Nutrition Education Intervention to Limit Added Sugar Intake among University Female Students

Walaa Mumena; Fatima  Abdulhakeem; Najwan Jannadi; Shatha Almutairi; Sara Aloufi; Abeer Bakhishwain; Hebah Kutbi

doi:10.23751/pn.v22i3.9764

Nutrition Education Intervention to Limit Added Sugar Intake among University Female Students

Authors

Walaa A. Mumena Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
Fatima A. Abdulhakeem Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
Najwan H. Jannadi Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
Shatha A. Almutairi Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
Sara M. Aloufi Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
Abeer A. Bakhishwain Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia
Hebah A. Kutbi Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia

Keywords:

Nutrition education, intervention, added sugar, dietary intake, students

Abstract

Background/Aim: To evaluate the effectiveness of a nutrition education intervention to limit added sugar intake among undergraduate female students.
Material and Methods: This is a quasi-experimental pretest-posttest control group study that was conducted among 46 healthy participants who were selected in random (23 each in intervention and control groups). All participants were undergraduate students at Taibah University, Madinah, Saudi Arabia. The intervention included two face-to-face educational sessions and weekly messages during the 8-week study period provided information about the definition, health consequences of excessive intake, food sources, label reading, and healthy alternatives to foods containing high amounts of added sugar. Dependent variables were dietary data and anthropometrics. Independent variable was the group assignment.
Results: In the intervention group, reduction of 58.3% of added sugar intake occurred, and added sugar contributed to 4.95% of the total energy. In the control group, it contributed to 10.7% of the total energy.
Conclusion: The nutrition education intervention was effective in reducing over half the students’ added sugar consumption in the intervention group. The used nutrition education intervention could be adopted effectively in the community to limit added sugar intake.

Author Biographies

Walaa A. Mumena, Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia

Ph.D.

Clinical Nutrition Department

College of Applied Medical Sciences

Hebah A. Kutbi , Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia

References

Gilbert AP, Khokhar S. Changing dietary habits of ethnic groups in Europe and implications for health. Nutr Rev 2008;66:203-15. https://doi.org/10.1111/j.1753-4887.2008.00025.x

Steyn NP, Mchiza ZJ. Obesity and the nutrition transition in Sub-Saharan Africa. Ann NY Acad Sci 2014;1311:88-101. https://doi.org/10.1111/nyas.12433

American Heart Association. Added Sugars. 2018 [Available from: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars.

Lusting RH, Schmidt LA, Brindis CD. The toxic truth about sugar. Nature 2012;482:27-9. https://doi.org/10.1038/482027a

Thompson FE, McNeel TS, Dowling EC, Midthune D, Morrissette M, Zeruto CA. Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey 2005. J Am Diet Assoc 2009;109:1376-83. https://doi.org/10.1016/j.jada.2009.05.002

Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012;70:3-21. https://doi.org/10.1111/j.1753-4887.2011.00456.x

Mumena WA, Alamri AA, Mahrous AA, Alharbi BM, Almohaimeed JS, Hakeem MI, et al. Knowledge, attitudes, and practices towards added sugar consumption among female undergraduate students in Madinah, Saudi Arabia: A cross-sectional study. [Unpublished manuscript]. 2020.

Khawaja AH, Qassim S, Hassan NA, Arafa EA. Added sugar: Nutritional knowledge and consumption pattern of a principal driver of obesity and diabetes among undergraduates in UAE. Diabetes Metab Syndr 2019;13:2579-84. https://doi.org/10.1016/j.dsx.2019.06.031

Macedo DM, Diez-garcia RW. Sweet craving and ghrelin and leptin levels in women during stress. Appetite 2014;80:264-70. https://doi.org/10.1016/j.appet.2014.05.031

Waterland WE, De haas WE, Van Amstel I, Schuit AJ, Twisk JW, Visser M, et al. Energy density, energy costs and income – how are they related? Puplic Health Nutr 2010;13:1599-608. https://doi.org/10.1017/S1368980009992989

Tierney M, Gallagher AM, Giotis ES, Pentieva K. An online survey on consumer knowledge and understanding of added sugars. Nutrients 2017;9:37.

