• Journal of Nutrition and Health
• /
• v.40 no.sup
• /
• pp.9-21
• /
• 2007

This study aimed to assess the total sugar intake for Korean and to identify major food sources contributing to those food components. Korean adults aged over 20 years old from the Korean National Health and Nutrition Examination Survey (KNHANES) 2001 and 2002 were selected. The data were analyzed to obtain nationally and seasonally representative information on the health and nutritional status of the Korean. Forty food groups were used in identifying food sources of total sugar and energy intake. Total sugar contents of foods in the KNHANES data sets were estimated by food code matching technique with Release 18 of the USDA National Nutrient Database for Standard Reference. Sample weighted means, standard errors, and population percentages were calculated using SAS and SUDAAN. The mean total sugar intake of the Korean was 60.3g in 2001, 40.9g in spring 2002, 45.7g in summer 2002, and 52.1g in fall 2002, which were 30-44% of intake of US people. Fresh fruit was identified as the most significant food source for total sugar intake in Korean population in all age groups and all seasons. The next major food sources following fresh fruits were candy/jelly/syrup/honey, coffee/coffee caream, vegetables, Kimchi, soft drinks, milk, fruit juice, cookie/cracker/cake, and vegetable juice/grain juice, which showed similar results through the seasons. While carbonated soft drink was the most significant food sources for total sugar or added sugar intakes for US people. The total sugar intakes were significantly higher in women, higher educational level, and residing in metropolitan area. As intake of total sugar increased, intakes of protein, fiber, calcium, phosphorus, iron, Vit A, B1, B2, C, niacin showed significantly increased, while high intakes of added sugars showed low intakes of some micronutrients in the US people. Percentages of people who consumed nutrients below EAR were less in higher total sugar intake group than in lower intake group. From these results, we can conclude that the food consumption habits including the total sugar intake of Korean people seems relatively good so far. More reliable database of total sugar and added sugar composition tables in public domain should be established in the future, and also more researches about total sugar and added sugar for Koreans should be continued.

• Journal of Nutrition and Health
• /
• v.40 no.sup
• /
• pp.3-8
• /
• 2007

Sugars are a ubiquitous component of our food supply and are consumed as a naturally occurring component of many foods and as additions to foods during processing, preparation, or at the table. Most fruits and dairy products are high in sugars and thus naturally occurring sugars are consumed as part of a healthy diet. Some countries developed recommended daily intake figures(daily values : DVs or guideline daily amounts: GDA) for nutrients, and some countries, but not most have developed DV/GDA for total sugars. Dietary Reference Intakes for Koreans established by the Korean Nutrition Society in 2005, did not include the reference values for total sugar or added sugar. The committee on Dietary Reference Intakes for sugar was constituted in 2006 and discussed whether to special added sugars or total sugar. Although added sugars are not chemically or physiologically different from naturally occurring sugars, many foods and beverages that are major sources of added sugars have lower micronutrient densities compared with foods and beverages that are major sources of naturally occuring sugars. But it was so hard to calculate a dietary intake of added sugar for Korean people, because there was insufficient information about contents of added sugar during processing or preparation of Korean food. Currently Korean or US food labels contain information on total sugars per serving but do not distinguish between sugars naturally present in food and added sugars. Therefore the committee decided to set the reference value for total sugar for Koreans. According to the recommended diet pattern for Koreans suggested by the Korean Nutrition Society, estimated sugar intake from the sugar containing food based on 2,000 kilocalories is 67 g or 13% of total energy. Based on the data available on risk of obesity, hypertension, hyperlipidemia, insulin resistance, and metabolic syndrome from the analysis of Korean NHANES, it was insufficient evidence to set a UL for total sugar, but tended to increase serum LDL cholesterol and obesity at over 20-25% of energy from total sugar when consumed with high carbohydrates. Therefore the committee on Dietary Reference Intakes for sugar set the Acceptable Macronutrient Distribution Range for total sugar as 10-20% of total energy intake.

