl plque s influenced by ingestion of sucrose, other reserch (5-9) hs shown evidence tht certin other common dietry crbohydrtes my lso serve s substrtes for extrcellulr polyscchride biosynthesis in plque. Further, the form nd frequency which vrious fermentble crbohydrtes re consumed hs been found to influence the occurrence of dentl cries (8, 1-13). Edgr et l. (12) concluded tht those foods which give rise to profound flls in ph of plque fter ingestion, e.g., cookies, ckes, pies, nd cndies, should be voided in order to reduce tooth destruction. Food texture nd the frequency of eting were shown by Bibby (8) to ply n importnt role in development of dentl cries. More recent reserch by Bibby (14) showed the frequency of sugr intke to be equl to or more importnt thn mount of sugr intke. Glss nd Fleisch (1) concluded tht the criogenicity of food my be relted to its consistency, the time ofconsumption, nd the conditions under which it is eten, s well s its sugr content. These cited studies hve ll ddressed possible reltionships between the ingestion of crbohydrte nd dentl cries. However, no comprehensive studies hve been executed to ssess the sources from which the mjority of children obtin the sugrs they et. Morgn et l. (15) reported the verge totl sugr consumption of cross-sectionl smple of Americn children ges 5 to 12 yr to be 134 g dily. The study reported herein investigtes the food sources of this totl sugr consumption by children. The totl sugr vrible ws composed of ll simple sugrs From the Deprtment of Food Science nd Humn Nutrition, Michign Stte University. Est Lnsing. Michign 48824. 2 Published s Michign Agriculturl Experiment Sttion Journl Article no. 9122. Address reprint requests to: Dr. Kren J. Morgn. 236B Food Science Bldg.. Michign Stte University. Est Lnsing, Michign 48824. 44 The Americn Journl of linicl Nutrition 34: MARH 1981, pp. 44-413. Printed in U.S.A. 1981 Americn Society for linicl Nutrition Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
TOTAL SUGAR 1N HILDREN S DIETS 45 including glucose, sucrose, lctose, mltose, nd other reducing scchrides. Both verge consumptions nd distribution of consumptions were ssessed for 13 food groups nd for four ge clssifictions of children. Methods A smple popultion of 657 rndomly selected, United Sttes children ges 5 to 12 yr were utilied in this investigtion. Seven-dy food diries were collected in fll 1977. Procedures for collecting. coding. nd nlying the food intke of the smple children hs been described by Morgn et l. (15). The smple of children is highly representtive of cross-sectionl smple of middle to upper-middle clss, two prent fmilies composed of four to six members with prents who hve ttined n eductionl level somewht higher thn the generl popultion. Most of the children were found to hve consumed dequte mounts ofthe 25 nutrients for which evlution ws done: however. frequent low intkes were found for vitmin B,,. clcium. mgnesium. nd inc. For this investigtion the totl smple (n = 657) ws nlyed, s well s, four individul ge groupings: 5 to 6 yr olds (n = 162), 7 to 8 yr olds (n = 168). 