Malik VS, Popkin BM, Bray GA, Després J-P, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010;121:1356-64. https://doi.org/10.1161/CIRCULATIONAHA.109.876185

Stanhope KL. Sugar consumption, metabolic disease, and obesity: The state of the controversy. Crit Rev Clin Lab Sci 2016;53:52-67. https://doi.org/10.3109/10408363.2015.1084990

Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lusting RH, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009;120 1011-20. https://doi.org/10.1161/CIRCULATIONAHA.109.192627

Rippe JM, Angelopoulos TJ. Relationship between added sugars consumption and chronic disease risk factors: current understanding. Nutrirnts 2016;8:697. https://doi.org/10.3390/nu8110697

Danging H, Lixiao C, Wenjie J. Sugar-sweetened beverages consumption and the risk of depression: a meta-analysis of observational studies. J Affect Disord 2019;245:348-55. https://doi.org/10.1016/j.jad.2018.11.015

Cabrera Escobar MA, Veerman JL, Tollman SM, Bertram MY, Hofman KJ. Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health 2012;13. https://doi.org/10.1186/1471-2458-13-1072

Huth PJ, Fulgoni VL, Keast DR, Park K, Auestad N. Major food sources of calories, added sugar, and saturated fat and their contribution to essential nutrient intake in the U.S. diet: data from national health and nutrition examination survey (2003-2006). Nutr J 2013;12:116. https://doi.org/10.1186/1475-2891-12-116

Louie JC, Tapsell LC. Association between intake of total vs added sugar on diet quality: a systematic review. Nutr Rev 2015;73:837-57. https://doi.org/10.1093/nutrit/nuv044

Charlton KE, Kolbe-Alexander TL, Nel JH. Micronutrient dilution associated with added sugar intake in elderly black South Africa women. Eur J Clin Nutr 2005;59:1030-42. https://doi.org/10.1038/sj.ejcn.1602208

Duffey KJ, Poti J. Modeling the effect of replacing sugar-sweetened beverage consumption with water on energy intake, HBI score, and obesity prevalence. Nutrients 2016;8:395. https://doi.org/10.3390/nu8070395

Nakhooda RE, Wiles N. Consumption of added sugar among undergradute students at a South African university and its association with BMI. South Afr J Clin 2018:1-8. https://doi.org/10.1080/16070658.2018.1553360

Alsukait R, Bleich S, Wilde P, Singh G, Folta S. Sugary drink excise tax policy process and implementation: Case study from Saudi Arabia. Food Policy 2020;90:101789. https://doi.org/10.1016/j.foodpol.2019.101789

Alsukait R, Wilde P, Bleich SN, Singh G, Folta SC. Evaluating Saudi Arabia's 50% carbonated drink excise tax: Change in prices and volume sales. Econ Hum Biol 2020;38:100868. https://doi.org/10.1016/j.ehb.2020.100868

World Health Organization. Taxes on sugary drinks: why do it? 2017 [Available from: https://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf?sequence=1.

Lua PL, Wan Putri Elena WD. The impact of nutrition education interventions on the dietary habits of college students in developed nations: a brief review. Malays J Med Sci 2012;19:4-14.

Fairclough SJ, Hackett AF, Davies IG, Gobbi R, Mackintosh KA, Warburton GL, et al. Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE ! randomised intervention study. BMC Public Health 2013;626. https://doi.org/10.1186/1471-2458-13-626

Vanwormer JJ, Boucher JL, Pronk NP. Telephone-based counselling improves dietary fat, fruit, and vegetable consumption: a best-evidence synthesis. J Am Diet Assoc 2006;106:1434-44. https://doi.org/10.1016/j.jada.2006.06.008

Khandpur N, Rimm BE, Moran JA. The influence of the new US nutrition facts label on consumes perceptions and controlled experiment. J Acad Nutr Diet 2019;120:197-209. https://doi.org/10.1016/j.jand.2019.10.008

Weaver D, Finke M. The relationship between the use of sugar content information on nutrition labels and the consumption of added sugar. Food Policy 2003;28:213-19. https://doi.org/10.1016/S0306-9192(03)00028-9

Greenblatt Y, Gomez S, Alleman G, Rico K, Mcdonald AD, Hingle M. Optimizing nutrition education in WIC: findings from focus groups with Arizona clients and staff. J Nutr Educ Behav 2016;48:289-94. https://doi.org/10.1016/j.jneb.2016.01.002

Mandracchia F, Llaurado E, Tarro L, Del bas JM, Valls RM, Pedret A, et al. Potential use of mobile phone applications for self-monitoring and increasing daily fruit and vegtabel consumption : a systematized review. Nutrients 2019;11. https://doi.org/10.3390/nu11030686

Gow RW, Trace SE, Mazzeo SE. Preventing weight gain in first year college students: an online intervention to prevent the ''Freshman Fifteen''. Eat Behav 2011;11:33-9. https://doi.org/10.1016/j.eatbeh.2009.08.005

Poddar KH, Hosig KW, Anderson ES, Nickols-Richardson SM, Duncan SE. Web-based nutrition education intervention improves self-efficacy and self regulation related to increased dairy intake in college students. J Am Diet Assoc 2010;110:1723-7. https://doi.org/10.1016/j.jada.2010.08.008

Franko DL, Cousineau TM, Trant M, Green TC, Rancourt D, Thompson D, et al. Motivation, self-efficacy, physical activity and nutrition in college students: randomized controlled trial on internet-based education program. Prev Med 2008;47:369-77. https://doi.org/10.1016/j.ypmed.2008.06.013

World Health Organization. Body mass index - BMI 2020 [Available from: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.

