Sugar Intake and Obesity in Australian Children: A Detailed Analysis

This article evaluates the intake of sugar and the source of food in relation to obesity in Australian children. The survey involved 2598 children and adolescents who had undergone through dietary records. The article provides a detailed analysis of the relationship between sugar intake and obesity in Australian children.

HUMAN NUTRITION: SUGAR INTAKE AND OBESITY IN AUSTRALIAN CHILDREN
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Abstract
Several studies have been concerned with
the relationship between the consumption
of sugar and the existence of obesity in
Australian children. In this connection, we
did an evaluation of the intake of sugar and
the source of food in relation to obesity in
Australian children. In this detailed
analysis, data were collected from four
surveys carried out between 2001 and
2010. The survey involved 2598 children
and adolescents who had undergone
through dietary records. The total sugar
was realized to be more in young females
than in males (5). More accurately, sugar
intake in girls was 54.2g while that of boys
was 46.5, giving a probability whose value
is less than 0.0001(p<0.0001). Sugar
intake from certain beverages did not
highly contribute to obesity especially in
girls (14). However, beverages with high
sugar content were found not to contribute
to obesity in girls but rather had a
remarkable contribution in boys. Obesity
in boys was 0.51 i.e. 95% CI. The results
show that sugar intake and obesity in
Australian children taking sugar-
sweetened drinks is comparatively lower
than obesity versus sugar that exists in
kinds of milk and fruits.
Keywords: dietary sugar intake; nutrition;
obesity; children; Australian

Introduction
Obesity is has been a major problem
affecting children and adolescents across
the world. Researchers have indicated that
the problem of obesity was placed at
approximately 16.8% for ages between 2
to 9 year old in the U.S, while it was 13%
for ages between 2 to 15 years old in the
United Kingdom (1). In a country like
Australia, the rate of obesity has
remarkably risen in the last ten years. It is
observed that the prevalence rate of
obesity in Australian boys was 12.1% and
7.1 in girls respectively. Health research
associates obesity in children with high-
level risks in chronic diseases like diabetes
and heart diseases. Approximately 70% of
children who suffer from obesity in
childhood usually remain obese even in
adulthood. Therefore, it is important to
manage obesity so that when children
grow to adulthood, the problems
associated with obesity such as heart
problems can be minimized (4). Although
obesity can also be caused by other factors
like cultural, socioeconomic, genetic,
environmental, and behavioral factors,
dietary factors is the leading contributor
(3). Other studies have reported that early
intake of energy in children and frequent
daily meals contribute to obesity in
childhood. Over the past decades, there
have been a lot of changes in lifestyle and
dietary methods in Australia. The western
diets have been associated with obesity
(4). One of the investigations looked at the
composition of sugar in processed foods.
In the recent studies, pieces of evidence
that indicate that there is the connection of
sugar and obesity have been presented.
According to the analysis of 14 surveys
that included children, high intake of sugar
and sugar-sweetened foods usually form
the baseline of obesity in children. Several
studies were concerned with the
relationship between obesity or overweight
and sugared foods and beverages with
sugar (6). Due to this trend of increased
sugar intake in Australia, there is a need to

investigate the effects caused by this
increase; explain the consequences, and
recommend the steps to be taken to curb
the problem (17). More specifically, the
amount of sugar intake by Australian
children in the last decade is approximated
to have risen from 66.4g to 69.5g in six to
eleven years and 76.4g to 79.0g in twelve
to eighteen year old.
Methods
Data collection and population study
The data were derived from 5 surveys
carried out on Australian children between
2001 and 2010. All the criteria for the
analysis of secondary data were included
and the study looked at quantitative data
for diets, which included at least three days
of analyzing the data for the children's
diet. A total of five studies employed
similar procedures for the assessment of
dietary sugar intake in children. However,
some outcome variables, for example, the
mineral density of the bone and the food
allergy had no similarities (9). Some
detailed information about the five studies
has been shown in Appendix Table A1.
The original study looked at 4952 children
and for a good comparison, this number
included adolescents. The ages of the
respondents were between 8-13 years.
These children were from 7 elementary
school, 2 middle-level learning centers,
and a care center. The criteria used was
that if any survey completed 3 or more
days of the diets’ records and other
parameters such as age and gender with no
disease (n=4087). Out of the 4087
subjects, we exempted the ones without
accurate information or those with
incomplete information on anthropometric
measurement e.g. length and mass (n=94)
and incomplete data for material education
(n= 1254). The last sample contained 2598
children and adolescents (1047 males and
1551 females) 8-13 years old. The survey
was endorsed by the Institutional Review
Board.