9 to $ yr olds (n = 165), nd 1 I to 12 yr olds (n = 162). The five smple clssifictions were utilied to ssess totl sugr consumption from ll foods consumed nd from thirteen groupings of the foods. These food clssifictions were: brekfst cerels: ckes, cookies, pies nd other desserts: cndy subdivided into chocolte nd/or chocolte contming, crmel nd/or crmel like, hrd, nd ll othcr5; crckers, breds nd wffles:5 dessert suces: donuts nd sweet rolls; fruit: fruit juices: jellies. syrups nd tble sugr: milk: sweetened beverges: sweetened diry products nd froen confections: nd ll other food items.9 After determining verge (nd stndrd devition) consumption of totl sugr for the vrious ge clssifictions nd from the 13 food groups, generl liner model, SAS ( 16) computer progrm, ws used to test for significnt differences mong the observed mens. Duncn s multiple rnge test ( 17) ws then utilied to pin-point further the source ofthe significnt differences. To provide more complete description of sugr consumption, verge dily consumption (bsed on 7-dy record) for individul children grouped by ech of four ge clssifictions ws plotted through use of computeried progrm on the Michign Stte University D 65 which provided lest squre cubic spline pproximtion following the procedures of Ahlberg et I. ( 18). The procedure, which is n effective tool in elementry processes of interpoltion nd pproximte integrtion. ws lso used to project the distribution of totl sugr consumption from the intke of the thirteen food groups for the totl smple. To obtin more visible curve on the digrm, the observtions for ero consumption of ny given food group were not included in the spline plots but hve been reported in the text. ln n ttempt to closely exmine the sources of sugrs in diets of children who consume reltively lrge quntities of totl sugr, the smple ws prtitioned into three clsses: 1) 25% (n = 164) of smple who consumed the gretest quntities of totl sugr, 2) 25% (n = 164) of smple who consumed the smllest quntities of totl sugr. nd 3) 5% (n = 329) of smple who consumed wht might be considered n verge mount of totl sugr. lss I. composed ofthose children who consumed reltively lrge quntities of sugrs. ws then nlyed for food sources of their totl sugr intke by the sme methods utilied in investigting the totl smple. Results nd discussion Anlyses of the totl smple of children indicted the verge dily consumption of totl sugr ws 134.3 g with stndrd devition of 48. 1 g (Tble 1). When totl smple ws broken into four ge groups (Tble 3), the verge dily consumption of totl sugr by 5 to 6 yr olds (124.8 g) ws found to be significntly less (p.5) thn tht of the 9 to 1 yr olds (133.7 g) nd the 1 1 to 12 yr olds (143.2 g). However, when totl sugr consumption ws ssessed in reltion to verge totl cloric consumption by the vrious ge groups (1941 kcl for 5 to 6 yr olds, 21 kcl for 7 to 8 yr olds, 2231 kcl for 9 to 1 yr olds, nd 2369 for 1 1 to 12 yr olds), children in the older groups were found to hve obtined lower percentge of clories from sugrs consumed thn the younger ged children (25.7% for 5 to 6 yr olds, 25.8% for 7 to 8 yr olds, 24.% for 9 to 1 yr olds, nd 4 The food group of ckes, cookies, pies. nd other desserts lso contined puddings, geltin desserts. nd specilty items such s chocolte torte. 5 The food group of crckers. breds nd wffles lso contined pi, stuffings, muffins. biscuits, noodles nd rice. I) The food group of donuts nd sweet rolls lso contined brekfst brs nd sweet breds such s bnn bred.. The food group of sweetened beverges included both crbonted drinks, e.g., cols. nd non-crbonted drinks, e.g., reconstituted powdered drink mixes. 1cmonde nd fruit drinks. 8 The food group of sweetened diry products nd froen confections included ll forms of ice crem nd sherbet, froen novelties such s ice crem brs, flvored milk, nd yogurt. 9 The food group of other food items ws composed of such items s mets, vegetbles. eggs. combintion min mel dishes, nuts. condiments nd ll types of slted chips. Spline is technique to compute lest squre cubic spline pproximtion to set of dt points. The cubic spline is piecewise cubic polynomil over n intervl whose end points re clled knots. The number nd loction of the knots determine the resultnt pproximtion. Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
