Children naturally gravitate towards sugary diets. The effects may go unnoticed in them by parents for an extended period of time until they land in the hospital. VINCENT KURAUN speaks with experts about the effects of high consumption of sugar among children.
Several studies have asserted that excessive consumption of sugary drinks poses a grave health issue to humans. The additives that come along with sugar-sweetened beverages may also have damaging effects on human health and in children when not properly checked.
But while paediatricians all over the world have long advised children and adolescents to desist from and/or reduce intake of sugary beverages, the consumption of these sugar-sweetened beverages is believed to be on the rise. It is also expected that the huge intake of sugar-sweetened beverages will continue to increase because of urbanisation and economic development that have increased access to and availability of these beverages.
Nigeria is estimated to have over 12 million people suffering from obesity and at the same time the country has the highest diabetes prevalence in Africa. A 2019 survey ranked Nigeria as having the fourth-highest soft drinks sales globally and the seventh-highest consumption of carbonated soft drinks per capita. Another survey also estimated that 38.6 million litres of sugar-sweetened beverages are sold annually in Nigeria and most of our children consume a lot of these sugary drinks.
In 2022, President Muhammadu Buhari-led Federal Government imposed sugar-sweetened beverages (SSB) tax in line with the 2021 Financial Act. According to the act, an excise tax of N10 per litre is placed on all non-alcoholic, carbonated and sugar-sweetened beverages by the government.
The government also said the policy would prevent and discourage excessive consumption of sugar in beverages which contributes to obesity and other non-communicable diseases like diabetes mellitus, chronic cardiovascular diseases and complications like heart attack, stroke, kidney failure, blindness, and cancers, among others. But this policy has not in any way reduced the consumption of heavily sweetened beverages by children and even their parents. The beverage companies have continued to smile to the banks while the unintended health cosequences are left for the future.
Is anything wrong with sugar intake?
While the consumption of sugar in itself is not bad, the amount consumed is a worry for many. The World Health Organisation (WHO) has reported that high consumption of sugar results in a rise in the body mass index (BMI). It, therefore, recommends that both adults and children reduce their daily intake of sugar to less than ten cubes of sugar in a day.
Sunday Tribune spoke with an array of experts to ascertain the effects of these sugar-sweetened beverages on the health of children and adolescents.
Though a paediatrician/paediatric cardiologist at the University of Benin Teaching Hospital, Dr Emmanuel Eyo-Ita, told Sunday Tribune that there is nothing wrong with sugar consumption among children, he expressed grave concerns about the amount of sugar in these fizzy drinks.
According to him, “is there anything wrong with sugary drinks? The answer is no, sugar is energy, sugar is a carbohydrate and it is good for our bodies, especially for children. However, the problem with sugary drinks is the amount of sugar they contain.”
A healthy child, explained, already has “glucose consumed from drinks and another glucose already forming from other foods that he/she consumed. The excess is mopped-up and stored in the body not as muscles but as fats. In the long run, the damaging effect might start manifesting.”
Eyo-Ita added that “parents may not see it so early but a child may end up with obesity which comes with diabetes type 1 or type 2, and this diabetes comes with elevated blood pressure. It comes with hyperlipidaemia (abnormally high level of fats in the blood which includes cholesterol and triglycerides), and all these have ramifications for different organs in the body like heart disease, increased incidence of heart failure, and increased risk of kidney issues and these bring increased incidences of renal disease that we are having among children now.
“All these issues mentioned above are gradually becoming adolescents’ problems. Recently, we are seeing a lot of teenagers who are having heart issues, blood pressure issues, and kidney issues. The numbers are rising and something needs to be done about it.”
He further warned that children may not need refined sugars in their systems, as feeding them with refined sugars contained in sweetened drinks is not the way to go. He added that if “children are afforded a balanced diet (meals containing an adequate representation of all food groups), they will have enough of their energy needs and more to ensure growth and development.”
Corroborating Eyo-Ita’s claims, a registered dietician, Toluwalope Phoebe Farodoye, said: “Carbohydrate foods like rice, oat, plantain, yam, potatoes, milk, grains, as well as various fruits, contain naturally occurring sugars. Having an adequate diet gives you the sugar needed by the body. Carbohydrates also provide fibre and other nutrients to the body. Eating a variety of carbohydrate foods is a healthy way to meet these daily targets.
“Sugar-sweetened beverages have no nutritional value; it is just empty calories that increase the energy and sugar level of the body and when we talk about sugar sweetened beverages, we are referring to carbonated drinks, fruit juices, teas, coffee, sports drinks, malt drinks, flavoured milk drinks, basically any form of beverage with added sugar whether homemade or commercial.”
While warning against high consumption of sugary drinks, the Chief Dietician at the University College Hospital (UCH), Ibadan, Ann Ozoh, told Sunday Tribune that “most of the sugar-sweetened beverages are empty calorie. They are just energy givers with zero nutrients. They are not enriched, and they lack vitamins and minerals.”
According to her, “there are a lot of sugar-sweetened beverages in Nigeria and these are drinks or liquids that have added sugars in them. The sugar could be brown sugar, dextrose, glucose, fructose corn syrup malt syrup even honey among other added sugars. Sometimes, sugar is added to some herbs in other to enhance the taste. Sometimes you find them in bitter lemon and even some alcoholic drinks that are bitter. But people consume these herbs because they believe it is good for malaria and so on.
“But they have actually forgotten that the amount of sugar added to sweeten it, to make it palatable for consumption, is quite higher which is dangerous to one’s health even though it has health benefits such as instant energy.
