DOI: 10.1590/1413-81232021263.07872019 1153 Provision of information on the amount of sugar FREE THEMES in processed foods Camila Cremonezi Japur (https://orcid.org/0000-0003-0513-1758) 1,4 Dyessa Cardoso Bernardes Assunção (https://orcid.org/0000-0003-4711-7508) 2 Raíssa Aparecida Borges Batista (https://orcid.org/0000-0002-9928-5872) 2 Fernanda Rodrigues de Oliveira Penaforte (https://orcid.org/0000-0001-8483-1562) 3,4 Abstract The objective of this study was to assess the provision of information on the amount of sugar and identify the position of sugar in the list of ingredients of processed foods. A cross-sectional study was conducted to analyze all processed tra- ditional and diet/light/zero food products sold in a hypermarket containing the word sugar or sucrose in the list of ingredients. The food labels were read and the position of sugar on the list of ingredients and presence, or absence, of information on the amount of sugar in the nutrition facts table were 1 Divisão de Nutrição recorded. Information on the amount of sugar was e Metabolismo, Departamento de Ciências also requested from the manufacturers by e-mail da Saúde, Faculdade de or telephone. A total of 2,200 food products were Medicina de Ribeirão Preto, assessed, 2,164 (98.4%) of which were tradition- Universidade de São Paulo (USP). Av. Bandeirantes al foods and 36 (1.6%) diet/light/zero foods. The 3900, Monte Alegre. 14049- amount of sugar was declared in only 14.4% and 900 Ribeirão Preto SP 13.9% of these products, respectively (p=0.84). Brasil. [email protected] 2 Curso de Nutrição, Only 7.7% (n=12) of the 156 companies con- Faculdade de Medicina, tacted provided the requested information. Sugar Universidade Federal de was present in the first three positions of the list of Uberlândia. Uberlândia MG Brasil. ingredients in 75.8% of the traditional foods and 3 Departamento de Nutrição, 77.8% of the diet/light/zero foods (p=0.93). The Instituto de Ciências da data show that sugar was the main ingredient in Saúde, Universidade Federal do Triângulo Mineiro. the majority of the food products analyzed and Uberaba MG Brasil. that the level of provision of information on the 4 Laboratório de Práticas amount of sugar is low. e Comportamento Alimentares, Curso de Key words Sugars, Industrialized Foods, Nutri- Nutrição e Metabolismo, tional Labeling Faculdade de Medicina de Ribeirão Preto, USP. Ribeirão Preto SP Brasil. 1154 et al. Japur CC Japur Introduction cording to the Brazilian Supermarket Associa- tion, it is the second largest supermarket chain in Recent decades have witnessed various changes the country and offers a wide range of processed in eating habits in Brazil and around the world. products16. Prior written authorization was ob- There has been an increase in the consump- tained from the store manager. tion of high energy density, fat, sugar and salt The study was conducted in 2015 in two stag- (ultra-processed) foods, together with a reduc- es. First, we read the labels of all available food tion in the consumption of foods that are good products in the store. All products containing the sources of fiber and micronutrients. There is a word sugar or sucrose in the list of ingredients strong association between these changes and were included in the study. Different sized prod- increased prevalence of noncommunicable dis- ucts of the same brand, composition, and flavor eases (NCDs), such as diabetes mellitus, obesity, were excluded. Only the terms sugar and sucrose systemic hypertension, cardiovascular diseases, were used, instead of other types of sugar (such as and cancer1-6. fructose, liquid glucose, maltodextrin, dextrose, Epidemiological evidence suggests that high corn syrup, fructose syrup, agave syrup, guarana intakes of added sugar is a risk factor for NCDs7- syrup, lactose, polydextrose, galapolydextrose, 11. The term added or “free sugars” refers to all maltose, galactose, fruit juice concentrate, malt sugars added to drinks and food during prepara- extract, mannitol, xylitol, invert sugar, muscova- tion or industrial processing9,12. do sugar, starch, and sorbitol), because they refer In 2015, the World Health Organization to table sugar, the most widely known and com- (WHO) issued a guideline that recommends re- monly used type of sugar. ducing the intake of free sugars in both adults The following particulars of the products and children to less than 10% of total energy in- were recorded: technical name; product name; take (strong recommendation) and a further re- brand; customer support information; position duction to below 5% of total energy intake (con- of sucrose and/or sugar on the list of ingredients; ditional recommendation)9. The following year, and presence, or absence, of information on the the Pan American Health Organization proposed amount of sugar in the nutrition facts