WHO South-East Asia Journal of Public Health
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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 90-94

Free sugar intake and dietary sources among adult population in Brunei: The national health and nutritional status survey


1 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
2 Health Promotion Centre, Ministry of Health, Brunei Darussalam
3 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam; School of Nursing, University of Michigan, USA

Date of Submission15-Oct-2020
Date of Decision29-Jan-2022
Date of Acceptance28-Feb-2022
Date of Web Publication30-Apr-2022

Correspondence Address:
Dr. Nur Zakirah Hamdani
Universiti Brunei Darussalam, Gadong
Brunei Darussalam
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WHO-SEAJPH.WHO_SEAJPH_275_20

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  Abstract 

High sugar consumption is associated with increased risk of noncommunicable diseases. This study identifies the dietary sources of free sugars and explores association of sugar intake with related factors among adult population in Brunei. Data from the National Health and Nutritional Status Survey 2010, of 1559 adult residents of Brunei, aged 18–75 years, were extracted and analyzed. The results revealed that mean daily free sugar intake was 55.5 g/day (standard deviation [SD] -51.4), contributing to 14.5% of total energy intake. The prevalence of free sugar intake of <10% and 5% among the adult population was 60.1% (95% confidence interval [CI]: 57.6, 62.5) and 82.6% (95% CI: 80.6, 84.4), respectively. Free sugar from sugar-sweetened beverages was sourced from beverages prepared with sugar (17.9%), cordial and syrup (15.1%), and carbonated drinks (14.6%). Free sugar consumption was significantly higher in men (66.6 g/day, SD – 61.2) than women (46.2 g/day, SD – 39.1) (P < 0.001). Younger participants had significantly higher free sugar intake and percentage of energy from free sugar compared to older participants. This study provides justification for addressing sugar intake as a component of strengthening nutrition policy in Brunei.

Keywords: Adults, dietary sources, free sugars, national health nutritional status survey


How to cite this article:
Hamdani NZ, Haji Kamis HZ, Rahman HA. Free sugar intake and dietary sources among adult population in Brunei: The national health and nutritional status survey. WHO South-East Asia J Public Health 2021;10:90-4

How to cite this URL:
Hamdani NZ, Haji Kamis HZ, Rahman HA. Free sugar intake and dietary sources among adult population in Brunei: The national health and nutritional status survey. WHO South-East Asia J Public Health [serial online] 2021 [cited 2023 Feb 5];10:90-4. Available from: http://www.who-seajph.org/text.asp?2021/10/2/90/344473


  Introduction Top


Free sugars refer to the monosaccharides and disaccharides added to foods and drinks by the manufacturer, cook, or consumer, and not the sugars naturally present in honey, syrups, fruit juices, and nectar juices.[1] The high consumption of free sugars is of concern as it is associated with an increased risk of dental caries, obesity, and risk of noncommunicable diseases (NCDs).[2],[3] A systematic review and meta-analysis of 39 clinical trials concluded that higher intake of sugar raised triglyceride levels, resulted in weight changes and raised blood pressure.[4]

The World Health Organization (WHO) strongly recommended reducing the intake of free sugars to <10% of total energy intake for additional health benefits.[1] Many countries worldwide exceed this recommended limit. For example, in Australia, more than half (55·7%) of the study population (8202 participants) had higher free sugar intake than the WHO's recommendation.[5]

Increased intake of food high in sugar content is often seen as a major factor contributing to the rise of obesity. In Brunei, the prevalence of obesity in adults has increased more than double, from 12% in 1997 to 27.2% in 2011.[6] According to Global Nutrition report 2016, Brunei has the highest prevalence of obesity in adults among South-east Asian countries.[7] The Sugar Sweetened Beverages (SSB) tax was introduced in 2017 in an attempt to curb the epidemic.[8] Despite that, there is a lack of published information on the free sugar intake and dietary sources of free sugar in Brunei to evaluate effectiveness of current risk reduction measures. Therefore, the primary objective of the study was to analyze the National Health and Nutritional Status Survey (NHNSS) data to identify the dietary sources of free sugars and explore the association with related factors among adult population in Brunei.


  Methods Top


Study design, population, and sample

The study involved the analysis of dataset extracted from The NHNSS 2010.[9] This was the first nationwide, cross-sectional survey, to explore health and nutritional status of Brunei citizens or permanent residents aged 18–75 years. A total of 1559 participants agreed and joined the study. The data collected included following information:

  1. Sociodemographic (Self-reported): Gender, district, age, marital status, ethnicity, education level, employment status, and income level
  2. Measurements: Waist circumference, waist-height ratio, body mass index, triglyceride, systolic blood pressure, diastolic blood pressure, and full blood sugar (not fasting)
  3. Food and nutrient intake based on 24-h dietary recall.


