They have argued that a nationwide survey using multiple 24-hour recalls, as well as the use of biomarkers, is urgently needed to provide more accurate information on which to base policy decisions.
At present, due to the discrepancy between a low level of reported food intake and high level of overweightness and obesity, it is likely that the methods used in Indonesia’s nationwide food consumption surveys failed to capture precisely the levels of intake.
“A single 24-hour recall can estimate group mean intakes but cannot be used to estimate usual or long-term intake,” said the researchers.
“Levels of sugar intake can be estimated more accurately by using biomarkers to validate dietary data, for example urinary fructose and glucose or isotope ratios in red blood cells and hair,” they added.
They explained that correlating dietary biomarkers with disease biomarkers provides a more valid and precise approach to studying diet-disease relationships and enables the development of more specific and practical dietary guidelines.
The disadvantage is that biochemical methods are invasive and expensive.
For this report, information was extracted from food balance sheets, household expenditure surveys, nutrition surveys, published studies, unpublished theses or dissertations and government reports.
But the inaccuracy of the methods has led to differences in findings.
Amounts of sugar intake and food sources
National surveys suggested sugar intakes were within World Health Organization (WHO) recommendations of below 50g a day or below 10% of energy intake, and within the national guidelines of below 25g per day. However, published studies suggested higher levels.
One such study among children showed intake levels above 50g per day. Among adults and the elderly, studies showed sugar intake levels above the Indonesian recommendation.
The 2014 Total Diet Study estimated that 11.8% of Indonesia’s population consumed more than 50g of sugar per day.
From nationwide surveys, the common sources of added sugar shown were table sugar, sweetened condensed milk and syrup. From published studies, sources were sweetened beverages, condensed milk, sweet desserts and confectionery.
Other types of studies suggest that there has been a shift in the local diet towards the inclusion of more processed foods containing added sugars and fat, contributing to increased energy intake.
Consumer purchasing linked to increased sugar intake
What’s more, the increasing availability of Western fast food containing high fat and sugar may contribute to the increased level of obesity in Indonesia. According to 2014 research, Indonesian and oriental fast food had significantly lower energy densities than that of Western fast food.
Market reports also indicate an increasing demand for sugar. Information from Euromonitor International in 2010 showed that Indonesian consumer spending on sugar and confectionery increased from US$3.2b in 2007 to US$3.6b in 2009, and was projected to increase further to US$7.3b in 2014. This is consistent with reports that Indonesia’s sugar imports were expected to increase by 29% from 2014 to 2015, driven by increasing domestic demand for sweetened foods and beverages.
Considerations for the future
“Hence, accurate estimates of sugar intake levels in different population groups are needed and food sources that contribute significantly to sugar intake should be identified in order to guide intervention and policy, together with promoting healthier diet and lifestyle among Indonesians,” the researchers agreed.
The authors recommended that it be included in the Indonesian Dietary Guidelines to limit the intake of soft drinks and fruit drinks sweetened with sugars and to choose fresh fruit for snacks instead of sweetened food.
Source: Asia-Pacific Journal of Clinical Nutrition
“Consumption and sources of added sugar in Indonesia: a review”
Authors: Maria Sofia Amarra, et al.