46 MORGAN AND ZABIK TABLE 1 Men nd SD of dily totl sugr consumption (bsed on 7-dy diries) by children ges 5 to 12 yr (n = 657) nd men, SD, nd percentge of totl sugr obtined from 13 food groups Food groupt Men (g) nd SD Percentge of totl sugr Brekfst cerels 4.2± 4.6 3.3 kes, cookies, pies, nd 15.3± 13.4 11.2 other desserts ndy 3.7± 6.2 2.6 rckers, breds, wffles 5.2± 4. 4.1 Dessert suces 4.5± 13.6 2.5 Donuts nd sweet rolls 2.2± 42h 1.6 Fruit 17.1±3.1 11.5 Fruit juices 12.± 14.6 8.8 lellies. syrups, nd tble 12.8± 11. 9.8 sugr Milk 25.9± 14. 2.4 Sweetened beverges 17.9± I6.4 13.8 Sweet diry products nd 7.4± 8.4 5.5 froen confections Other food items 6.1± 3.4 4.9 All foods (totl) 134.3± 48.1 1. Totl sugr is composed of ll simple sugrs including glucose, sucrose, lctose, mltose, nd other reducing scchrides. t See footnotes in text for composition ofgood groups. :1:Mens with the sme letter re not significntly different (p <.5) (Duncn, 1957). 24.2% for 1 1 to 12 yr olds). These differences were not found to be sttisticlly significnt. Tble 1 illustrtes tht, on the verge, significntly greter (p s.5) quntities of totl sugr were obtined from the consumption of milk thn from the other 12 food groups. The consumption of sweetened beverges nd fruits contributed the second nd third gretest verge quntities of sugrs (17.9 nd 17. 1 g, respectively) to the verge child s diet nd were found to be significntly greter thn ll other food groups sugrs contribution except, s previously indicted, tht of milk (25.9 g). Utiliing Tble 2, it cn be observed tht, on the verge, these children consumed slightly more thn two 8-o glsses of milk per dy, less thn 8-o of sweetened beverge, nd vrible mount of fruit depending on type nd preprtion (pple = 15.7 g sugrs nd /2 cup cnned peches in syrup = 25.3 g sugrs). kes, cookies, pies, nd other desserts consumption by the smple popultion mde significntly greter (p.5) impct on verge totl sugr consumption thn ny of the remining nine food groups. Although there ws no sttisticlly significnt difference between the verge mount of sugrs obtined from the ingestion of fruit juices nd jellies, syrups nd tble sugr, the consumption ptterns for these two food groups were found, on the verge, to contribute more totl sugr TABLE 2 Totl sugr content in serving of selected foods Whole Food erels: rem of whet orn flkes Apple lck s Desserts: Angel cke hocolte cke, iced hocolte chip cookie Apple pie nill pudding ndy: hocolte br with lmonds rmel Butterscotch ke donut, plin innmon bun, plin milk #{19} cup I cup or I o I cup or 1 o /i2th of tube cke /12th of 9 lyercke 2 inch dimeter /th of 9 pie /2 cup 1 o br Apple nned peches / cup with hevy syrup Ornge juice. fresh 4 o glss ondiments: tsup Pickle Jelly Sweetened relish Beverges ol type ol Lemonde nill ice crem Ice crem br Sugr 1 tblespoon 1 tblespoon 1 tblespoon 8 o glss 8 o glss 12 o cn 8 o glss i/ cup 1 tespoon Sersing Serving sie weight g 2. 1. 28.4 2. 28.4 16. 52.9 92. 18. 157.9 147. 28.4 1. 5. 42. 5. 25. 39.6 6.7 33.9 15.4 14.4 7.6 4.7 8.4 2.8 138. 15.7 128. 25.2 124. 12.2 15. 3.4 15..6 2. 14.1 244. 11.5 246.4 369.6 248. 66.5 47. 4.2 Totl sugr seming g 24.9 37.4 26.5 15.9 in 8.5 4.2 Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