Measurement of diet and the intake of
sugar
The diet data were found from the archives
reviewed for 2-6 working days. Individual
group was given and was properly
instructed on the best way of recording
data from the dietary survey. This was
done by trained staff. After the completion
of the process of recording, the completed
diet records were handed over to a trained
staff for review. The unclear or incomplete
records were also made clear by the
interviewer. Calculation of all the intakes
of nutrient was done using the computer-
aided nutritional analysis software (18).
For the evaluation of the adequacy of the
intake of the nutrient, the reference of
dietary for Australians was applied and the
intake of the energy was checked against
the specific requirement by age and gender
(8). The daily intake of sugar was
calculated in reference to Australian food
items and applied in this survey. However,
this database could only be composed of
the total sugar amount for each type of
food. The total sugar could thus be
evaluated by putting together four main
types of food e.g. milk, fruits, and foods
that are processed (5). The fruits that were
chosen include fresh and dry fruits and not
forgetting one hundred percent fruit juices
that could yield the same result as the fresh
and dry fruits. The foods that are already
been processed included drinks, bread,
snacks, fermented milk among others.
Measurement of anthropometry and
obesity in children
The anthropometry data consisted of
height and weight and their measurement
was done by trained surveyors in all the
studies. About 92% of the subjects were
accurately measured with only 8% of them
had self-reported (21). The mass index of
the body was calculated as body weight in
kilograms over body height squared
(kg/m2). Overweight obesity of pediatric
was explained depending on the national-
reference age and gender from the
Australian growth chart (3). The

overweight took 85th percentile of Base
Mass Index (BMI); obesity occupied 95th
percentile giving a BMI of 25kg/m2. It was
realized that subjects within the percentiles
explained above are overlapping with Base
Mass Index (BMI) within the range
allowed for overweight, however, more
than 25kg/m2 was considered to be having
obesity.
Contradictory Variables
Contradictory variables are considered to
include those variables with basic
characteristics, for example, age and
gender with an aspect of socioeconomic
features e.g. maternal education level (24).
The survey also included lifestyle factors
which helped to obtain physical activity
(2). The analyses were grouped into
gender i.e. boys and girls because of varied
characteristics of physical growth (22).
Data that was used in this survey was
derived from five studies and each of them
had varied variables and they were
categorized differently. The measurement
of physical activity was also done
differently considering each study in
reference to the number of sessions per
week or time per day. The population was
categorized as physical activity, either
active or not active (8). The definition of
physical activity was arrived as one with
respondents being active for 20 minutes
while those that are considered not active
may participate in the activity for more
than 20 minutes per day.
Statistical Analysis
All the analyses concerning statistics were
analyzed with the help of the Statistical
Analysis System. The p-values were two-
sided written as p< 0.04 and considered to
represent the significance of statistics.
Variables for demographic and
anthropometry were put as the +/- standard
deviation for variables that are continuous.
The estimation of the daily mean for
nutrient intake from sources of food was
presented as adjusted mean +/- standard
error. The pattern of sugar intake was well

identified by categorizing samples using
age groups. A residual method was applied
to adjust the amount of intake of sugar
from processed food by both male and
female (10). Additionally, a binomial
regression method was used to determine
the relationship between sugar intake and
overweight or obesity. The regression
method helped in determining the odds and
made it easy to estimate ratios for every
outcome.
Results
General features of study components
The number of Australian children that
were included in this survey was 2598.
This number included even the
adolescents. Their average age was
11.3+/- 1.7 years. However, the number of
girls in the study was higher than that of
boys; with approximately 40% being boys
and the remaining 60% taken by girls. The
table 1 below indicates the general features
of respondents according to their gender.
The boys had higher height and weight
than girls for all the variables i.e. p <
0.0001. More specifically, boys were seen
to frequent problems of obese than their
counterparts, for instance, they occupied a
percentage of approximately 15.0%
compared to girls which were 13.0%.
Additionally, education given by mothers
referred to as ‘maternal education' was
greater in boys than in girls. However, it
was realized that boys were frequently
involved in certain physical activities that
girls could not do. For instance, this gave a
probability of p<0.0001.
Table 1
Some general features of sturdy respondents concerning gender and age group
Males (n=1047) Females (n=1551)
8-10 years 11-13 years 8-10 years 11-13 years p-Val
Age in years 9.8+/-0.7 13.0 9.8 13.0 <0.0001