Azais-Breasco V, Sluik D, Maillot M, Kok F, Moreno LA. A review of total & added sugar intakes and dietary sources in Europe. Nutr J 2017;16:6. https://doi.org/10.1186/s12937-016-0225-2

Lei L, Rangan A, Flood VM, Yu Louie JC. Dietary intake and food sources of added sugar in the Australian population. Brit J Nutr 2016;115:868-77. https://doi.org/10.1017/S0007114515005255

Amoutzopoulos B, Steer T, Roberts C, Collin D, Page P. Free and added sugar consumption and adherence to guidelines: The UK national diet and nutrition survey (2014/15-2015/16). Nutrients 2020;12:393. https://doi.org/10.3390/nu12020393

Flack KD, Ufholz K, Casperson S, Jahns L, Johnson L, Roemmich JN. Decreasing the consumption of foods with sugar increases their reinforcing value: a potential barrier for dietary behavior change. J Acad Nutr Diet 2019;119:1099–108. https://doi.org/10.1016/j.jand.2018.12.016

Abood DA, Black DR, Birnbaum RD. Nutrition education intervention for college female athletes. J Nutr Educ Behav 2004;36:135-7. https://doi.org/10.1016/S1499-4046(06)60150-4

You JS, Sung MJ, Chang KJ. Evaluation 8-week body weight control program include sea tangle (Laminaria japonica) supplementation in Korean female collage students. Nutr Res Prac 2009;3:307-14. http://dx.doi.org/10.4162/nrp.2009.3.4.307

Medina EL, Loques Filho O, Mesquita CT. Health social networks as online life support groups for patients with cardiovascular diseases. Arq Bras Cardiol 2013;101:39-45. http://dx.doi.org/10.5935/abc.20130161

Chung JE. Social networking in online support groups for health: How online social networking benefits patients. J Health Commun 2014;19:639-59. https://doi.org/10.1080/10810730.2012.757396

Ha EJ, Caine-Bish N. Effect of nutrition intervention using a general nutrition course for promoting fruit and vegetable consumption among college students. J Nutr Educ Behav 2009;41:103-9. https://doi.org/10.1016/j.jneb.2008.07.001

Wagner MG, Rhee Y, Honrath K, Blodgett Salafia EH, Terbizan D. Nutrition education effective in increasing fruit and vegetabel consumption among overweight and obese adults. Appetite 2016;100:94-101. https://doi.org/10.1016/j.appet.2016.02.002

Shahril MR, Wan Putri Elena WD, Lua PL. A 10-week multimodal nutrition education intervention improves dietary intake among university students: Cluster randomised controlled trial. J Nutr Metab 2013;2013:1-11. https://doi.org/10.1155/2013/658642

Hedrick VE, Davy BM, You W, Porter KJ, Estabrooks PA, Zoellner JM. Dietary quality changes in response to a sugar-sweetened beverage-reduction intervention: results from the Talking Health randomized controlled clinical trial. Am J Clin Nutr 2017;105:824–33. https://doi.org/10.3945/ajcn.116.144543

Richards A, Kattelmann KK, Ren C. Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption. J Am Diet Assoc 2006;106:1405-11. https://doi.org/10.1016/j.jada.2006.06.005

Bourdeaudhuij ID, Cauwenberghe EV, Spittaels H, Oppert J-M, Rostami C, Brug J, et al. School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev 2011;12:205-16. https://doi.org/10.1111/j.1467-789X.2009.00711.x

MeeSook C. Effects of nutrition education and exercise intervention on health and diet quality of middle-aged women. Korean J Nutr 2009;42:48-58.

Yeom MY, Cho YO. Nutrition education discouraging sugar intake results in higher nutrient density in diets of pre-school children. Nutr Res Pract 2019;13:434–43. http://dx.doi.org/10.4162/nrp.2019.13.5.434

Hawkins KR, Burton JH, Apolzan JW, Thomson JL, Williamson DA, Martin CK. Efficacy of a school-based obesity prevention intervention at reducing added sugar and sodium in children's school lunches: the LA Health randomized controlled trial. Int J Obes (Lond) 2018;42:1845–52. https://doi.org/10.1038/s41366-018-0214-y

Rauba J, Tahir A, Milford B, Toll A, Benedict V, Wang C, et al. Reduction of sugar-sweetened beverage consumption in elementary school students using an educational curriculum of beverage sugar content. Glob Pediatr Health 2017;4: 2333794X17711778. https://doi.org/10.1177/2333794X17711778

World Health Organization. Guideline: sugars intake for adults and children 2015 [Available from: https://www.who.int/publications-detail/9789241549028.