Bakri et al. / Malaysian Journal of Fundamental and Applied Sciences Vol. 15, No. 5 (2019) 695-698 695 Determination of sugar types and content in formulated milk of infants and children in Malaysia Noor Nazahiah Bakri a,* , Intan Nur Amalina Rashid a , Fathin Faiza Abdul Rahman a , Zatilfarihiah Rasdi b , Nor Faezah Md Bohari a , Nawwal Alwani Mohd Radzi a , Ahmad Nadzri Mohamad c a Centre for Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia. b Centre of Preclinical Sciences Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia. c Faculty of Information Management, Universiti Teknologi MARA, Puncak Perdana Campus, Shah Alam, Malaysia. * Corresponding author: nazahiahb@gmail.com Article history Received 11 Mac 2019 Revised 21 April 2019 Accepted 20 July 2019 Published Online 15 October 2019 Abstract High sugar intake contributes to an increased risk of non-communicable diseases such as diabetes, obesity, hypertension, and dental caries. Infants and young children who drink formulated milk have been exposed to free sugars early in their life. Objectives: To determine the amount of free sugar in different brands of formulated milk that are available in Malaysia and to compare the recommended serving size of the formulated milk according to the guideline of daily free sugar intake by WHO for infants and children. Methods: High-Performance Liquid Chromatography (HPLC) was used to determine the sugar amount in five different brands of age-specific formulated milk (0-9 years old). The sugar amount for each sample was determined by 1:100 dilution of milk and HPLC for 8 minutes. Percentage of free sugar intake per day was calculated based on the HPLC result and the recommended serving size per day was compared to the nutritional label of the formulated milk and further compared to the recommended calorie intake by WHO. Results: The total free sugar for all samples were ranged from 0.08% - 23.28% out of the total calories for each age. One out of the 20 aged-specific formulated milk exceeded the WHO recommendation of free sugar intake per day. Conclusion: The amount of sugar in formulated milk should be monitored by health policy as some of the formulated milk has exceeded the recommended free sugar intake by WHO. Keywords: Formulated milk, sugar content, free sugar, infants and children © 2019 Penerbit UTM Press. All rights reserved INTRODUCTION Non-communicable diseases (NCDs) such as diabetes mellitus, obesity, and hypertension are accounted for 68% of world's death in 2012 (WHO, 2014). In recent years, these diseases have increased due to the ageing population, globalization, urbanization and most importantly because of lifestyle changes. By 2020, it is predicted that seven out of every 10 deaths in the world are caused by these diseases (WHO, 2013). World Health Organization (WHO) concerns are focusing on preventable modified risk factors in order to reduce the incidence of NCDs worldwide. Poor dietary intake and reduced physical activities are common causes of NCDs. Increased intake of free sugar in the diet may contribute to an increased overall energy intake, therefore reducing the intake of food containing more nutritionally adequate calories and leading to an unhealthy diet, weight gain and increased risk of NCDs. Diet with high sugar intake is also associated with an increased risk of dental caries (WHO, 2015). Carbohydrate is the primary source of energy and an important mediator for hormonal regulation in the body (Tornheim & Ruderman, 2011). Carbohydrate can be divided into monosaccharide, disaccharide, oligosaccharide and polysaccharide. "Free sugars" is defined by WHO as all monosaccharides and disaccharides that are being added to foods and beverages by the manufacturer and consumer, as well as sugars that are naturally presented in honey, syrups and fruit juices concentrates (Ministry of Health Malaysia, 2017). The life-course epidemiology of chronic diseases suggested that the accumulation of the risk factors such as tobacco use, physical inactivity and unhealthy diet throughout the life course may increase the risk of chronic diseases (Nicolau et al., 2007). High consumption of sugar may affect the health status of the children which may progress to chronic severe diseases as they get older (Lucase et al., 1994). Therefore, these risks should be controlled very early in life. During the first six months of life, the primary nutrition for infants at this age solely depends on human or formulated milk as their digestive tract is still developing. Formulated milk is a product from cow milk or other animals or a mixture of other nutritional ingredients which helps in the development of infants and children. Formulated milk can be in the form of powder, liquid or concentrated liquid. Formulated milk contains carbohydrate, water, energy, fat, protein, minerals and vitamins in different portions compared to breast milk (Martin et al., 2016). Previous studies showed that human and formulated milk are different in terms of nutrition and biological constituents (Institute of Medicine (US) Committee, 2004; Hernell, 2011). Some formulated milk may have extrinsic sugars that are not presented in human milk and the actual sugar content, in terms of both type and proportion, of infant formula is not widely known. The main aims of this study were to investigate the sugar amount in 20 aged-specific formulated milk available in Malaysian market by using high-performance liquid chromatograph (HPLC) and to compare with recommended free sugar intake per day by WHO. This study also aimed to identify the total carbohydrate intake of all the RESEARCH ARTICLE