Micronutrient dilution associated with alcohol and added sugar intake in the THUSA population / Marita Serfontein.
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The micronutrient intake of the average South African is not optimal. National fortification of staple foods does not solve all micronutrient deficiencies. Furthermore, urbanisation causes a shift in food intake, increasing the availability of cheaper and more energy dense food and drinks that are often lacking in micronutrients. It is unclear whether the current literature provides sufficient evidence of nutrient dilution by the moderate consumption of alcohol and/or added sugar. The aim of the present study was to evaluate the dietary intakes of a population in nutrition transition and determine the effect of intake of alcohol and added sugars on intakes of micronutrients and food groups to provide information for the development of preventive strategies in public health. A number of countries, including South Africa, suggest limited alcohol and sugar intakes in the Food Based Dietary Guidelines but do not quantify this recommendation. Data from the "Transition and Health during Urbanisation in South Africa" survey (THUSA) were analysed for dietary intakes (as determined by a validated quantified food frequency questionnaire), age and body mass index (BMI). The THUSA study was conducted during 1996 and 1998 in the North West Province and included 1854 "apparently healthy". Respondents aged 15 years and older from 37 randomly selected sites from rural and urban areas. Alcohol intake (absolute intake and percentage of energy) was the highest for men living in middle class urban areas. With increased urbanisation, the type of beer shifted from sorghum based to commercial beer. Sixty-one percent of men and 25% of women reported that they consumed alcohol at the time of the survey. Eighteen percent of men and 11.7% of women consumed more than 30g and 15g alcohol per day, respectively (intakes which are regarded as moderate). Men and women consuming the most alcohol had significantly higher mean intakes of most macro and micronutrients. However, the intake of vitamin Bi2, B6, folate, vitamin E and vitamin C did not meet the recommended dietary intake (RDA) across all levels of alcohol intake. Although the total energy intake increased with increased alcohol intake, there was no significant difference between the mean BMI of men or women with different levels of intake. One third of the population consumed more than a 100g of added sugar daily. Intake of sugar was the highest in the farm dwellers but the intake of sweets, cakes, cookies and cold drinks was the highest in the urban areas. As sugar intake increased so did energy, carbohydrates and most micronutrients. However, the intake of vitamin B12, folate, vitamin C and calcium did not meet the RDA across all levels of sugar intake. BMI did not differ between respondents with the highest and lowest sugar intake and no association was found between BMI and sugar intake. The THUSA study was conducted before fortification of staple food became law in October 2003. Maize meal and wheat flour are nowadays fortified with certain vitamins and minerals which may alleviate some micronutrient deficiencies. For future research it is imperative to establish the reasons for low intake of certain micronutrients rather than to look at a single food item in the diets of the South African adult population. Proper education on the intake of cheaper food sources of micronutrients needs to be highlighted at all levels of the health sector.
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