Height in cm 141.0+/-7.0 162.5 141.3 157.3 <0.0001
Weight in kg 39.7+/-9.0 56.2 36.8 50.8 <0.0001
BIM in kg/m2 19.4+/-3.2 21.0 18.2 20.5 <0.0001
Normal weight 310 491 758 476
Overweight 69 29 121 72
Obesity 40 104 68 50
The Body Mass Index and the body weight
were shown in the 85th and 95th percentiles
respectively and these specified genders,
age, and the Body Mass Index. Obesity
was indicated to be greater than or equal to
95th percentile i.e.</=95th. Every
continuous variable was tested with the
help of a linear model. Evaluation and
categorization were done on the chi-
square.
Food nutrients and the intake of sugar
The mean for the daily sugar and nutrient
consumption from different food sources is
summarised in table 2. The energy
consumption in boys was found to 1805.0
+/- 19.0 kcal and that of girls was 1631.8
+/- 16.8 kcal. This fell within the
probability greater than 0.0001 i.e. p<
0.0001. It is therefore evident that the
energy intake in boys is higher than that of
girls. The rate of nutrient and sugar intake
in both gender also differ depending on the
age bracket of the subjects under
discussion (19). When looking at the
vitamin and nutrient intake for each group,
boys gave a higher response compared to
girls of the same age group (2). The most
common nutrient in the survey was
thiamine and iron. The value of iron
present was in girls within the range of age
8-10 years were 166.5% and 112.2% for
boys between 12 and 14 years old. The
total sugar in girls was found to be much

more than that in boys, with average sugar
in girls being 54.2g. This value was a little
higher than the average value of sugar in
boys, which was 46.5g (26). It is clear that
these values depend on gender in question.
Additionally, it is important to note that
the major sources of sugar are processed
foods including milk, drinks, bread, and
snacks. The average intake of sugar by
girls was recorded as higher than in boys
(3). This was approximately 34.8g and
27.8 grams in girls and boys respectively.
The survey revealed that the consumption
of sugar that is derived from processed
food was slightly higher for those who
were within 11-13 years of age than the
values noticed or the ages between 8-10
years. These values could be stated as 25.6
grams for 11-13 years old and 37.0 grams
for the range 8-10 years. The probability
for these two set of values was p=0.006.
Apart from the processed foods, fruits
played a greater role in contributing to the
total intake of sugar for every group (18).
It is evident that the consumption of sugar
from fruits gave a higher value in girls
than in boys. The values for the intake of
sugar from fruits by girls and boys were
given as 8.7 grams and 7.4g respectively.
This yield a probability of 0.00080 or
p=0.00080
.
Table 2: Average nutrient daily intake and sugar from varied food sources
Males (n=1047) Females (n=1551)
8-10 years 11-13 years 8-10 years 11-13 years
Energy (kcal/day) 1694 1948.2 1575.4 1681.8
Carbohydrate (gram/day) 258.5 258.7 238.0 236.5
Protein (gram/day) 73.2 70.0 60.8 64.2
Fat (gram/day) 57.3 5.6 50.5 48.2
Thiamine 143.4 143.7 127.6 110.1

Vitamin C 83.8 66.4 84.2 65.2
Calcium 63.8 49.2 58.5 52.7
A relationship between dietary sugar
intake and obesity
Table 3 summarises the relationship
between dietary sugar intake and obesity
for the adjusted and non -adjusted data.
The data is based on two food sources i.e.
milk and fruits. After doing an adjustment
for confounding subjects in girls, sugar
intake from milk and fruit was realized to
have little contribution to obesity and
overweight (9). In contrary, no association
was recorded for this case in boys.
A relationship between dietary sugar intakes for the adjusted food sources
Dietary sugar quartiles
Q1 Q2 Q3 Q4
Intake of sugar from milk and fruits in grams/day
Boys (n=1047)
Sugar intake 3.1 8.5 15.0 31.5
Normal 1.0 1.1 1.10 1.28
Overweight 1.0 0.97 0.80 0.70
Obesity 1.0 0.67 0.87 0.68
Girls (n=1551)
Sugar Intake 4.1 10.6 17.7 34.5
Normal 1.0
Overweight 1.0 0.60 0.66 0.51
Obesity 1.0 0.68 0.72 0.41