TOTAL SUGAR IN HILDREN S D1ETS 47 to the children s diets thn sweetened diry products nd froen confections; crckers, breds nd wffles; cndy: donuts nd sweet rolls; dessert suces; brekfst cerels; nd the group of ll remining food items. As indicted in Tble 1, there were significnt differences mong the remining food groups whose consumption contributed to the verge totl sugr ingestion in the following descending order: sweetened diry products nd froen confections; other food items; crckers, breds nd wffles; dessert suces; brekfst cerels; cndy; nd donuts nd sweet rolls. Though these rnk orderings of food groups re of interest in understnding sources of sugrs in children s diets, certinly no conclusions cn be drwn between these findings nd possible cries ctivity becuse: 1) no distinction hs been mde between time of consumption, i.e., mel versus between mel consumption, 2) no recognition hs been mde of the vrying sugrs retention on the surfces of the teeth of the vrious food stuffs, nd 3) no distinction hs been mde between the reltive criogenicity of liquid versus solid sugrs. All of these fctors hve been found to impct on cries ctivity (8, 1, 12, 14, 19). ndy ws subdivided into four clssifictions for dditionl ssessment. This nlysis indicted chocolte nd chocolte contming cndy contributed on the verge, significntly greter mounts of sugrs (2.4 g) thn did crmel (.6 g), hrd (.5 g). or other types of cndies (.2 g). These consumption ptterns for cndy re of interest since it hs been reported tht chocolte, which contins lrge proportion of ft, my decrese the cries-promoting effect of sugr nd my contin smll mounts of ntienymtic nd ntibcteril substnces (19). When the smple ws clssified into four seprte ge groups nd the thirteen food groups were nlyed, no significnt differences were found mong the ge groups for the verge mount of totl sugr obtined from the consumption of milk; brekfst cerels; cndy; fruit; fruit juices; dessert suces; nd jellies, syrups, nd tble sugr (Tble 3). This indictes tht the verge 5- to 12-yr-old child, regrdless of specific ge clssifiction, consumed similr quntities of these food items. However, for the remining seven food TABLE 3 Mens nd SD for dily consumption (bsed on 7-dy diries) of totl sugrs nd totl sugr obtined from 13 food groups by four children s ge clssifictions (5 to 6 yr. 7 to 8 yr. 9 to 1 yr. nd 11 to 12 yr). Food groupt Men (g) nd SDf 5 6 yr (n - 162) 7 8 yr n - 16$) 9-1 yr (n - 65) I 1-12 yr In - 62) Brekfst cerels kes, cookies, pies, nd other desserts ndy rckers. breds, wffles 4. 1 ± 4.3 13.1 ± I 1.1 3.7 ± 5.6 4.4 ± 4. 4.5 ± 4.8 14.9 ± 13.2 3.3 ± 4.6 4.8 ± 3.? 4. ± 4.4 17.8 ± 15.5 3.6 ± 6.4 5.5 ± 3.9 6 4. ± 4.8 15.6 ± 13. 4.2 ± 6.4 6.1 ± 4.6 Dessert suces 4.4 ± 14.6 5.3 ± 14.6 4. ± 12.6 4.4 ± 12.8 Donuts nd sweet rolls 1.4 ± 2.3 2. 1 ± 4.3 6 2.5 ± 44U 2.7 ± 5.2 Fruit 14.8 ± 22.2 19.3 ± 14.4 16.5 ± 12.5 17.7 ± 31.2 1 1.1 ± 13.9 1 1.8 ± 1.1 25.6 ± 18.2 19.3 ± 17. 6 5.9 ± 5.6 13.3 ± 18.7 12.4 ± 1.4 25.4 ± 12.7 16.1 ± 15.56 7.6 ± 8.4 13.2 ± 13.9 13.4 ± 1 1.5 25.4 ± 1.6 14.8 ± 12.8 1.4 ± 1.5 13.4 ± I 1.8 27.4 ± 13.6 21.7 ± 18.9 8.9 ± 8.5 Fruitjuices lellies, tble sugr. nd syrups Milk Sweetened beverges Sweetened diry products nd fro- 7.2 ± 9.9 6 en confections Other food items 4.9 ± 4. 4.9 ± 4.86 5.2 ± 296 6.2 ± 3.6 All foods (totl) 124.8 ± 45.5 135.3 ± 53.3 133.7 ± 42.9k 143.2 ± 48.? 5 Totl sugr is composed of ll simple sugrs including glucose. sucrose, lctose, mltose, nd other reducing scchrides. t See footnotes in text for composition of food groups. :1:Row mens without letters nd row mens with sme letters re not significntly different (p <.5) (Duncn, 1957). Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
