Sources of Added Sugar in the diet of US Children and Adolescent

The Problem with Added Sugar

Chances are if you or your child have a favorite food, added sugar is high on the ingredient list.  Our palates are programed to crave sweetness, and food manufacturers have been exploiting this sweet preference for decades in an effort to get us to purchase and consume more of their products. This added sugar, which we crave, is making us collectively less healthy.

How much added sugar do Americans eat each day?

The United States Department of Agriculture (USDA) estimated that in 2015, every American consumed more than 75 pounds of added sugar, which is about half a cup, 22 teaspoons, or 94 grams a day.1 Depending on who is making the recommendation, that is almost 2 to 4 times the daily recommended amount! (more on daily recommended intake of added sugars).  This is true for both adults and children. By the time children are 12, they are consuming the same amount of added sugar as an adult. Below is a breakdown of added sugar consumption by age in the US.

Added Sugar Intake
US Children and Adolescents Added Sugar Consumption. Charts created from data included in “Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association” (reference 2, link). Data Source: What We Eat in America (WWEIA), NHANES 2009-2012.

So where does all this added sugar come from?

Below is a chart categorizing the sources of added sugars in the American diet.2

Sources of Added Sugar in the diet of US Children and Adolescent
Sources of Added Sugar in the American Diet, ages 2 years and older. Chart adapted from the 2015-2020 Dietary Guidelines for Americans categorizing the sources of Added Sugars in the US population (reference 3, link). Data Source: What We Eat in America (WWEIA), NHANES 2009-2010.

It is pretty clear that we, as a nation, like to eat sweet treats and drink soda. Almost half of our daily intake of added sugar comes from sweetened beverages (soda, fruit drinks, coffee drinks, sports and energy drinks). But sugary drinks and treats are not the only sources of added sugars in our diet. There are a lot of “healthy” foods that contain added sugar. The added sugar content of “healthy” foods becomes especially apparent when looking at the added sugar consumption of younger children.

Sources of Added Sugar All Ages
Sources of Added Sugar in the diet of US Children and Adolescents. Charts created from data included in “Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association” (reference 2, link).  Data Source: What We Eat in America (WWEIA), NHANES 2009-2012.

Dairy (15%) and grains (14%) account for a sizable amount of their daily intake of added sugar. If you find that surprising, just read the label of a flavored yogurt or cereal (more on flavored yogurt and cereal soon).

Why should we care about excess added sugar consumption?

Added Sugars are Empty Calories

There are no nutrients in added sugars.  They are simply empty calories that are added to foods to make them taste better.  Numerous experts and government agencies including the US Department of Health and Human Services, Academy of Nutrition and Dietetics, and American Heart Associate agree that it is very challenging, if not impossible, to meet our daily nutrient requirements while while consuming added sugars at our current level.2,4,5 Either we are displacing nutrient dense foods that should be the majority of our daily diet with the empty calories of added sugar, or we are consuming added sugar in addition to our regular caloric intake, which leads to obesity. Because of this, sweetened beverages and sugary snacks should be considered treats for occasional consumption, not daily staples.

Excess Added Sugar Consumption is Making Us Fat

There is a strong linkage between consuming more than 10% of daily calories from added sugar (especially in the form of sweetened beverages) and excess weight gain. A randomized, controlled clinical trial was conducted in the Netherlands to evaluate the impact of sugar sweetened beverages on the weight of school children. After 18 months, a slower rate of weight gain and less fat accumulation was measured in the group drinking the noncaloric beverages.6

Excess Added Sugar Consumption is Associated with Increased Triglyceride Levels

High levels of triglycerides, a lipid (fat) in your blood, can increase your risk of coronary heart disease. Numerous clinical studies indicate that consuming fructose from added sugar can increase triglyceride levels, and in studies where patients reduced their fructose intake, they experienced a corresponding reduction in triglyceride levels.2,7  This is because common added sugars, such as table sugar and high fructose corn syrup, contain approximately equal amounts of glucose and fructose. Though glucose can be used by almost every cell in the body for fuel, fructose is metabolized almost exclusively in the liver. When too much fructose is consumed at one time, the liver is overwhelmed creates new lipids (fat molecules) from the excess fructose. These lipids can accumulate in the liver or be released into the blood, resulting in increased triglyceride levels.

