Effects of Added Sugar In Children's Milk Formula

“Is sugar harmful to a child’s health? What exactly are added sugars in FMPC? How to choose the right milk without the added sugars? What are the consequences?” are among frequently asked questions.

Is sugar harmful to a child’s health?

Sugar is not necessarily bad as it provides children the energy they need to grow. However, it becomes a problem when the amount is excessive and much higher than the daily recommended intake as it increases the chances of various health problems.

Human cells use sugar (glucose) as a major source of energy. Our body breaks down complex carbohydrates and changes it into glucose. Carbohydrate is an important part of our diet, and more so for growing children. According to Malaysia Recommended Nutrient Intake (RNI) recommendations, 50 to 65 per cent of energy intake should come from carbohydrate, 25 to 30 per cent from fat and 10 to 20 per cent from protein.

Take note that these carbohydrates should come mostly from natural food sources like grains, fruits, vegetables and legumes. Carbohydrates for children should not come from free sugars such as that added into food and sugars naturally present in syrup and fruit juices. Free sugars  should constitute less than 5 per cent of total calories, i.e., around 16g per day (about three teaspoons) for preschool children.

What exactly are added sugars in FMPC?

In Malaysia, sugars are listed as sucrose, fructose, sorbitol, mannitol, corn syrup, honey, malt, malt extract, maltose, extracts of rice, molasses, golden syrup and inverted sugar on food labels. (http://www.myhealth.gov.my/v2/index.php/en/nutrition/general/fakta-mengenai-gula)

The “carbohydrate” printed on the Nutrient Information Panels (food labels) of food products refers to available carbohydrate, which includes monosaccharides, disaccharides, oligosaccharides, polysaccharides and a mixture, such as glucose syrup or corn syrup. Regardless of the source of carbohydrate, whether it is derived from intact starch or corn syrup, enzyme amylase that is present in our gut ensures all starch and starch fragments are quickly digested into glucose.

Milk, one of the best sources of carbohydrates for children is good for health and easily consumed. It is rich in calcium (healthy bone) and many other essential nutrients, e.g., protein (tissue growth and repair), vitamins A (healthy eyes) and D (calcium and phosphorus absorption, for bone thickness and strength), and minerals like zinc (immune function) and magnesium (calcium absorption). The carbohydrate in milk is lactose, or “natural milk sugar”, a naturally occurring healthy sugar in milk.

However, most FMPCs in Malaysia are made up of two types of carbohydrates: lactose, and sugars that are added to the milk powder. As such, under the Malaysian Food Labeling Regulations, the term “carbohydrate” on milk powder labels means lactose and added sugars.

How to choose the right milk, without the added sugars?

Lack of awareness on the various terminologies used to describe carbohydrates is often the cause of uninformed decisions on FMPCs. One of the commonest misconceptions is the term “sugars”, commonly perceived only as table sugar (sucrose). Sugars include glucose, fructose and lactose, which may be added on its own and therefore identified in the ingredient list, or hidden within a mixture such as corn syrup in which case they would not be specifically identified in the ingredient list.

All available carbohydrates in FMPC including naturally present milk sugars (lactose) and added sugars are declared as “carbohydrate” on food labels, and thus serve as a guide to how much the body will digest as glucose. In addition to increased glucose intake, added sugars in FMPC also often result in extra energy intake and increase glucose and insulin response.

What are the consequences?

Worldwide, obesity is on the rise and Malaysia is not spared. Between the years of 2000 and 2010, the rate of overweight and obese Malaysian children was estimated between 5 and 6 per cent. However, this rate has since jumped to 12 per cent in 2013, approximately 2 times more. It is believed that the reason for the dramatic rise in obesity in recent years is closely related to environmental factors such as excessive calorie intake and sedentary lifestyle.

Studies showed that consumption of sugar-sweetened beverages (SSB) increase overall energy intake and may reduce the intake of nutrient-dense foods leading to an unhealthy diet weight gain and increased risk of non-communicable diseases (NCD). Obese children have also been shown to have a higher tendency to grow into obese adults, i.e., obese six-year-olds have an over 50 per cent chance of becoming obese adults.

This increases exponentially as they get older to a 70 to 80 per cent chance of becoming obese adults if they are obese as a teenager! A long term follow up study showed that being overweight in adolescence have 2 fold higher risk for coronary heart disease independent of adult weight. This is worrisome because it means that these children have a dangerous head start to suffering heart attacks and strokes.

As trends suggest that overweight and obese children continue to rise, parents must do something by following recommended energy intake guidelines for complex carbohydrates and keeping free sugar intake to less than 5 per cent of total energy intake. Parents must do their homework and take time to study food labels in order to know if sugar is added into the food and where to find hidden sugars.

Professor Dr Muhammad Yazid Jalaludin
MBBS (UM), MPaeds (UM), Paed Endocrinology Fellowship (USA)
Senior Consultant Paediatric Endocrinologist
University Malaya Medical Centre