48 MORGAN AND ZABIK groups, significnt differences (p.5) were ssessed mong the ge clssifictions. For exmple, the 5 to 6 yr olds nd the 7 to 8 yr olds were found, on the verge, to obtin significntly less totl sugr from the consumption of ckes, cookies, pies, nd other desserts thn the 9 to 1 yr olds. Further, children in these two ge clssifictions s well s the 9 to 1 yr olds consumed significntly less sugrs from eting the foods contmed in the group of ll other food items thn did the I I to 12 yr olds. As cn be seen in Tble 2, there were few sttisticlly significnt differences between the ge clssifictions of 5 to 6 nd 7 to 8 yr for the mount of sugrs obtined from the vrious food groups. Similrly, there were few sttisticlly significnt differences found between the 9 to 1 nd 1 1 to 12 yr olds. Exceptions to this generl pttern were found for the food group of sweetened beverges. The children of ges 7 to 8 nd 9 to 1 were found, on the verge, to hve obtined significntly smller quntities of sugrs from the consumption of sweetened beverges thn the 11- to 12-yr old children; however, there ws no significnt difference mong the 11 to 12 yr olds nd the 5 to 6 yr olds. Figure 1 provides more complete description of the totl sugr consumption by the four ge clssifictions. As evidenced in this figure, the group of children of ges 5 to 6 yr hd less consistent verge consumption ptterns thn the other three ge clssifictions. The spline pproximtion indictes consumption peked, i.e., lrgest number of children consumed t specified level, t both 83 nd 124 g oftotl sugr, wheres for the other ge groups of 7 to 8 yr. 9 to 1 yr. nd 1 1 to 12 yr consumption peked only once t 122, 12, 124 g, respectively. These most common levels of totl sugr consumption re considerbly less thn the clculted verge consumption figures for the vrious ge groups. Such findings indicte tht some children in the smple re consuming rther lrge mounts of sugr nd thus contributing to higher men consumption figure. This consumption pttern is especilly prevlent mong the 7- to 8- nd 9- to 1-yr-old smple. As indicted in Figure 1, these two groups of children hd few members who consumed, on the verge, over 28 g of sugrs per dy. Figure 1 lso shows tht few children consumed less thn 44 g of sugrs in n verge dy. A further description of sources of totl sugr consumed by children is portryed in Figures 2 through 5. The number of ero consumption observtions, i.e., no consumption of product during week, is not plotted on figures s such would distort the spline p- 6 14. 12-5-6 yers 7-8 yers 9-1 yers U12 yers -c 4-8 6 4. 2. I...,, 4 8 2 16 2 24 28 32 gm Totl Sugr I FIG. I. Spline distributions of verge dily consumption of totl sugr by four ge groups of children. Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
TOTAL SUGAR IN HILDREN S DIETS 49 16 12 Donuts, Sweet Rolls, rckers, Breds, Wffles 8 4 16 32 48 64 gm Totl Sugr gm Totl Sugr 16 Brekfst erels 12 Sweetened Diry Products nd Froen onfections j8 4 24 32 16 32 48 64 gm Totl Sugr gm Totl Sugr FIG. 2. Spline distributions of verge dily intke of totl sugr from the consumption of sweetened diry products nd froen confection: donuts nd sweet rolls: crckers, breds, nd wffles; nd brekfst cerels by children ges 5 to 12 yr. I l As evidenced in Figures 2 nd 3 the lrge mjority of children obtined rther smll mounts of totl sugr, on n verge dily bsis, from the ingestion of sweetened diry products nd froen confections; donuts nd sweet rolls; crckers, breds nd wffles; brekfst cerels; cndy; jellies, syrups nd tble sugr; nd ll other foods. These figures show tht few children obtmed sible quntities of sugrs from prticulr food groups even though the mjority of children did not. For exmple, few children consumed jellies, syrups nd tble sugr t such level s to obtin nerly 65 g from it