Excess Added Sugar Consumption May Raise Blood Pressure

Epidemiological and clinical trial data suggest that excessive fructose consumption (in the form of excess added sugar consumption) results in increased blood pressure in children, young adults, and adults.2,8 The converse also appears to be true.  In a small-scale clinical trial, 28 people were placed on a very low fructose diet and after 6 weeks saw an average decrease of 6 mmHg in both systolic and diastolic blood pressures.9

Excess Added Sugar Consumption May Lead to Consumption of Lower Quality Foods

Overall diet quality is thought to be impacted by total added sugar consumption, though the precise cause is unclear.  A study focusing on young children (3-5 yo) examined vegetable consumption when paired with either a sugar sweetened beverage or water. The researchers found that consuming even small amounts of a sweetened beverage led children to be less accepting of vegetables.  Conversely, when given water to drink, the children ate a larger portion of vegetables. The researchers hypothesize that the sweetness of the beverage clashed with the less-sweet and sometimes bitter flavor profile of the vegetables, reducing their likability.10 And excess added sugar consumption does not just impact vegetable consumption.  In a 9-year study of Finnish children (1-9 yo), researchers found that long-term excessive added sugar intake replaced dairy products, grain and other micronutrient-dense foods in the children’s diet.11 Whether these less healthy food choices are the result of an impact of excess sweetness on the palate or learned eating behaviors, it is important to realize that high levels of added sugar consumption may negatively influence the overall nutritional quality of our diet.

Summary

One of the simplest ways to potentially improve our long-term health is to reduce the amount of added sugar we eat in our daily diet. The first step is to realize just how much added sugar we are in fact eating. If your added sugar consumption is high (most of ours is), start reducing it. Limit sugary beverages and treats or cut them out all together, except on special occasions. Set a daily added sugar budget and try to stick with it.  Make judicious food choices and help your children do the same.

Interested in learning more about added sugar?

References:

  1. USDA, ERS (Economic Research Service), Sugar and Sweeteners Outlook.  Data compiled from Table 51, Table 52, and Table 53. (link)
  2. Added Sugars and Cardiovascular Disease Risk in Children. 
  3. Dietary Guidelines for Americans, 2015-2020, Eighth Ed. Data from Figure 2-10. (link)
  4. US Department of Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee.  Washington, DC: US Government Printing Office; 2015. (link)
  5. Position of the Academy of Nutrition and Dietetics: Total Diet Approach to Healthy Eating.  J Acad Nutr Diet. 2013;113:307-317 (link)
  6. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012; 367:1397-1406. (link)
  7. Examining the Health Effects of Fructose. Ludwig DS. JAMA. 2013;310(1):33-34. (link)
  8. Dietary Sugars Intake and Cardiovascular Health. ,
  9. Low-fructose diet lowers blood pressure and inflammation in patients with chronic kidney disease. Nephrol. Dial. Transplant. (2012) 27 (2): 608-612 (link).
  10. Contingent choice. Exploring the relationship between sweetened beverages and vegetable consumption. Appetite. 2013 Mar;62:203-8. (link)
  11. High sucrose intake is associated with poor quality of diet and growth between 13 months and 9 years of age: the special Turku Coronary Risk Factor Intervention Project. Pediatrics. 2008 Jun;121(6):e1676-85. (link)
  12. Validity of U.S. nutritional surveillance: National Health and Nutrition Examination Survey caloric energy intake data. PLoS One. 2013; 8(10):e76632. (link)

Note: With the exception of the USDA estimate on annual per capita added sugar consumption, all data referenced in the charts in this post came from “What We Eat in America” (WWEIA), a component of the National Health and Nutrition Examination (NHANES) survey. NHANES is a national survey conducted every few years to assess the health and nutritional status of adults and children in the United States (more information).  The data collected for WWEIA / NHANES are self-reported where the participant recalls what they ate in the past 24-hrs and this information is interpreted by an interviewer.  In an analysis of historical NHANES data, researchers have shown that the self reported data from a majority of the respondents were not “physiologically plausible”.12  In other words, the participants severely under-reported their daily energy intake. So it is quite likely that actual added sugar consumption is higher than reported.

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