table. that processed and ultra-processed foods should In the second stage, the food companies were be considered high in sugars when the amount contacted by telephone (when it was freephone), of free sugars is ≥10% of the total energy value email, or via the customer service website and (kcal) of the recommended portion size13. The asked to provide information on the amount of effective implementation of these recommenda- sugar per portion or per 100g. tions requires clear food labeling that provides The selected foods were separated into two information on the amount of free sugars con- groups: traditional foods and diet/light/zero tained in the product. foods. Each group was divided into 15 food cat- In Brazil, while the declaration of the ener- egories based on the Brazilian Food Categoriza- gy and macronutrient content on food labels is tion System created by Brazil’s National Health mandatory for processed foods, the declaration Surveillance Agency (Anvisa)17. The term diet is of the amount of sugar contained in the food used for special purpose foods used for nutrient remains voluntary14,15. The lack of such infor- restriction (total or insignificant amounts), con- mation makes it difficult for consumers to make trolling weight, or low sugar diets15. According conscious food choices and control sugar intake. to ANVISA Resolution 54/2012, the term “light” The aim of the present study was therefore to as- may be used on the food label as supplementary sess the provision of information on the amount nutrition information when the food contains of sugar and identify the position of sugar in the 25% less of a nutrient than the traditional food list of ingredients of sweet and savory traditional or when its absolute content is below the “low” and diet/light/zero foods containing sugar. threshold, while the term “zero” may be used when the product “does not contain” the nutri- ent18. Methods After data collection and entry, the data was checked by two different researchers and descrip- A cross-sectional study was conducted of pro- tive statistical analysis was performed. The prev- cessed traditional and diet/light/zero foods sold alence of the declaration of the amount of sugar in a hypermarket in Uberlândia, Minas Gerais. and presence of sugar in the first three positions The store was deliberately selected because, ac- of the list of ingredients was compared between 1155 Ciência & Saúde Coletiva, 26(3):1153-1162, 2021 26(3):1153-1162, Coletiva, & Saúde Ciência the two groups using the chi-squared test, adopt- ry these components are not analyzed separately, ing a significance level of 0.05. Statistical analysis and 49 (34%) failed to reply. was performed using GraphPad InStat version 3.05. Discussion Results The findings show that the majority of the pro- cessed foods analyzed by this study did not pro- We assessed 2,200 processed food products con- vide information on the amount of sugar in the taining the word sugar or sucrose in the list of nutrition facts tables. However, sugar was present ingredients, 98% of which (n=2,164) were tra- in the first three positions of the list of ingredi- ditional foods and 1.6% diet/light/zero foods ents, and therefore a prominent ingredient, in the (n=36). majority of both traditional and diet/light/zero Information on the amount of sugar was pres- food products. Approximately 30% of the foods ent on the labels of 14.4% of the traditional foods containing sugar were savory, meaning that it is and 13.9% of the diet/light/zero foods (p=0.84). not clear to the consumer that these products The prevalence of the declaration of the amount contain sugar. In addition to not providing in- of sugar in the traditional foods group was great- formation on the amount of sugar on food labels est in the following food categories: candies and (despite including sugar as a main ingredient), confections (35.3%), pre-prepared milk mixtures the majority of companies contacted failed to (26.5%), cereals and/or cereal products (22.9%), provide information on the amount of sugar per snacks (20.4%), and bread products and cookies portion or per 100g when requested. (19.8%). In the diet/light/zero foods group, the Brazil’s 2008-2009 Household Budget Sur- amount of sugar was declared only in the fol- vey revealed that 61.3% of the Brazilian pop- lowing categories: pre-prepared milk mixtures ulation show excessive sugar intake due to the (50%) and bread products and cookies (30%), as addition of sugar to foods and consumption of shown in Table 1. processed and ultra-processed foods19. It is esti- Sugar was present in the first three posi- mated that ultra-processed foods that are high in tions of the list of ingredients in 75.8% (1,668) sugar, fat and sodium make up 21.5% of the diet of the food products overall, 75.8% of the tra- of the Brazilian population20.