• Journal of Nutrition and Health
• /
• v.40 no.sup
• /
• pp.29-38
• /
• 2007

The purpose of this study was to establish an association between the percent of energy from total sugar and disease prevalence of obesity, hypertension, dyslipidemia, insulin resistance, and metabolic syndrome with the context of the current population dietary practice in Korea. The Korean National Health and Nutrition Survey, 2001 and 2002 dataset were used as the source of data for this research. Usual nutritional intakes for over 20 years old people were calculated from the two non-consecutive dietary intake data from KNHANES 2001 and 2002 dataset. SAS and SUDAAN were used for statistical analyses. Sample weighted means, standard errors, and population percentages were calculated, and multiple logistic regression model with adjustment for covariates were used to determine the odds ratios(ORs) and 95% confidence intervals. Subjects were categorized as 3 ways and compared the LS means and ORs for heath factors. First, subjects excluding pregnant women, were categorized according to percent of energy from the usual total sugar intakes as ${\leq}10%$, 11-15%, 16-20%, 21-25%, >25%. Risk of LDL cholesterol showed a tendency to increase in the '>25%' group compared to the '<10%' group. The risks of the other health effects did not show any significant differences. Second, the subjects were categorized considering both Acceptable Macronutrient Distribution Range(AMDR) from carbohydrate and %Energy from total sugar as 'CHO<55% & Total sugar ${\leq}10%$', 'CHO 55-70% & Total sugar 11-25%', and '$CHO{\geq}70%$ & Total sugar ${\geq}25%$'. The risk of obesity tended to increase in the '$CHO{\geq}70%$ & Total sugar ${\geq}25%$' group compared to the 'CHO<55% & Total sugar ${\leq}10%$'. Third, the subjects were categorized as 'CHO<55% & Total sugar ${\leq}10%$', 'CHO 55-70% & Total sugar 11-20%', and '$CHO{\geq}70%$ & Total sugar ${\geq}20%$'. The risk of obesity also tended to increase in the '$CHO{\geq}70%$ & Total sugar ${\geq}20%$' group compared to the 'CHO<55% & Total sugar ${\geq}20%$' group. In conclusion, risk of LDL cholesterol showed a tendency to increase in the over 25% total sugar intake group, and the risk of obesity tended to increase in the 20-25% total sugar intake and high carbohydrate intake group. The risks of hypertension, hyperlipidemia, insulin resistance, and metabolic syndrome were not associated with total sugar intakes. More research to elucidate the association for Korean between the intakes of total sugar, added sugar, glucose, fructose, and sweeteners and diseases prevalences shoud be excuted in the future.

• Nutrition Research and Practice
• /
• v.16 no.sup1
• /
• pp.21-36
• /
• 2022

BACKGROUND/OBJECTIVES: The long-term health impacts of dietary sugar have begun to be reported. The committee on the 2020 Dietary Reference Intakes for Koreans for sugar intended to update the scientific evidence on the association of added sugar intake with health outcomes, including mortality. This study evaluated the evidence on the association of dietary sugar with the all-cause and cardiovascular disease mortality from cohort studies. SUBJECTS/METHODS: The PubMed and ScienceDirect databases were searched until July 2021. The search terms were based on multiple combinations of keywords, such as added sugar, beverage, and mortality, included in the title or abstract. Two authors independently assessed the eligibility criteria of study selection and extracted the information from each selected article for this systematic review. RESULTS: The literature search identified 276 articles. Seventeen cohort studies met the inclusion criteria and were included in this systematic review. This study extracted information on the cohort and participants, dietary assessment methods, exposure and its comparison groups, health outcomes, and risk measures. Five articles reported added sugar intake, and 15 articles reported the food sources of the added sugar in the association with mortality. Increased mortality was observed in higher added sugar intake and a lower intake of less than 5% of energy, while higher discrepancies between gender, age groups, and countries were noted. In addition, nutritious sugary foods and beverages did not increase mortality. CONCLUSIONS: A 'U' or 'J' shaped relationship between the added sugar intake and mortality was estimated. The observed discrepancy indicated the need for more evidence to establish the dose-response relationship for Koreans.

• Food Science and Industry
• /
• v.49 no.3
• /
• pp.2-11
• /
• 2016

As recently many studies on the relationship between excessive sugar intake and chronic disease have been reported across the world, more attention to sugar intake has been paid. Sugars, called simple sugars, is a kind of carbohydrate and sum of monosaccharides and disaccharides. Sugars that are particularly related to health are added sugars or free sugars, which are added to food by processing or cooking. It is generally not to give satiety and increases energy density without other nutrients. Especially, the major food source of added sugar is sugar-sweetened beverages(SSBs), from which sugars are closely linked with health outcome. The total sugar intake in Korea is 61.4 g per day and it is almost half of those in the western countries such as the U.S. or Australia and it is within the recommendation level by the Dietary Reference Intakes for Koreans. However, when it is classified by age groups or food sources, sugar intake in adolescents and young adults are high and the sugar from processed foods is also high that would lead to high intake levels of added sugar. Particularly, the frequency of SSBs, the major food source of added sugar, is the highest among 20's. While the studies of excessive sugar intake with chronic diseases including obesity, type 2 diabetes, metabolic disease, cardiovascular disease reported in the Western populations, those in the Korean populations have just started. Given our dietary practice is very different from those in the western population, more prospective studies would be necessary to evaluate sugar intake by type or food source exactly and examine its relationship with chronic diseases in the Korean population.

