Sodium Content and Food Additives in Major Brands of Brazilian Children's
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DOI: 10.1590/1413-812320182312.21812016 4065 Sodium content and food additives in major brands ARTICLE ARTIGO of Brazilian children’s foods Conteúdo de sódio e aditivos alimentares das maiores marcas de alimentos destinados para crianças brasileiras Antônio Zenon Antunes Teixeira 1 Abstract The objective of this paper is to evaluate Resumo O objetivo deste trabalho é avaliar o the sodium content and additive usage in pack- teor de sódio e a utilização de aditivos em ali- aged food products targeted at Brazilian children. mentos industrializados destinados às crianças no Commercial database and manufactures’ websites Brasil. Bancos de dados comerciais foram usados were used to identify major brands of child-ori- para identificar as principais marcas de alimen- ented foods. Samples were categorized as “chil- tos. Foram classificadas como “alimentos para dren’s foods” (n = 214) and “infant’s foods” (n = crianças” (n = 214) e “alimentos infantis” (n = 86). Nutrition Facts labels were used to calculate 86). Os rótulos nutricionais foram usados para the median Na content (mg/serving, mg/kcal, and calcular a mediana de sódio (mg/porção, mg/kcal mg/100g); the ingredient lists to note the use of e mg/100g) e a lista de ingredientes comprovou o food additives. The sodium content found in sam- uso de aditivos alimentares. O teor de sódio en- ples varied widely among brands. The amount of contrado em amostras variou entre as marcas. A sodium was high (> 210 mg/serving) in 20% of quantidade de sódio foi elevada (> 210 mg/por- the products. Sodium density exceeded 1 mg/kcal ção) em 20% dos produtos. A concentração de in 40% of the products with the savory foods had sódio superior a 1 mg/kcal em 40% dos produtos the highest densities. More than 30% of the foods com os alimentos salgados representou as maiores categories (corn snacks, filled biscuits, sliced loaf quantidades. Mais de 30% das categorias (salga- bread, and cereals) did not fulfill the 2014 sodi- dinho de milho, biscoitos recheados, pão de for- um reduction targets. Food additives present in all ma e cereais) não cumpriram as metas de 2014 children’s foods varied from two to nine additives de redução de sódio. Os aditivos presentes em ali- numbers. However, some products had incredible mentos de crianças variaram de dois a nove adi- numbers of additives, such as instant noodles and tivos. No entanto, alguns produtos tiveram mais mini cakes. Although some infants’ foods catego- aditivos, tais como macarrão instantâneo e mini ries were additives free, most products contained bolo. Alguns alimentos infantis estavam livres de 1 Instituto Federal de up to three numbers of additives. Continuing sur- aditivos, mas a maioria dos produtos continha até Educação, Ciência e veillance is crucial to evaluate the progress of salt três. Um constante monitoramento é fundamental Tecnologia de Goiás. reduction and to revise the maximum permissible para avaliar o progresso na redução de sódio e no Av.Universitária Vereador Vagner da Silva Qd 01, limit of additives. limite máximo admissível de aditivos. Lt 1-A Parque Itatiaia, Key words Children’s foods, Additives, Processed Palavras-chave Alimentos para crianças, Aditi- 74968-755 Aparecida de foods, Sodium vos, Alimentos processados, Sódio Goiânia GO Brasil [email protected] 4066 Teixeira AZA AZA Teixeira Introduction Methods According to the Brazilian Institute of Geogra- A commercial database of the biggest supermar- phy and Statistics (IBGE) survey in 2009, one in ket retails (Grupo Pão de Açúcar) and manufac- three Brazilian children (5- to 9-years-old) was turers’ websites were used to identify the major overweight1. Recently, the Health Ministry-IBGE brands of children-oriented foods. Data collec- revealed that 32% of children less than 2-years- tion was performed from March to June 2014. old consumed soft drinks and artificial juic- Then, we exclude children’s foods products that es while 60% of them ate packaged of biscuits, are easily perceived for additives content such as cookies and filled cakes2. Moreover, the Federal candies/gums, gelatins, lollipops and artificial University of São Paulo - Department of Pedi- juices. The final 300 products were identified atrics disclosed that 65% of children aged 9-36 for additives and sodium content analysis. The months attending day care centers consumed products were classified into two categories: 1) instant noodles in their first year of lives3. The children’s foods (n = 124) comprised eight sub- practice of this eating behavior has led a concern categories: biscuits/cookies, corn snacks, bread/ to the possible health risks due to the excess of mini cakes, cereals, instant noodles, frozen foods sodium and additives present in processed foods. (foods that require minimal preparation