Statistical analysis

All analyses were computed using RStudio v. 4.3.3. Free sugar (g) intake and the percentage of energy from free sugars were compared using the independent t-test and one-way ANOVA. Simple logistic regression was used to explore the possible factors that significantly affect the study outcomes of free sugar (>10 g/day) and free sugar (>5 g/day), and additional outcomes, including waist-height ratio (≥0.5 unit), body mass index (≥25), body mass index (≥30), systolic blood pressure (≥130 mmHg), diastolic blood pressure (≥90 mmHg), blood sugar (≥7 mmol/l), and triglyceride (≥1.7 mmol/l). Multiple logistic regression was done with the variables that were significant with free intake of sugar >10% of total energy as the outcome variable.

Ethical considerations

The institutional review board from the Ministry of Health and Universiti Brunei Darussalam approved this study.


  Results Top


A total of 1,599 participants of age 18 years and older were extracted from the NHNSS 2010 dataset. The prevalence of the adult participants exceeding WHO recommendation of free sugar <10% and 5% of total energy intake was calculated. It was observed that the prevalence of free sugar intake >10% among the adult participants was 60.1% (95% confidence interval [CI]: 57.6, 62.5). The prevalence of free sugar >5% was 82.6% (95% CI: 80.6, 84.4).

[Table 1] illustrates the intake of free sugar in adults, in terms of grams/day and as a percentage of the daily energy. Estimated mean daily intake of free sugars was 55.5 g/day, contributing 14.5% of the total daily energy intake. Men (66.6 g/day) had significantly higher mean free sugar intake as compared to women (46.2 g/day) (P < 0·001). Those with diastolic pressure ≥90 mmHg (48.7 g/day) and systolic pressure ≥130 mmHg (49.2 g/day) had a lower free sugar intake than those with lower diastolic (56.6 g/day) and systolic pressure (59.9 g/day).
Table 1: Free sugar (g/day) and percentage energy from free sugar (n=1559)

Click here to view


[Table 2] shows the dietary sources of free sugar among the adult population. All the foods and beverages were categorized into 28 groups, where they were further classified into solid and liquid foods. Sugar sweetened beverages (SSBs) contributed the largest proportion of free sugar intake (78%) among the adult population in Brunei. The highest sources of free sugar from beverages were prepared with free sugar (17.9%), cordial and syrup (15.1%), and carbonated drinks (14.6%).
Table 2: Dietary sources of free sugar among adult population in Brunei (n=1559)

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[Table 3] represents the factors associated with intake of free sugar >10% and free sugar >5%. The results showed that the participants aged 41–50 years and 51 and above were 0.59 times and 0.44 times less likely to have free sugar >10% as compared to those aged 18–30 years old, respectively. The result also showed that the odds of having free sugar >5% decreased by 0.64 times when diastolic pressure was >90.
Table 3: Factors associated with free sugar >10% and free sugar >5% using simple and multiple logistic regression (n=1559)

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  Discussion Top


The present study indicated several important findings. The adherence of the adult participants to the WHO recommendation for free sugar intake <10% and <5% of total energy was overall low. More than half (60.1%) of the adult participants in the present study consumed more than the WHO recommendation for free sugar. Only 17.4% of the participants met the recommendation for free sugar <5% of total energy. Approximately 51.1% of Brunei population consumed SSB daily. This is very alarming because high intake SSB has been strongly linked with weight gain and obesity in children and adults.[10] High intake of free sugar has been associated with unsatisfactory quality of diet and reduced micronutrients intakes due to micronutrients dilution.[11],[12],[13] Therefore, it is critical to address this issue and promote dietary patterns in accordance with the recommendations of free sugar consumption.

The free sugar intake was higher in men, which was consistent with the findings in several studies.[14],[15],[16] However, both men and women still had similar percentage of energy from free sugar intake. Furthermore, this study also found that those in older age group had lower free sugar intake and percentage of energy from free sugar compared to the younger participants, even after significant confounding factors were adjusted. This result follows the trend observed in other studies.[15],[17],[18] This could be because of the reduced appetite in elderly population and the presence of existing comorbidities.