• Nutrition Research and Practice
• /
• v.10 no.5
• /
• pp.537-545
• /
• 2016

BACKGROUND/OBJECTIVES: Dietary sugar intake, particularly added sugar and sugar-sweetened beverages, has received worldwide attention recently. Investigation of dietary behaviors may facilitate understanding of dietary sugar intakes of children and adolescents. However, the relationship between dietary sugar intake and dietary behaviors in the Korean population has not been investigated. Thus, this study aimed to estimate dietary sugar intake and food sources according to sex as well as examine the relationship of dietary sugar intake with frequent snacking and dietary patterns among Korean children and adolescents. SUBJECTS/METHODS: We pooled data from five studies involving Korean children and adolescents conducted from 2002 to 2011. A total of 2,599 subjects aged 9-14 years were included in this study. Each subject completed more than 3 days of dietary records. RESULTS: Mean daily total sugar intake was 46.6 g for boys and 54.3 g for girls. Compared with boys, girls showed higher sugar intakes from fruits (7.5 g for boys and 8.8 g for girls; P = 0.0081) and processed foods (27.9 g for boys and 34.9 g for girls; P < 0.0001). On average, 95.4% of boys and 98.8% of girls consumed snacks during the study period, and total sugar intake showed a significantly increasing trend with increasing energy intake from snacks (P < 0.0001 for both sexes). Two dietary patterns were identified by cluster analysis: Traditional and Westernized patterns. Total sugar intake was higher in the Westernized pattern (56.2 g for boys and 57.2 g for girls) than in the Traditional pattern (46.5 g for boys and 46.3 g for girls). CONCLUSIONS: These results suggest that multilateral and practical development of a nutrition education and intervention program that considers dietary behaviors as well as absolute sugar intake is required to prevent excessive sugar intake in Korean children and adolescents.

• Journal of Nutrition and Health
• /
• v.42 no.2
• /
• pp.135-145
• /
• 2009

This study was performed to investigate added sugar intakes from processed food-snacks and participation behaviors of special event days sharing sweet foods among adolescents in Korea. Questionnaire survey (n = 959), dietary survey (n = 71) by food record method for 3 days, and snack survey (n = 230) for 3 days were carried out, and subjects were overlapped among three surveys. As a result, middle school students (MS) preferred milks and fermented milks while high school students (HS) preferred breads and fast foods as a snack (p < 0.01). MS and HS took snacks three to six times a week, and HS took snacks more frequently than MS (p < 0.05). Most subjects participated in special event days sharing sweet foods such as friend's birthday (68.4%), Peppro's day (61.5%) and Valentine's day (42.6%). As for merits of these events, MS said ‘they could get along with their friends' and ‘relieve stress', while HS said ‘they could enjoy their own events' and ‘confess their affection to whom they like' (p < 0.01). A group of cookies, biscuits, breads and, cakes was major source of added sugars followed by beverages, sweet jellies of red bean, chocolates and candies for subjects. For MS and HS, daily total added sugar intakes from whole processed food-snacks were $30.5{\pm}23.5g/d$ (3.0-137.9 g/d) and $31.7{\pm}23.2g/d$ (1.2-126.1 g/d), and ratios of daily total energy taken from added sugars of whole processed food-snacks in proportion to daily total energy taken from diet (energy percent of added sugars from snacks) were $6.3{\pm}4.7%$ (0.6-26.1%) and $6.3{\pm}4.4%$ (0.3-23.9%), respectively. These results showed that subjects frequently participated in special event days sharing sweet foods. In addition, energy percent of added sugars from snacks was more than the UL suggested by WHO/FAO for some subjects. Therefore, it is highly critical to monitor adolescents' sugar intakes on a long-term basis and to take nutritional management on their high sugar intakes.

• Journal of Korean Home Economics Education Association
• /
• v.33 no.2
• /
• pp.95-113
• /
• 2021

