Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Micronutrient dilution associated with added sugar intake in elderly black South African women

Abstract

Objectives:

To investigate the association between added sugar and macronutrient and micronutrient intakes, and to assess whether added sugar intake is related to biochemical indices of nutritional status, Mini-Nutritional Assessment (MNA) score, body mass index (BMI) and performance on physical function tests.

Design:

A cross-sectional, analytical study.

Setting and subjects:

Convenient sample of 285 institutionalised and community-dwelling black South African men and women aged 60+ y.

Methods:

An interviewer-administered 24-h dietary recall and MNA were performed. Serum albumin, vitamin B12, ferritin, cholesterol, haemoglobin, red blood cell (RBC) folate and plasma vitamin C were measured. Handgrip strength, BMI, ‘sit-to-stand’ and ‘get-up-and-go’ tests were measured. Outcome variables were analysed according to tertiles of added sugar, in grams and as a percentage of total energy (% E).

Results:

In each tertile of sugar intake, mean MNA score fell in the ‘at-risk’ classification. In women, energy, protein, % E protein, fibre, thiamin, riboflavin, niacin, vitamin B6, folate, pantothenic acid, biotin, vitamin C, calcium, iron, magnesium, phosphorus, zinc, copper and selenium intake were significantly lowest in subjects in the highest % E sugar tertile. In men, no differences were found for micronutrient intake according to tertiles of total added sugar or % E added sugar. Physical function declined with increasing sugar intake, and suboptimal RBC folate and plasma ascorbic acid status was associated with increasing sugar intake (in women). No relationship was found between added sugar intake and the very high prevalence (65%) of obesity in women.

Conclusion:

A nutrient-diluting effect of added sugars intake was demonstrated in elderly black South African women. Further studies in this population are required in order to develop food-based dietary guidelines, which include messages on added sugar intake.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1

References

  • Alexy U, Sichert-Hellert W & Kersting M (2002): Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents. J. Nutr. 132, 2785–2791.

    CAS  Article  Google Scholar 

  • Alexy U, Sichert-Hellert W & Kersting M (2003): Association between intake of added sugars and intakes of nutrients and food groups in the diets of German children and adolescents. Br. J. Nutr. 90, 441–447.

    CAS  Article  Google Scholar 

  • Baghurst KI, Baghurst PA & Record SJ (1992): Demographic and nutritional profiles of people consuming varying added levels of added sugars. Nutr. Res. 12, 1455–1465.

    Article  Google Scholar 

  • Bester FCJ, Weich DJV & Danhauser A (1993): Nutrient intakes of elderly blacks on the Orange Free State. S. Afr. J. Clin. Nutr. 6, 6–11.

    Google Scholar 

  • Bolton-Smith C & Woodward M (1995): Antioxidant vitamin adequacy in relation to sugar consumption. Eur. J. Clin. Nutr. 49, 124–133.

    CAS  PubMed  Google Scholar 

  • Bourne LT (1996): Dietary intake in an urban African population in South Africa—with special reference to the nutrition transition. PhD thesis, University of Cape Town,.

  • Bowman SA (1999): Diets of individuals based on energy intakes from added sugars. Fam. Econ. Nutr. Rev. 12, 31–38.

    Google Scholar 

  • Broderick K (2002): Correlation between scores on two screening tools for dementia in Xhosa women. S. Afr. J. Occup. Ther. 32, 8–13.

    Google Scholar 

  • Brooke P & Bullock R (1999): Validation of a 6-item Cognitive Impairment Test with a view to primary care usage. Int. J. Geriatr. Psychiatry 14, 936–940.

    CAS  Article  Google Scholar 

  • Charlton KE, Bourne LT, Steyn K & Laubscher R (2001): Poor nutritional status in older black South Africans. Asia Pac. J. Clin. Nutr. 10, 31–38.

    CAS  Article  Google Scholar 

  • Charlton KE, Kolbe T & Nel H (2003): Nutritional Status of Older Black South Africans: Towards the Development of a Nutrition Screening Tool for Use in this Population Research Report submitted to the Minimum Data Set Project of the World Health Organization, Observatory: University of Cape Town (unpublished).

    Google Scholar 

  • Charlton KE & Rose D (2001): Nutrition among older adults in Africa: the situation at the beginning of the millenium. J. Nutr. 131 (Suppl), 2424S–2428S.

    CAS  Article  Google Scholar 

  • Charlton KE & Lambert EV (1999): Validation of a food frequency questionnaire in older South Africans. S. Afr. Med. J. 89, 184–189.

    Google Scholar 

  • Charlton KE, Wolmarans P & Lombard CJ (1998): Evidence of nutrient dilution with a high sugar intake in older South Africans. J. Hum. Nutr. Diet. 11, 331–343.

    Article  Google Scholar 

  • Department of Health and Social Security (1989): Dietary Sugars and Human Disease Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects 37, London: HMSO.

  • Department of Health (1992): The Nutrition of Elderly People. London: HMSO.

  • Emmett PM & Heaton KW (1995): Is extrinsic sugar a vehicle for dietary fat? Lancet 345, 1537–1540.

    CAS  Article  Google Scholar 

  • FAO/WHO/UNU (1985): Energy and Protein Requirements Report of a Joint Expert Consultation. Technical Report Series No. 724 Geneva: WHO.

  • Ferreira M, Møller V, Prinsloo FR & Gillis LS (1992): Multidimensional Survey of Elderly South Africans, 1990–91: Key Findings. Cape Town: HSRC/UCT Centre for Gerontology.