While noting that sugar-sweetened beverages are sometimes medically recommended in regulated quantity for patients with hypoglycaemia (low blood sugar level) as in the case of people with type 1 diabetes who are insulin-dependent, Ozoh noted that “sugar-sweetened beverages have side effects, especially among children and these side effects could be excess weight gain,” she said.
Speaking further on a 2021 study she participated in on the issue of sugar-sweetened beverages in Ibadan North Local Government Area of Oyo State, Ozoh said, “the result was really disappointing. Our findings show that the school environment itself encourages such. It was discovered that most of the homes are the one that encourages it. Caregivers or parents tend not to guide children on what to buy. In the school environment, sugar-sweetened beverages are being sold more than healthy food and these children found themselves buying more of these sugar-sweetened beverages and they are also influenced by peer pressure.
“The research indicated that 68 per cent of these students were given sugar-sweetened beverages by their parents while 13 per cent got it on their own. What that means is that parents are the contributory factors to the intake of sugar-sweetened beverages taken by our children and adolescents because that is what we the parents trained them with.
“That is what parents put in their lunch bags when they were young and this research was done in both private secondary and public secondary schools within Ibadan North Local Government Area of Oyo State. Parents are the major predisposing factor to the intake of sugar-sweetened beverages, it is a behaviour which we need to refrain from.
“These sugar-sweetened beverages have short- and long-term consequences on the child. The short-term consequences of these are micronutrient deficiency and poor healthy dietary intake. Most of them are already full when they take these sugar-sweetened beverages and there will be no room for healthy meal intake when they are already satisfied. When they take this and get home, they lose interest in the healthy meals.”
Ozoh said, “tooth decay is also another one of the short-term health effects on children, having tooth decay dental caries, the sugars in the sugar-sweetened beverages drinks store in the teeth and then microbial organism which later over time been acidic resulting into micros growing up there because of lack of teeth maintenance.
“The long-term consequences of sugar-sweetened beverages are cardiovascular diseases like hypertension, heart diseases, type 2 diabetes, and kidney diseases among others.”
The harmful additives
Speaking further with Sunday Tribune, Dr Eyo-Ita noted that “the additives, flavouring, colouring, must also be looked at closely because these are chemicals which are largely non-nutritive. What exactly they do in our bodies is not entirely clear but there are rising or growing suspicions that these chemicals contribute to oxidants pool in our bodies.
“Oxidants are things that would by oxidative stress-damaged tissues. Prolong repetitive oxidants stress is one of the things that we know and has been linked to the causation of cancers. Cancers are other things that we are seeing in increasing numbers now among our children.
“Even when these flavouring, colouring and artificial sweeteners are not added as they claim, some of those were used on fruits in the form of pesticides and other manure-chemicals on the farms where those fruits are grown,” he said.
Validating Dr Eyo-Ita’s opinion on additives, Ozoh, UCH Chief Dietician said, “these additives were under scrutiny and they were said to be good for human consumption while some still believe the different colouring had a way of altering genetic mutation on individual gene and resulting in hypersensitivity to allergies and a lot of other genetic mutations changing the body genetic mutation, especially among children under two years.
“With this, there is also a risk of non-communicable diseases like cancer later in life especially as a result of early introduction to sugar-sweetened beverages because these children are just undergoing a kind of maturation development, so they are hypersensitive with hypersensitivity occurring to anything that can alter their immune functions.”
Though the United States Food and Drug Administration (FDA) and European Food Safety Authority (EFSA) have concluded that the dyes or colouring do not pose a significant health risk but not everyone agrees with that conclusion because some of the dyes approved by the FDA are banned in Europe. Some dyes are approved in some countries but banned in other countries.
Various studies confirmed that artificial food dye consumption has increased in the last 50 years and children are the biggest consumers. Claims have been made that artificial dyes cause serious side effects such as hypersensitivity, especially in children, increase inflammation and disrupt the functioning of the immune system. Also, some of the most commonly used food dyes are contaminated with known carcinogens or cancer-causing substances but yet according to the FDA, these contaminants are present in food dyes at a “safe level.”
“If these dyes in foods could do all these, then it can defiantly alter one’s health,” Ozoh said while urging the public, especially parents, to be role models to their children.
“School environment should encourage good food with healthy snacks rather than constant sugar-sweetened beverages. These sugar-sweetened beverages should be alternated twice or thrice a week.
“There are a whole lot of healthy snacks out there; groundnut, popcorn, apples, carrots etc. are healthy snacks,” she added.
In her contribution to energy drinks, Farodoye said: “In 2020, a review revealed that energy drinks are different from other beverages and soft drinks. While soft drinks are mainly carbonated water, sugar and flavouring, energy drink contains a high concentration of caffeine.
“Also, sports drinks contain water, electrolytes and sugar. Some large energy drinks contain up to 21 teaspoons of sugar and about 80mg of caffeine per can, making them a risky drink choice for anyone.
“Studies have also highlighted the negative effects of the consumption of energy drinks. It includes an increase in the heart rate, systolic and diastolic pressures and a decrease in the cerebral blood flow.”
She, therefore, encouraged the public to consume more water as it is the best alternative to sugar-sweetened beverages.
“Water is the best drink your body needs with a daily requirement of six to eight glasses per day. Avoid sugar-sweetened beverages as part of your daily diet. Eat more whole grain foods, fruits and vegetables to get the required sugar needed by the body,” she advised.