This study examined the food group and dietary nutrient intakes by sugar-sweetened beverage(SSB) intake level in high school students aged 15~18 years(n=2,377) using the 2007~2015 Korea National Health and Nutrition Examination Survey. Subjects were classified into three groups by SSB(included carbonated drinks, sports drinks, and caffeinated drinks that contained added sugars) intake level obtained from 24-hour recall method: SSB 1(SSB intake 0 g/d), SSB 2(0 g/d < SSB intake < 50th percentile) and SSB 3(SSB intake ≥ 50th percentile). Result of daily intakes of SSB were 160.6±10.5 g/d for boys and 98.6±7.1 g/d for girls and it increased for boys(p<0.0001) and girls(p=0.0280) by year. The highest intakes were carbonated drinks followed by fruit juices for boys and girls. Intakes of carbonated drinks increased as 2.7 times for boys(p<0.0001) and 1.6 times for girls between 2007 and 2015 year. Daily intakes of vegetables were the lowest in SSB 3 of three groups for boys and girls(p<0.0001), and those of fruits were lower in SSB 2 and SSB 3 than SSB 1 for boys(p=0.0013). Daily intakes of milk & milk products decreased toward SSB 3 group for boys(p<0.0001) while those were the lowest in SSB 3 of three groups for girls. Daily intakes of dietary fiber(21.3~25.3%) and calcium(49.6~59.8%) were very low compared to the dietary reference intakes. Percentage of daily intakes compared to the dietary reference intakes increased for energy for boys and girls(p<0.0001) while decreased for vitamin C toward SSB 3 group for boys(p<0.0001) and girls(p=0.0382). Those of calcium were the lowest in SSB 3 of three groups for boys(p<0.0001) and girls(p=0.0008). Ratio of excess intakes of energy/fat increased toward SSB 3 group for boys and girls(p=0.0002). Ratio of calcium deficiency was not different among groups but that was very high(85.9~92.5%). Therefore, it should be emphasized to reduce SSB intakes in order to improve diversity in food group and dietary nutrient intakes among high school students through dietary education and government support.

• Journal of Nutrition and Health
• /
• v.48 no.3
• /
• pp.248-257
• /
• 2015

Purpose: The aim of this study was to estimate total sugar intake and sugar intake-related dietary habit and nutrient intake of middle school students. Methods: Subjects included 1,184 middle school students (476 males and 708 females) residing in Jeju. This research analyzed daily dietary intakes of subjects using the 24 hour recall method and surveyed the dietary habit related to total sugar intake using questionnaires. Descriptive analysis, chi-square test, t-test, and ANOVA, using the SAS program were used for analysis of data. Results: The average daily total sugar intake was 60.3 g (male 50.5 g, female 66.9 g). Total sugar intake per meal was 6.5 g (10.8%) from breakfast, 9.0 g (14.9%) from lunch, 11.8 g (19.6%) from dinner, and 33.0 g (54.7%) from snacks. Food groups that contribute to the majority of total sugar intake were grains and their products (23.0 g), milk (11.0 g), fruits and their products (7.3 g), sugars and sweets (6.1 g), and vegetables and their products (5.8 g). In terms of total sugar intakes by cooking methods, desserts showed a greater amount than main and side dishes, and indicated in order of amount as follows: bread and cookies (11.5 g), dairy products (7.5 g), ice cakes (6.2 g), beverages (5.3 g), and fruits (4.5 g). Total sugar consumption was high for rice and side dishes such as noodles (10.2 g), fried foods (2.9 g), stir-fried foods (2.0 g), and cooked rice with seasoning (1.7 g). The daily intake of natural sugar, added sugar, and natural and added sugar was 18.3 g, 35.8 g, and 6.2 g, respectively. The high sugar intake group, which was over 20% of the energy from total sugar intakes, consumed significantly less Fe, Zn, vitamin B6, niacin, and vitamin E than the low sugar intake group, which was below 20%. Conclusion: Total sugar intake of second graders of middle schools on Jeju Island was 60.3 g/day, mostly obtained from snacks (54.7%). Therefore, nutritional education for proper selection of better snacks and for reduction of dietary sugar intake is needed for middle school students.

• Nutritional Sciences
• /
• v.7 no.2
• /
• pp.88-91
• /
• 2004

New Dietary Reference Intakes (DRIs) forthe United States and Canada have recently been set for both macronutrients and micronutrients, and are likely to be of interest to health professionals in Korea as well. DRIs are now available for nutrients that did not have Recommended Dietary Allowances set in the past (amino acids, n-3 and n-6 fatty acids, total fiber, added sugar, choline, boron, nickel, and vanadium). Furthermore, the units for the DRIs do not always match those traditionally carried on food composition tables (FCTs). FCT developers will also need to consider carrying new variables to allow the calculation of folate intake in $\mu$g of dietary folate equivalents, vitamin E intake as mg of a-tocopherol (not as mg of a-tocopherol equivalents), and vitamin A intake as $\mu$g of retinol activity equivalents (not as $\mu$g of retinol equivalents). Because the new recommendations for upper levels of intake sometimes refer to a specific form or source of a nutrient, nutrients occurring in foods must be separated from added or supplemental forms for vitamin E, niacin, and folate; pharmacological magnesium must be carried as a separate variable; and preformed vitamin A must be separated from vitamin A from carotenoids. For more information on the DRIs, see: www.nap.edu.