The intake of sugar from milk and
processed food was energy-adjusted by the
aid of the residual method and put into
quartiles (20). Using the quartiles, the
overweight occupied 85th to 95th percentile
for age and gender. A binomial regression
method was used to arrive at the
relationship between the dietary sugar
intake and the different sources of food.
Discussion
In the study of a large sample of Australian
children in relation to obesity and sugar
intake, the research found that the overall
sugar intake and what it contributes to the
total energy intake remained with little
impact on the result. Looking at sugar
intake considering the different sources of
food, the only result that was associated
with obesity and overweight is only the
sugar derived from fruits and milk (15).
The mean sugar intake from three or more
days of diet intake as recorded in this
survey is 51.3 grams and this was in
comparison with the result of the resent
study that indicated sugar intake as 61.2
grams. Other studies indicate that this level
of dietary sugar intake is lower compared
to the amount of sugar intake as revealed
by other studies from other western
countries (13). More specifically, in one
country, the amount of sugar intake
reported in a certain research outcome was
138 grams for ages between 1 to 18 years
old. This was a research carried out
between 2009 and 2011 specifically in the
US. In the UK, the average sugar intake in
male children has been recorded as 107.1
grams and 172 grams for boys in Canada.
The rate of the effect of obesity and
overweight was also reported to be low in
Asian countries compared to western
countries. In this survey, the average
sweetened sugar intake was approximately
62ml per day (11). This is much lower
than that reported in a different study in
Australia that recorded 126ml per day in
Australian children and adults between 2
to 16 years of age. The average energy
from sugar-sweetened beverages in the

resent study was 26-kilo calories per day.
This value is lower as compared to the one
given by a similar study in the United
States of America which was 140 kcal per
day and 111 kcal for boys and girls
between 6 to 11 years respectively.
However, sugars derived from processed
foods did not contribute directly to obesity
nor did they contribute to overweight.
Many studies, however, have reported that
high intake of high intake of sugar-
sweetened beverages contributes
immensely to obesity and overweight (4).
However, most of these studies were
carried out in western countries; other
studies, especially in Asian countries, do
not prove the relationship between obesity
and overweight and sugar-sweetened
beverages (SSBs). Therefore, this may
reveal that there are inconsistencies in the
results from these studies and perhaps
there may be a little contribution of SSBs
to obesity and overweight.
Sugar-sweetened beverages (SSBs) may
contribute to obesity as reported by a few
studies but it also forms a poor eating or
unhealthy eating behavior. Considering
eating behavior and diet patterns,
Australian children and adolescents have
been seen as having different diet practices
(1). Because of economic growth and
adaptation to western kind of lifestyle,
many people have shifted to modern
dietary behaviors where modified foods
including beverages are introduced in our
meals. This, we must say have a greater
impact on our body resulting in a number
of metabolic reactions and varied growth
patterns.
Concerning different diet practices and
behaviors in Australia, the varied results
about the relationship between sugars
sweetened beverages and obesity or
overweight can be highlighted to prove
that there is a contribution of consumption
of excess sugar to the development of
obesity and overweight in children and
adolescents16. This is observed mostly in

boys than girls. Therefore, the prevalence
of obesity in Australian boys is much
higher especially sugar-sweetened
beverage drinkers (12). It was only in girls
that we observed an inversely proportional
relationship between sugars sweetened
beverages and obesity. Because of the lack
of a database of added sugars in Australia,
the researchers were not able to do an
evaluation of added sugar intake. To
compensate for this lapse, we were able to
evaluate the sugar intake from different
sources of food, milk, and fruits. However,
only sugars from milk and fruits indicated
a substantial impact on the reduction of
weight.
In this study, it is evident that sugars from
milk and fruit may have a little
contribution to overweight and obesity
especially in girls and therefore should be
considered as factors contributing to
obesity in Australian children and
adolescents (7). Additionally, it is reported
in other studies that Australian children
aged between 1 to 8 years of age consume
a lot of sugar from food sources occurring
naturally and this indicates that as these
children grow, they may develop diet
problems if their dietary behavior or
pattern is left unchecked (6). It is therefore
important to monitor not only the dietary
behavior of these children but also the
sources of food so that they do not end up
feeding on one type of nutrient which may
result into them developing obesity and
growing overweight1. In this regard, there
should be effective national nutrition
policies and guidelines to see that every
individual and especially parents,
caregivers, dieticians, and guardians are
enlightened on the benefits of ensuring that
children under certain age limit are
regularly considered for the best dietary
behaviour.
This study has many shortcomings. Firstly,
the study was derived from five previous
surveys. This made it quite difficult to
miss discrepancies between this study and

other studies. However, the necessary
information for this study was adequately
collected three days prior to the conduction
of the study. To reduce the effect of this
problem, we tried to spread the study
number in all the steps of analyses.
Finally, this study was cross-sectional so
there was difficulty in determining the
exact relationship between sugar intake
and the risks caused by obesity.
Conclusions
In conclusion, the sugar intake in
Australian children is observed as quite
low compared to that of Asian children.
Sugars derived from milk and fruits relate
to decreasing in obesity and overweight in
Australian children. It is therefore
important to keep monitoring the dietary
sugar intake to establish an accurate
relationship between sugar intake and
obesity.

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