Project co-financed by:

Description of the project:

Sugars are simple carbohydrates that the body uses for energy. While many foods contain sugars naturally, they are also commonly added to foods during processing. According to the WHO definition, free sugars are all sugars added to foods or drinks by the manufacturer, cook or consumer, as well as sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. Sugarsweetened beverages (SSBs) and desserts are among the top sources of free sugars, but many other foods contain free sugars.

High intake of free sugars increases the risk of overweight, obesity and dental caries, and other health problems. Avoiding excess free sugars intake is, therefore, an accepted dietary guideline throughout the world. This is highly applicable also for Slovenia, where high prevalence of obesity is reported in both, children and adults. Free sugars intake can be reduced by limiting the consumption of foods and drinks containing high amounts of free sugars, and eating whole fruits and vegetables instead of free sugar in liquid form and sugary snacks.

There are several initiatives trying to lower intake of free sugar, both internationally and nationally. However, a precise knowledge of the current situation regarding sugar intake in the population is required for successful policy decisions. This is also noted in the Slovenian Resolution on Nutrition and Physical Activity for Health 2015–2025. Voluntarily measures to reduce sugars in SSBs were accepted in 2015 by the Slovenian food industry association, but the efficacy of these has not yet been evaluated. We are also lacking the data on the sugar intakes in different populations. Studies from other European countries are showing that consumption of free sugars is exceeding current recommendations, but the data for Slovenia is scarce. While excess free sugars intake is clearly recognized as a health concern, a number of controversies exists regarding the real reasons for the observed negative health effects. These can be either free sugars intake related to high energy intake, intake of specific foods (i.e. SSBs), intake of total sugars, or intake of specific sugars.

The proposed project’s overall hypothesis is that due to the high content of added sugar in foods and drinks their intake in the population exceeds the recommendations and presents a public health risk. For this reason sugar content in processed foods should be lowered, while consumption of foods high in sugar should be reduced. Applying a highly multidisciplinary approach, we will: (O1) collect data on the composition of foods on the market, use sales-weighting approach to identify major sources of (added) sugars, and make a comparison with situation prior to self-regulation of the food industry; (O2) collect data on broadcasted marketing of foods to children and assess effectiveness of implementation of nutrition profiles to regulation in 2017; (O3) determine total and free sugars intakes in the population, using the nationally representative sample; (O4) identify population groups with the highest free sugars intakes and assess their overall dietary and lifestyle habits, associated with risks for noncommunicable diseases, particularly obesity; (O5) determine the effectiveness of nutritional counseling in regard to a decreased intake of foods with high free sugars content using a prospective trial in obese adolescents; (O6) investigate consumer’s behaviors and preferences for free sugarscontaining food groups, also focusing on free sugars alternatives; and (O7) inform policymakers with the evidence needed for future decisions related to free sugars in foods and diets.

Publications:

• ZUPANIČ, Nina, HRISTOV, Hristo, GREGORIČ, Matej, BLAZNIK, Urška, DELFAR, Nataša, KOROUŠIĆ-SELJAK, Barbara, DING, Eric L., FIDLER MIS, Nataša, PRAVST, Igor. Total and free sugars consumption in a Slovenian population representative sample. Nutrients. 2020, vol. 12, iss. 6, str. 1-18, ilustr. ISSN 2072-6643. https://www.mdpi.com/2072-6643/12/6/1729
• ZUPANIČ, Nina, HRIBAR, Maša, FIDLER MIS, Nataša, PRAVST, Igor. Free sugar content in pre-packaged products: does voluntary product reformulation work in practice?. Nutrients. 2019, vol. 11, iss. 11, str. 1-14, ilustr. ISSN 2072-6643. https://www.mdpi.com/2072-6643/11/11/2577, DOI: 10.3390/nu11112577. [COBISS.SI-ID 40290053]
• DUNFORD, Elizabeth K., NI MHURCHU, Cliona, HUANG, Liping, VANDEVIJVERE, Stefanie, SWINBURN, Boyd, PRAVST, Igor, TOLENTINO-MAYO, Lizbeth, REYES, Marcela, L'ABBE, Mary, NEAL, Bruce C., KUŠAR, Anita (sodelavec pri raziskavi), ŽMITEK, Katja (sodelavec pri raziskavi), HRIBAR, Maša (sodelavec pri raziskavi), LAVRIŠA, Živa (sodelavec pri raziskavi), PIVK KUPIROVIČ, Urška (sodelavec pri raziskavi), et al. A comparison of the healthiness of packaged foods and beverages from 12 countries using the Health Star Rating nutrient profiling system, 2013-2018. Obesity reviews, 2019, https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12879, doi: 10.1111/obr.12879. [COBISS.SI-ID 40156421]
• LAVRIŠA, Živa, PRAVST, Igor. Marketing of foods to children through food packaging is almost exclusively linked to unhealthy foods. Nutrients, 2019, vol. 11, iss. 5, str. 1-11, ilustr. https://www.mdpi.com/2072-6643/11/5/1128, doi: 10.3390/nu11051128. [COBISS.SI-ID 40163589]
• PIVK KUPIROVIČ, Urška, MIKLAVEC, Krista, HRIBAR, Maša, KUŠAR, Anita, ŽMITEK, Katja, PRAVST, Igor. Nutrient profiling is needed to improve the nutritional quality of the foods labelled with health-related claims. Nutrients, ISSN 2072-6643, 2019, vol. 11, iss. 2, str.1-15, preglednice. https://www.mdpi.com/2072-6643/11/2/287, doi: 10.3390/nu11020287. [COBISS.SI-ID 39951877]
• KELLY, Bridget, MIKLAVEC, Krista, PRAVST, Igor, et al. Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries. Obesity reviews, ISSN 1467-7881, 2019, https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12840, doi: 10.1111/obr.12840. [COBISS.SI-ID 39994117]
• PRAVST, Igor, KUŠAR, Anita. Labeling of nonalcoholic beverages. V: GALANAKIS, Charis M. (ur.). Trends in non-alcoholic beverages. 1st ed. London: Academic Press, an imprint of Elsevier, 2019, str. 263-307, ilustr. https://www.elsevier.com/books/trends-in-non-alcoholic-beverages/galanakis/978-0-12-816938-4, doi: 10.1016/B978-0-12-816938-4.00009-4. [COBISS.SI-ID 40158725]
• ZUPANIČ, Nina, FIDLER MIS, Nataša, PRAVST, Igor. Soft drinks : public health perspective. V: GALANAKIS, Charis M. (ur.). Trends in non-alcoholic beverages. 1st ed. London: Academic Press, an imprint of Elsevier, 2019, str. 325-369, ilustr. https://www.elsevier.com/books/trends-in-non-alcoholic-beverages/galanakis/978-0-12-816938-4, doi: 10.1016/B978-0-12-816938-4.00011-2. [COBISS.SI-ID 40158981]
• GREGORIČ, Matej, ZDEŠAR KOTNIK, Katja, PIGAC, Igor, GABRIJELČIČ BLENKUŠ, Mojca. A web-based 24-h dietary recall could be a valid tool for the indicative assessment of dietary intake in older adults living in Slovenia. Nutrients, ISSN 2072-6643, 2019, vol. 11, str. 1-13, doi: 10.3390/nu11092234. [COBISS.SI-ID 5165903]
• ZUPANIČ, Nina, MIKLAVEC, Krista, KUŠAR, Anita, ŽMITEK, Katja, FIDLER MIS, Nataša, PRAVST, Igor, PIVK KUPIROVIČ, Urška (sodelavec pri raziskavi), LAVRIŠA, Živa (sodelavec pri raziskavi). Total and free sugar content of pre-packaged foods and non-alcoholic beverages in Slovenia. Nutrients. 30 Jan. 2018, vol. 10, iss. 2, str. 1-16, ilustr. ISSN 2072-6643. http://www.mdpi.com/2072-6643/10/2/151
• LAVRIŠA, Živa, ERJAVEC, Karmen, PRAVST, Igor. Trends in marketing foods to children in Slovenian magazines : a content analysis. Public health nutrition, ISSN 1368-9800, 2018, https://dx.doi.org/10.1017/S1368980018002513. [COBISS.SI-ID 39759109].