during the verge dy even though the mjority of the smple children received bout 7 g of sugrs per verge dy from the consumption of jellies, syrups, nd tble sugr. Similr findings re seen for the food groups donuts nd sweet rolls, cndy, nd ll other foods. ery different findings were obtined for the food groups milk; ckes, cookies, pies, nd other desserts; nd fruit. As indicted in Figure 4, these food groups contributed to more norml distribution pttern of totl sugr intke. Although tils were obtined t the upper end of these curves, thus indicting children consumed lrge quntities of some of these items, most children exhibited consumption ptterns of ner norml distributions of these foods. Somewht different distributions were obtined for the remining three food groups, i.e., sweetened beverges, fruit juices, nd dessert suces. For these food Number of ero observtions for ech food group ws: sweetened beverges, 69: sweetened diry products nd froen confections, 129: ckes, cookies, pies. nd other desserts, 3: donuts nd sweet rolls, 317: jellies. syrups nd tble sugr, 25: dessert suces, 369: fruit. 68: cndy, 327: fruit juices. 115: milk 4: crckers, breds. nd wffles, 5: brekfst cerels, 76: nd ll other foods. 6. Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
41 MORGAN AND ZABIK Jellies, Syrups, nd Tble Sugr contribute lrge quntities of sugrs to some children s diets, the food consumption ptterns of smple children who were identified s hving consumed greter thn verge mounts of sugrs (25% of smple (n = 164) who consumed the gretest quntities of totl sugr) were investigted. Results of this s- 32 2 6 8 gm Totl Sugr 64 : J\,,,,kes.ookie,ies 16 48 32 16 4 gm Totl Sugr 16 32 48 64 gm Totl Sugr 2 2O 1:;,,,,,//t 5\% All Other IOther Foods 4 8 12 16 gm Totl Sugr lb 24 32 gm Totl Sugr FIG. 3. Spline distributions of verge dily intke of totl sugr from the consumption of cndy: jellies. syrups, nd tble sugr: nd ll other foods by children ges 5 to 12 yr., Milk groups, s shown in Figure 5, mny children obtined pproximtely 4 g of sugrs from eting the vrious items; however, quite few children lso obtined lrge quntities of sugrs from consumption of them, i.e., 8 to 1g. To further investigte foods which my gm Totl Sugr FIG. 4. Spline distributions of verge dily intke of totl sugr from the consumption of milk: ckes. cookies, pies, nd other desserts; nd fruit by children ges 5 to 12 yr. Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
TOTAL SUGAR IN HILDREN S DIETS 411 64 48 3 1#{128} 16 12 oi Fruit Juices gm Totl Sugr Dessert Suces order were milk, sweetened beverges, fruit, nd ckes, cookies, pies nd other desserts. The verge mount of totl sugr consumed by the prtitioned smple (n = 164) ws 23 g s compred to the verge mount of 134.3 g for the totl smple. The verge contribution of sugrs mde by ech of the 13 food groups incresed for the 25% of smple children consuming greter thn verge qun- I I I tities of sugrs thus indicting tht the 12 16 mount of food consumed within ech food group incresed for this smple. Lrgest grm increses were evidenced for the following food groups: fruit (14.2 g), milk (9 g), ckes, cookies, pies, nd other desserts (8.7 g) nd dessert suces (8. 