    Google Scholar 

  • Gibson S (2001): Dietary sugars and micronutrient dilution in normal adults aged 65 years and over. Pub. Health Nutr. 4, 1235–1244.

    CAS  Article  Google Scholar 

  • Gibson SA (1997): Do diets high in sugar compromise micronutrient intakes? J. Hum. Nutr. Diet. 10, 125–133.

    Article  Google Scholar 

  • Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA & Prentice AM (1991): Critical evaluation of energy intake data using fundamental principles of energy physiology. 1. Derivation of cut-off limits to identify under-recording. Eur. J. Clin. Nutr. 45, 569–581.

    CAS  Google Scholar 

  • Guigoz Y, Vellas B & Garry PJ (1996): Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr. Rev. 54, S59–S65.

    CAS  Article  Google Scholar 

  • Guralnik JM, Ferrucci L, Simonsick EM, Salive ME & Wallace RB (1995): Lower extremity function over the age of 70 years as a predictor of subsequent disability. N. Engl. J. Med. 332, 556–561.

    CAS  Article  Google Scholar 

  • Institute of Medicine (1998): Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride Food and Nutrition Board Washington, DC: National Academy Press.

  • Institute of Medicine (2000): Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids Food and Nutrition Board, Washington, DC: National Academy Press.

  • Institute of Medicine (2002): Dietary Reference Intakes for Energy, Carbohydrate, Fibre, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids Food and Nutrition Board, Washington, DC, National Academy Press.

  • Johnson S & van der Westhuizen J (1992): Nutritional evaluation of the black elderly in a rural village. S. Afr. J. Food Sci. Nutr. 1, 23–28.

    Google Scholar 

  • Katz SC & Stroud MW (1989): Functional assessment in geriatrics: a review of progress and directions. J. Am. Geriatr. Soc. 37, 267–271.

    CAS  Article  Google Scholar 

  • Kruger M, Sayed N, Langenhoven M & Holing F (1998): Composition of South African Foods. Vegetables and Fruit. Tygerberg: Medical Research Council.

    Google Scholar 

  • Labadarios D, Steyn NP, Maunder E, MacIntyre U, Swart R, Gericke G, Huskisson J, Dannhauser A, Voster HH & Nesamvuni AE (2000): The National Food Consumption Survey (NFCS): Children Aged 1–9 years, South Africa, 1999. Pretoria: Department of Health, Directorate: Nutrition.

    Google Scholar 

  • Langenhoven MJ, Conradie PJ, Wolmarans P & Faber M (1991a): MRC Food Quantities Manual 2nd Edition, Tygerberg: Medical Research Council.

    Google Scholar 

  • Langenhoven M, Kruger M, Gouws E & Faber M (1991b): MRC Food Composition Tables 3rd Edition, Parow: Medical Research Council.

    Google Scholar 

  • Lawton MP & Brody EM (1969): Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9, 179–186.

    CAS  Article  Google Scholar 

  • Mahoney FI & Barthel DW (1965): Functional evaluation: the Barthel Index. Med. State Med. J. 14, 61–65.

    CAS  Google Scholar 

  • Mathias S, Nayak USL & Isaacs B (1986): Balance in the elderly patients: the ‘get-up-and-go’ test. Arch. Phys. Med. Rehab. 67, 387–389.

    CAS  Google Scholar 

  • Schofield WN, Schofield C & James WPT (1985): Basal metabolic rate prediction. J. Hum. Nutr. Clin. Nutr. 39C (Supp 1), S1–S96.

    Google Scholar 

  • Sheiham A (2001): Dietary effects on dental diseases. Pub. Health Nutr. 4, 569–591.

    CAS  Google Scholar 

  • South African Medical Association (SAMA) and LASSA Working Group (2000): Diagnosis, Management and Prevention of the Common Dyslipidaemias in South Africa—Clinical Guidelines 2000. Pretoria: SAMA.

  • Steyn NP, Myburgh NG & Nel JH (2003): Evidence to support a food-based dietary guideline on sugar consumption in South Africa. Bull. World Health Organ. 81, 599–608.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Venter CS, McIntyre UE & Vorster HH (2000): The development and testing of a food portion photograph book for use in an African population. J. Hum. Nutr. Diet. 13, 205–218.

    Article  Google Scholar 

  • World Health Organization (1968): Nutritional Anaemias: Report of a World Health Organization Scientific Group, Technical Report Series No. 405, Geneva: World Health Organization.

  • World Health Organization (1997): GEMS/Food Regional Diets. Regional Per Capita Consumption of Raw and Semi-processed Agricultural Commodities Prepared by the Global Environmental Monitoring and Assessment Programme of Food Safety and Food Aid. WHO/FSF/FOS/98.3, Geneva: World Health Organization.

Download references

Acknowledgements

Financial support for this study was provided by the Minimum Data Set (MDS) Project of the World Health Organization. Financial support for the MDS Project was provided under a grant from the Behavioral and Social Research Program of the US National Institute on Aging, within the US Department of Health and Human Services National Institutes of Health, through an Inter-agency Agreement with the World Health Organization.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K E Charlton.

Additional information

Guarantor: KE Charlton.

Contributors: TLKA co-ordinated data collection, performed physical function tests and was responsible for subject recruitment. JHN performed data entry and statistical analyses.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Charlton, K., Kolbe-Alexander, T. & Nel, J. Micronutrient dilution associated with added sugar intake in elderly black South African women. Eur J Clin Nutr 59, 1030–1042 (2005). https://doi.org/10.1038/sj.ejcn.1602208

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602208

Keywords

  • micronutrient intake
  • added sugars
  • nutrient dilution
  • elderly
  • South Africans

Further reading

Search

Quick links