such As stated by Polonia and Peres4, children are the as breaded chicken, pizza, lasagna, hamburger, most vulnerable group to the adverse risks of bologna, and sausage), milk/flavored milk, yo- food additives as most of their diets contains ad- gurts/fermented milk, and petit-suisses and 2) ditives particularly synthetic food colors. infant’s foods (n = 86) comprised 4 sub-catego- Sodium is an essential nutrient to maintain ries: purred baby foods, infant formulas, nutri- the body fluid levels and to provide nerve signal- tive foods (powder and complementary foods for ing channels. However, excessive consumption toddlers), and porridge/cereals. Specific indica- in children is associated with obesity, hyperten- tors of children’s foods and criteria for inclusion in the samples were: foods that are marketed to sion and cardiovascular disease5. The Institute of appeal children by the use of cartoon images, Medicine (IOM) recommends that daily Dietary plays or colors, games and advertisings with chil- Adequate Intake (AI) for sodium: 1000 mg/d for dren. Infants’ foods were identified inmothers children aged 1-3 years, 1200 mg/d for aged 4-8, and babies section of the commercial website. 1500 mg/d for aged 9-13 years and less than 400 The sodium content (in mg) was computed mg/d for infants. IOM also defined daily Tolera- per serving, calories (kcal) and 100g of food from ble Upper Intake level (UL) for sodium at 1500 the Nutrition Facts labels. To determine the high mg, 1900 mg and 2200 mg for children aged 1-3, sodium levels per serving, we used the table of 4-8 and 9-13 years6. Although a small amount of daily recommended serving for children11 and sodium naturally presents in most foods, most of Elliot and Conlon’s methodology12. Only three the sodium in the diet comes from salt added to food groups were considered: 1) grain (cereal), 2) restaurants and packaged supermarket foods. meat and alternatives and 3) milk and derivatives Additives are substances intentionally added while fruit and vegetable categories were exclud- to foods for various reasons, such as to improve ed due to their small contents. There is a total of taste, texture and appearance, as well as to pre- seven, eight and ten daily serving opportunities serve foods. However, a consumption exceeds the to ingest sodium for children aged 1-3, 4-8 and Acceptable Daily Intake (ADI) may cause adverse 9-13 years respectively. Then, per-serving limit of health effects such as brain cancer, irritability, sodium intake can be determined. Children aged sleep disturbance, and hyperactivity in the long 1-3 have seven servings to ingest their AI of 1000 7-9 term . The ADI is the number of mg/kg of body mg of sodium but not exceed the UL of 1500 mg, weight (mg/kg bw) per day that can be ingested corresponding to 140-210 mg/serving. Children without possible health risks. Although the Bra- aged 4-8 and 9-13 year have relatively similar zilian legislation requires food industries to list results, giving 150-237 mg/serving and 150-220 all additives on the food labels10, the additive mg/serving correspondingly. Then, a product is amount used is not necessarily declared. deemed to have a high level of sodium if it ex- The objectives of this study are to evaluate the ceeds 210 mg/serving. IOM dietary reference in- sodium content and the additives usage obtained take also defined that sodium >210 mg/serving from Nutritional Facts labels of food products as a high level for children aged 1-3 years13. sold in Brazil in the period of 2014 which appeal The use of sodium density (mg/kcal) has to children. been proposed as a way to compare the sodium 4067 Ciência & Saúde Coletiva, 23(12):4065-4075, 2018 23(12):4065-4075, Coletiva, & Saúde Ciência content of foods with the same amount of cal- the large variations of the products’ serving size ories because sodium and kcal consumption are also contributed the variation in the Na content highly positively correlated14. When the required in mg/serving such as in yogurt/fermented milk. daily caloric intake is 2000 kcal, a food product In yogurts/fermented milk category for example, is considered to have high-level sodium if it sur- the median of the labels serving size (100 g) were passes 1 mg/kcal. far below of the current law (200 g). A similar Children’s foods were compared to the 2014 circumstance was published by Kraemer et. al.15 government salt reduction targets, the Food in their study on processed foods for snacks mar- and Drug Administration (FDA) “healthy” la- keted for children and adolescents in Brazil. The bel claim and the National Health Surveillance authors described that 14% of all the processed Agency (Anvisa) “low sodium” attribute. To fa- foods assessed did not comply the current serving cilitate these comparisons, sodium content was size rule that makes the customers have difficul- converted to the 100g standard serving size.