1 g). omprison of the percentge of totl sugr contributed by ech of the food groups for the totl smple versus the 25% of smple consuming greter thn verge quntities of sugrs indicted dessert suces, fruit, nd fruit juices hd the gretest impct on incresed totl sugr consumption wheres the percentge contribution ofjellies, 64 gm Totl Sugr TABLE 4 Men nd SD ofdily totl sugr intke by children ges 5 to 12 yr who consumed bove verge mounts oftotl sugr (n = 164) nd men, SD, nd percentge of totl sugr obtined from 13 food groups 48 Percentge Food groupt Men IgI nd SDf of totl sugr g 32 2 it Sweetened Beverges 12 gm Totl Sugr 16 FIG. 5. Spline distributions of verge dily intke of totl sugr from the consumption of sweetened beverges, fruit juices, nd dessert suces by children ges S to 12 yr. sessment, displyed in Tble 4, indicte tht for these children prime food sources of sugrs were milk (34.9 g), fruit (3 1.3 g). ckes, cookies, pies nd other desserts (24. g) nd sweetened beverges (23.9 g). These rnk order findings re similr to tht of the totl smple, i.e., top four contributors in rnk Brekfst cerels 5.2 ± 5.5 I 2.8 kes, cookies, pies, nd 24. ± 17.66 12.1 other desserts ndy 5.5 ± 8.2 2.8 rckers, breds, wffles 6.2 ± 4.3 3.2 Dessert suces 12.6 ± 23.6 5.8 Donuts nd sweet rolls 3.4 ± 6.4 I.8 Fruit 31.3 ± 55.3 13.4 Fruitjuices 19.5 ± 21.3 9.9 Jellies. syrups nd tble 17.1 ± 12.5 8.8 sugr Milk 34.9 ± 19.8 17.6 Sweetened beverges 23.9 ± 21. 12.1 Sweetened diry prod- 1 1.7 ± 12.6 5.7 ucts & froen confections Other food items 7.8 ± 4.7 4. All foods (totl) 23.1 ± 87.8 1. Totl sugr is composed of ll simple sugrs including glucose, sucrose, lctose, mltose, nd other reducing scchrides. t See footnotes in text for composition of food groups. :1:Mens with the sme letter re not significntly different (p :5.5) (Duncn, 1957). Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
412 MORGAN AND ZABIK syrups nd tble sugr, milk, sweetened beverges, nd crckers, breds, nd wffles decresed significntly for the hevier sugrs consumers. These findings suggest tht sources of totl sugr for children who consumed less pproprite quntities of sugrs (top 25% of smple) were widely vried but food groups of dessert suces, fruits, fruit juices, nd ckes, cookies, pies, nd other desserts hd greter impct on incresed sugrs consumption levels thn did the remining nine food groups. Summry nd recommendtions This study hs ssessed the verge dily totl sugr consumption of rndomly Selected smple of Americn children ges 5 to 12 yr old. Findings reveled these children were consuming, on the verge, 134 g of sugrs per dy. hildren ges 5 to 6 yr were found to hve consumed significntly (p.5) less totl sugr thn 7 to 8, 9 to 1, nd I 1 to 12 yr olds. However, this difference in intke level ws not found to be sttisticlly significnt when comprisons mong ge groups were mde for percentge of clories from sugrs consumed. Anlyses designed to unveil the food sources of these totl sugr consumption ptterns indicted milk to be the food group contributing the gretest verge mount of sugrs (25.9 g) nd the food group composed of sweetened beverges to hve contributed the second gretest verge mount of sugrs (17.9 g). This food group ws followed by fruit, i.e., contribution of 17. 1 g/verge dy. On the other hnd, the food groups contributing the lest mount of totl sugrs to the children s verge dily intke of sugrs were, in descending order, brekfst cerels (4.2 g), cndy (3.7 g). nd donuts nd sweet rolls (2.2 g). A number of sttisticlly significnt differences were found mong the thirteen food groups when contribution to totl sugr intke ws ssessed. Since verge intkes re of limited vlue in ssessing food consumption ptterns, distribution plots were mde for the four ge clssifictions nd for the 13 food groups. The spline distributions by ge clssifictions showed consumption ptterns vried somewht with few children consuming s much s 28 g of sugrs per verge dy. Similr plots for food groups indicted tht the food groups of sweetened beverges; ckes, cookies, pies, nd other desserts; nd fruit juices