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

Fox, Mary Kay; Gearan, Elizabeth; Schwartz, Colin

doi:10.3390/nu13020471

Cited by 18 publications

(17 citation statements)

References 29 publications

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“…Furthermore, about a quarter of the food items available in school canteens were classified as prohibited based on the new revised list of prohibited food and beverage items. This pattern of high-sugar content is consistent with previous studies in primary school canteens in Malaysia [32] and school meals reported in the United States [30,33]. The present findings emphasise that the dietary pattern of high sugar contents found in foods and beverages in school canteens is a major concern.…”

Section: Discussionsupporting

confidence: 92%

Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia

Foo

Tan

2021

Nutrients

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Schools are an important food environment to cultivate and promote healthy food choices and practices among children and adolescents. The aim of the present study was to assess the type and quality of food and beverages sold in school canteens in public primary and secondary schools in Kelantan, Malaysia. Eligible schools were randomly selected from the list of all schools and detailed information of all food and beverage items sold in the school canteens were collected during school days. Food and beverages were classified based on food groups derived from the Malaysian Food Dietary Guideline and the Recommended Foods for Healthy Cafeteria Guideline. An assessment of the traffic-light nutrition food-labelling system of the total sugar content in all pre-packaged foods was also undertaken. A total of 568 food items were identified, with secondary school canteens selling a greater proportion of food items than the primary schools (55.5% vs. 44.5%). In terms of the main food groups, grains and cereal products represented the largest food group served (33–36%), followed by beverages (21–25%) and confectionary and sweet foods (12–13%). In contrast, the vegetable and fruit group represented the smallest proportion of food items sold (1–3%). Comparisons between primary and secondary schools showed a similar trend and pattern of food types and quality of foods sold, except for animal-based foods. A greater percentage of food items in this category was found among secondary schools (12.1%) versus primary schools (6.7%). When total sugar content of all pre-packaged foods was quantified based on the traffic-light nutrition-labelling system, almost one-third of foods and beverages were classified as high (29.1%). Confectionary (19.1%) and flavoured milk and fruit drinks (10.0%) both exceeded the recommended sugar levels of >22.5 g per 100 g and >11.25 mL per 100 m L, respectively. Only one of these packaged foods and beverages (0.9%) was classified as a healthy food choice. About a quarter of the food items available in school canteens were classified as prohibited based on a new revised list of prohibited food and beverage items. These findings indicate that, despite the Guidelines, a large number of unhealthy food items are being sold in school canteens. Hence, interventions such as sustainable healthy school canteen menus should be implemented to promote healthy food choices amongst school-aged children.

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Section: Discussionsupporting

confidence: 92%

Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia

Foo

Tan

2021

Nutrients

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“…Higher intake of sugar sweetened drinks was associated with poorer dietary choices and correlated with higher BMI and waist circumference in children [ 36 ]. In fact, a recent study by Fox and colleagues has shown increased children’s sugar intake from added sources in school breakfasts and lunches [ 37 ]. About 63% of children were shown to surpass the limit defined by the Dietary Guidelines for Americans for 24 h intake of added sugars [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, a recent study by Fox and colleagues has shown increased children’s sugar intake from added sources in school breakfasts and lunches [ 37 ]. About 63% of children were shown to surpass the limit defined by the Dietary Guidelines for Americans for 24 h intake of added sugars [ 37 ]. In adults, increased daily dietary glycemic index was positively associated with higher BMI, with little effect of the percentage of calories from total carbohydrates or total carbohydrate consumption [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Distinct Impact of Natural Sugars from Fruit Juices and Added Sugars on Caloric Intake, Body Weight, Glycaemia, Oxidative Stress and Glycation in Diabetic Rats

et al. 2021

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Although fruit juices are a natural source of sugars, there is a controversy whether their sugar content has similar harmful effects as beverages’ added-sugars. We aimed to study the role of fruit juice sugars in inducing overweight, hyperglycaemia, glycation and oxidative stress in normal and diabetic animal models. In diabetic Goto-Kakizaki (GK) rats, we compared the effects of four different fruit juices (4-weeks) with sugary solutions having a similar sugar profile and concentration. In vitro, the sugary solutions were more susceptible to AGE formation than fruit juices, also causing higher postprandial glycaemia and lower erythrocytes’ antioxidant capacity in vivo (single intake). In GK rats, ad libitum fruit juice consumption (4-weeks) did not change body weight, glycaemia, oxidative stress nor glycation. Consumption of a matched volume of sugary solutions aggravated fasting glycaemia but had a moderate impact on caloric intake and oxidative stress/glycation markers in tissues of diabetic rats. Ad libitum availability of the same sugary solutions impaired energy balance regulation, leading to higher caloric intake than ad libitum fruit juices and controls, as well as weight gain, fasting hyperglycaemia, insulin intolerance and impaired oxidative stress/glycation markers in several tissues. We demonstrated the distinct role of sugars naturally present in fruit juices and added sugars in energy balance regulation, impairing oxidative stress, glycation and glucose metabolism in an animal model of type 2 diabetes.

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“…Currently, there is no nutrition standard for added sugars in school meals. Fox and colleagues evaluated levels of added sugars in school meals [ 47 ]. The majority of schools exceeded the Dietary Guidelines limit for added sugars (no more than 10% of calories from added sugars each day) at breakfast (92%), and 69% exceeded the limit at lunch [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fox and colleagues evaluated levels of added sugars in school meals [ 47 ]. The majority of schools exceeded the Dietary Guidelines limit for added sugars (no more than 10% of calories from added sugars each day) at breakfast (92%), and 69% exceeded the limit at lunch [ 47 ]. This indicates the importance of federal, state, and local policies for strengthening nutrition standards and school food policies.…”

Section: Discussionmentioning

confidence: 99%

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

et al. 2021

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Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.

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

Cited by 18 publications

References 29 publications

Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia

Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia

Distinct Impact of Natural Sugars from Fruit Juices and Added Sugars on Caloric Intake, Body Weight, Glycaemia, Oxidative Stress and Glycation in Diabetic Rats

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

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