The strengths of the study are national representativeness, large number and detailed food intake assessment. The main limitation is that it is a cross-sectional study and associations should not be treated as causal. There is a possibility of recall and reporting bias from the NHNSS survey. It may not be representative of the usual dietary intake of the participant as dietary intake usually varies each day, which might result in under-reporting. Various population-level interventions and policies are currently in place in Brunei to control and reduce SSB intake, for example, mass-media campaign, regulation, and guidelines of foods and beverages sold in the school canteens and more recently fiscal policy on SSB. The fiscal measure to control the demand and consumption of SSB by taxation of SSB has been implemented in Brunei, effective April 1, 2017.[8] Future studies should explore the trends of free sugar intake in Brunei over the years and look into the associations between free sugar intake and the health outcomes and chronic diseases to provide a more robust evidence for nutritional policy.


  Conclusion Top


In conclusion, the study reveals that the majority of the Bruneian adults exceeded the WHO's free sugar intake recommendation, and the main sources of free sugar come from SSBs. The present study analysis provides crucial evidence needed to strengethen nutrition policy and actions for the pevention and control of NCDs in Brunei.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Guideline: “Sugars Intake for Adults and Children.” Vol. 26. Geneva: Switzerland; 2015. p. 34-6.  Back to cited text no. 1
    
2.
Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: Systemic review to inform WHO guidelines. J Dent Res 2014;93:8-18.  Back to cited text no. 2
    
3.
Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: Systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2012;346:e7492.  Back to cited text no. 3
    
4.
Te Morenga LA, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: Systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr 2014;100:65-79.  Back to cited text no. 4
    
5.
Lei L, Rangan A, Flood VM, Louie JC. Dietary intake and food sources of added sugar in the Australian population. Br J Nutr 2016;115:868-77.  Back to cited text no. 5
    
6.
Ministry of Health Brunei Darussalam. Brunei Darussalam National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2018. Bandar Seri Begawan: Ministry of Health Brunei Darussalam; 2013. p. 1-90.  Back to cited text no. 6
    
7.
International Food Policy Research Institute. Global Nutrition Report – From Promise to Impact: Ending Malnutrition by 2030. Washington, DC: International Food Policy Research Institute; 2016.  Back to cited text no. 7
    
8.
Backholer K, Blake M, Vandevijvere S. Sugar-sweetened beverage taxation: An update on the year that was 2017. Public Health Nutr 2017;20:3219-24.  Back to cited text no. 8
    
9.
Ministry of Health. Brunei National Health and Nutritional Status Survey (NHANSS) 2009-2011-2012. Bandar Seri Begawan: Ministry of Health Brunei Darussalam; 2012.  Back to cited text no. 9
    
10.
Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis. Am J Clin Nutr 2013;98:1084-102.  Back to cited text no. 10
    
11.
Moshtaghian H, Louie JC, Charlton KE, Probst YC, Gopinath B, Mitchell P, et al. Added sugar intake that exceeds current recommendations is associated with nutrient dilution in older Australians. Nutrition 2016;32:937-42.  Back to cited text no. 11
    
12.
Mok A, Ahmad R, Rangan A, Louie JC. Intake of free sugars and micronutrient dilution in Australian adults. Am J Clin Nutr 2018;107:94-104.  Back to cited text no. 12
    
13.
Louie JC, Tapsell LC. Association between intake of total vs. added sugar on diet quality: A systematic review. Nutr Rev 2015;73:837-57.  Back to cited text no. 13
    
14.
Azaïs-Braesco V, Sluik D, Maillot M, Kok F, Moreno LA. A review of total & added sugar intakes and dietary sources in Europe. Nutr J 2017;16:6.  Back to cited text no. 14
    
15.
Fisberg M, Kovalskys I, Gómez G, Rigotti A, Sanabria LY, García MC, et al. Total and added sugar intake: Assessment in eight Latin American countries. Nutrients 2018;10:389.  Back to cited text no. 15
    
16.
Sluik D, van Lee L, Engelen AI, Feskens EJ. Total, free, and added sugar consumption and adherence to guidelines: The Dutch national food consumption survey 2007-2010. Nutrients 2016;8:70.  Back to cited text no. 16
    
17.
Park S, Thompson FE, McGuire LC, Pan L, Galuska DA, Blanck HM. Sociodemographic and behavioral factors associated with added sugars intake among US adults. J Acad Nutr Diet 2016;116:1589-98.  Back to cited text no. 17
    
18.
Thompson FE, McNeel TS, Dowling EC, Midthune D, Morrissette M, Zeruto CA. Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey, 2005. J Am Diet Assoc 2009;109:1376-83.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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