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Sugar-Sweetened Beverages (SSB) Consumption Patterns Among School-Age Children from Rural Quetzaltenango, Guatemala Content

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Sugar-Sweetened Beverages (SSB) Consumption Patterns Among School-Age Children from Rural Quetzaltenango, Guatemala Content Sugar-sweetened beverages (SSB) consumption patterns among school-age children from rural Quetzaltenango, Guatemala Content 1. Introduction 2. Presentation summary 3. Objectives 4. Methodology 5. Results and Discussion 6. Conclusions 7. Acknowledgments 8. References 1. Introduction o José Alfonso Castillo Miranda o Nutrition Bachelor´s degree Thesis o Rafael Landívar University o Quetzaltenango, Guatemala 2020 2. Presentation Summary Eating Sugar-sweetened School-age (Consumption) beverages children pattern Nutrition Double burden San José Chiquilajá, transition of malnutrition Quetzaltenango School-Age Children • Period during the life cycle, which includes children between 6 to 11 years old • In this period, the ability to classify and understand opinions is developed ü Close relationship with food practices and nutrition. ü The child acquires knowledge about which foods are beneficial for their health and which are pleasant to consume • Characterized by the influence of the school environment: school authorities, teachers, classmates, friends, school breaks, games and dynamics in classroom Krause, M. 2017; Noriega, R. 2018; Rivera, J. 2018 Eating (consumption) pattern • Represents the totality of all foods and beverages consumed. • It generates important data about eating practices or behaviors of a determined group ü Studies have shown that school-age children’s eating patterns may reflect the general population’s eating patterns ü This study focused on Sugar-Sweetened Beverages consumption patterns Popkin, 2001; Rivera, J. 2008; Barquera, S. 2010 Sugarly-sweetened beverages (SSB) • Beverages with addition of sugar during their formulation and preparation. • Bevareges that usually use marketing strategies • A significant increase of SBB consumption has been observed among school children: ü Guatemalan urban areas: 77 grams of sugar from usual diet come from SSB ü Urban area of Quetzaltenango: 20% from SSB. ü SSB high consumption can generate health problems, such as excess weight and chronic non-comnunicable diseases in adulthood Healthy NYC, 2018; Montenegro, G. 2010 Nutrition transition • Refers to eating behaviors changes due to preference and consumption modifications • Cheap, high-energy, free sugars and saturated fats in foods are consumed especially among developing countries rural áreas where nutrition transition is more evident • Children are exposed to food environments in which the consumption of unhealthy food items is promoted WHO 2020; Rivera, J. 2014; Díaz, L. 2015 Double burden of malnutrition • Is the coexistence of “undernutrition along with overweight and obesity, or diet-related noncommunicable diseases, within individuals, households and populations, and across the lifecourse” (WHO,2020) • Countries with lower incomes present higher prevalences: ü According to The Lancet, the prevalence of the double burden of malnutrition in Guatemala is 40% • The rural area population in Guatemala is more vulnerable and has a higher food and nutritional insecurity prevalence than urban peers WHO 2020; Rivera, J. 2014; The Lancet. 2020 San José Chiquilajá, Quetzaltenango • Rural community located in the northwest of Quetzaltenango municipality, 2357 meters above sea level • General data from Quetzaltenango municipality: • 56% live in poverty. • 38% live in rural areas • 31% are between 0 -14 years old • 47% of the children under 5 suffer stunting INE, 2018 3. Objectives To determine the sugar-sweetened beverages (SSB) consumption patterns among school- age children from a rural area of Quetzaltenango, Guatemala Specific objectives 1. To characterize the study population according to the research variables 2. To establish the caloric and macronutrients intake from diet 3. To establish children´s SSB constumption and their contribution to the total volumen of beverages consumed 4. To identify the caloric consumption from sugar-sweetened beverages and total beverages and their contribution to the energy intake 5. To estimate the energy density from sugar-sweetened beverages according to their classification 4. Methods Type of study: Participants: Children between 8 and 11 years old, Quantitative, descriptive who attend EORM José Martí School; San José and cross-sectional. Chiquilajá, Quetzaltenango Sample: No sample was applied, all Data Analysis: children who met the inclusion criteria were enrolled Microsoft Excel® (115 participants) SPSS® Process Approval of Reviewing CESSIAM Researchers pictorical 24 Human Studies trainning hours recall with Committee children Obtaining Coordination with Informed standard recipes the EORM José Consent and average Martí