my be sources for excessive totl sugr consumption for some children. Although this study hs reveled totl sugr consumption ptterns for children nd hs indicted probble sources of this totl sugr intke, no ttempt hs been mde to relte this consumption to the occurrence of dentl cries. Further, consistency ofthe food contining the sugrs, time of consumption ofthe sugrs, nd conditions under which the sugrs were eten hs not been ssessed. Additionl studies in this re re sorely needed to ssess whether or not there exists reltionship between diet nd the occurrence of dentl cries. In depth, longitudinl nlyses re recommended; methods for ssessing diet composition nd nutrient nlyses of foods re now sophisticted enough to be used in ssessing their reltionship to dentl helth. A study should be designed to ssess dentl helth every yer over 5-yr period with food consumption ptterns of the study prticipnts being ssessed every 6 months vi the utilition of 7-dy food diries. References 1. Fry AJ. Grenby TH. The effects of reduced sucrose intke on the formtion nd composition of dentl plque in group of men in the Antrctic. Arch Orl Biol 1974:17:873-82. 2. rlsson I. Presence of vrious types of non-hemolytic streptococci in dentl plque nd in other sites in the orl cvity. Odont Revy 1967:18:55-74. 3. rlsson J, Sundstorm B. ritions in composition of erly dentl plque following ingestion of sucrose nd glucose. Odont Revy l968;l9:161-7. 4. Newbrun E. Sucrose, the rch criminl of dentl cries. Odont Revy 1967:18:373-86. 5. Lech SA, Green RM, Hyes ML, Dd OA. Biochemicl studies on the formtion nd composition of dentl plque in reltion to dentl cries: extrcellulr polyscchride. J Dent Res 1969:48:81 1-7. 6. ritchley P, Wood IM, Sxton A. Lech SA. The polymeristion of dietry sugrs by dentl plque. ries Res 1967:1:112-29. 7. Higuchi M, Iwmi Y, Ymd T, Ary S. Levn synthesis nd ccumultion by humn dentl plque. Arch Orl Biol 197:15:563-7. 8. Bibby BG. The criogenicity of snck foods nd confections. I Am Dent Assoc 1975:9:121-32. 9. Mkien KK. The role of sucrose nd other sugrs in the development of dentl cries: review. tnt Dent 1 1972:22:363-86. 1. Glss RL, Fleisch S. Diet nd dentl cries: dentl cries incidence nd the consumption of redy-to- Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218
TOTAL SUGAR IN HILDREN S DIETS 413 et cerels. I Am Dent Assoc 1974:88:87-13. 11. Adti AK. Diseses ssocited with refined crbohydrtes: dentl cries nd periodontl disese. Plnt Foods Mn 1974:1:81-9. 12. Edgr WM, Bibby BG, Mundorif S. Rowley I. Acid production in plques fter eting sncks: modifying fctors in foods. I Am Dent Assoc 1975:9:418-25. 13. Plmer ID. Dietry hbits t bedtime in reltion to dentl cries in children. Br Dent 1197 1:13:288-93. 14. Bibby BG. Food reltionship to cries. Proceedings workshop on criogenicity of food, beverges, confections, nd chewing gum. Am Dent Assoc Helth Found, Sept 1977:29-44. 15. Morgn KI, Zbik ME, l R, Leveille GA. Nutrient intke ptterns for children ges 5 to 12 yers bsed on seven-dy food diries. Est Lnsing. Ml: Michign Stte University, Agriculturl Experiment Sttion, 198 (Reserch report no. 46). 16. Brr Al, Goodnight JU. Sil IS. Helwig IT. A user s guide to SAS 76. Rleigh, N: Sprks Press, 1976:127-8. 17. Duncn DB. Multiple rnge test for correlted nd heteroscidstes mens. Biometrics 1957:13:164-76. 18. Ahlberg JU, Nelson EN, Wlsh IL. The theory of splines nd their ppliction. New York: Acdemic Press, 1967. 19. Gustfsson BE, Quensel. Lnke LS. et l. The ipeholm dentl cries Study. Act Odontol Scnd 1954:XI:232-364. Downloded from https://cdemic.oup.com/jcn/rticle-bstrct/34/3/44/4692967 on 13 Mrch 218