administration weights Completion of the Instrument Analysis of data pictorial 24-hour preparation recall collected Data Collection • Approval was obtained from the Human Studies Committee of CESSIAM • Informed Consent was obtained from parents and children • A team of 4 trained nutritionists from CESSIAM provided participants with pictorial 24h recalls and office materials to fill out • Instructions were given and doubts were solved • Incomplete instruments were filled in next day with the help of nutritionists, teachers and parents • The food and beverages consumed were confirmed, establishing recipes, preparations, and products brands Data Analysis • The data input was done using in Excel® • The food composition tables from the United States Department of Agriculture (USDA) and INCAP, thus nutritional information from product labels, were used to establish calories and macronutrients total intake • The energy density of the SSB consumed by the children was estimated, according to 100 mL or g of product • A comparison of beverage consumption patterns in the population was made using two reference systems (Rivera, J. et al. And Barquera, S. et al.) To establish sweetened drinks consumption, all beverages were classified as follows: Sugar-sweetened beverages (SSB) No sweetened drinks Infusions (coffee and tea) Atoles (gruels) Natural drinks and smoothies Juices and drinks with added sugar Simple whole, skim, or low-fat milk (liquid or powdered) Plain water Soft drinks 5. Results • Demographics • Energy and macronutrient intake • Diversity and frequency of beverages consumed • Energy intake from Sugarly-sweetened beverages (SSB) • Nutrient (energy) density • Comparison of volume and energy intake School-Age Children Characteristics N = (115) % Demographics Sex of the Boys 57 49.6 Girls 58 50.4 participants Age (years) according to 8 40 34.8 9 37 32.2 age and sex 10 17 14.8 11 21 18.3 Energy intake from all foods Age Sex 8 – 9 years old 10 – 11 years old Boys Girls Energy and n = 77 n = 38 n = 57 n = 58 Nutrients Average ± DE Average ± DE p value Average ± DE Average ± DE p value Median Median Median Median Min– Max Min– Max Min – Max Min – Max 2016 ± 575 2015 ± 444 2033 ± 551 2018 ± 535 Calories (Kcal) 2023 1985 0.950 1985 2045 0.998 613 – 2993 1172 – 2860 928 – 3075 613 – 2993 64 ± 22 63 ± 16 63 ± 21 65 ± 21 Protein (g) 61 65 0.814 61 65 0.664 23 – 121 29 – 98 25 – 112 23 – 121 53 ± 26 49 ± 20 51 ± 24 53 ± 25 Fat (g) 49 41 0.632 47 48 0.935 5 – 120 23 – 107 5 – 120 12 – 119 332 ± 95 341 ± 90 343 ± 95 331 ± 93 Carbohydrates 330 339 0.475 333 331 0.601 (g) 105 – 536 190 – 587 168 – 540 105 – 587 Results Analysis Energy Adecuacy •Girls and younger participants have a higher energy consumption than the recommended for their age and sex by the World Health Organization (WHO). Gupta N. and WHO recommend that energy intake should be adequate according to sex and age in order to reduce risk of overweight and obesity and their comorbidities •In contrast, Díaz L. in a research conducted in Amatitlán, Guatemala presented adequate results regarding energy and macronutrients intake among school-age children Protein Adecuacy •Regarding protein, the school-age children reported a much higher intake than the WHO and the Institute of Nutrition of Central America and Panama (INCAP) recommendations •According to Pysz et al. the excessive protein intake among children has been associated to metabolic disorders and overweight as adults Gupta, N. 2012; Pysz, M. 2014; Díaz, L. 2015 Type of Clasification Beverage beverage Arroz en leche (rice and milk) Atol de fécula de maíz (cornstarch) Atol de elote (corn) Atol de masa (corn dough) Atol de plátano (plantain) Corazón de trigo® (wheat semola) Atoles (gruels) Incaparina® without milk Incaparina® with milk Atol de avena / mosh (oats) Sugar- Atol de maíz tostado (Toasted corn) Diversity of Vitacereal® (multi-cereal) sweetened Atol de maíz quebrantado (craked corn) beverages (SSB) Atol de cereales (multi-cereal) beverages Coffee with sugar Infusions Coffee with sugar and milk (Coffee and tea) Barley drink with sugar consumed Tea Artisan chocolate Juices and drinks with added sugar Powdered drink mix (liquid or powdered) Boxed juice Milk with sugar Soft drinks Soft drinks Plain Water Plain water Non- sweetened Milk without sugar Plain milk Natural smoothie drinks Natural drinks and smoothies Lemonade SSB consumption frecuency No 24 hour Breakfast Lunch Dinner Snack 1 Coffee with sugar Coffee with sugar Powdered drink mix Coffee with sugar Coffee with sugar Incaparina® without Vitacereal (wheat Incaparina® without 2 Milk with sugar Coffee with sugar milk gruel semola gruel) milk Incaparina® without Atol de plátano Arroz en leche (milk 3 Powdered drink mix Tea with sugar milk gruel (platain gruel) and rice gruel) Arroz en leche (Milk Vitacereal (wheat Atol de cereales Coffee with sugar and Incaparina® with milk 4 and rice gruel) semola gruel)
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