Intakes of Added Sugars, with a Focus on Beverages and the Associations with Nutrient Adequacy in US Adults (NHANES 2003-2018).

The Dietary Guidelines for Americans recommend adults increase their intake of nutrients that are under-consumed while limiting their intake of added sugars, sodium, and saturated fats. The purpose of this study was to examine the relationship between added sugars intake from specific types of beverages with added sugars (soft drinks, fruit drinks, sports and energy drinks, coffee and tea, and flavored milk) and nutrient adequacy among US adults (19+ y). Data from eight consecutive 2-y cycles of NHANES were combined (2003-2004 through 2017-2018), and regression analysis was conducted to test for trends in quantiles of added sugars intake from each beverage source and the rest of the diet (excluding those beverages) and nutrient adequacy. Results revealed significant associations that varied in direction according to the added sugars source, negative for some (i.e., soft drinks) in terms of greater percentages of adults not meeting a defined threshold of nutrient adequacy with higher added sugars intakes, and positive for others (i.e., fruit drinks, flavored milk, the rest of the diet) in terms of lower percentages of adults not meeting nutrient thresholds. In conclusion, the contribution of different added sugars sources to nutrient intakes is a critical consideration in developing population-based dietary recommendations.

Intakes of Added Sugars, with a Focus on Beverages and the Associations with Micronutrient Adequacy in US Children, Adolescents, and Teens (NHANES 2003-2018).

Added sugars intake from sweetened beverages among children, adolescents, and teens is a public health concern. This study examined the relationships between added sugars intake from specific types of beverages with added sugars and from the rest of the diet (excluding beverages with added sugars) and micronutrient adequacy among US children, adolescents, and teens. Data from eight consecutive 2 y cycles of NHANES were combined (2003-04 through 2017-18), and regression analysis was conducted to test for trends in quantiles of added sugars intake from each beverage source (soft drinks, fruit drinks, sport and energy drinks, coffee and tea, and flavored milk) and the rest of the diet (excluding those beverages) and micronutrient adequacy among children (2-8 y) and adolescents and teens (9-18 y). Among those aged 2-8 y, higher added sugars from flavored milk were associated with lower percentages below the estimated average requirement (EAR) for calcium. Among those aged 9-18 y, higher added sugars from soft drinks or coffee and tea were associated with higher percentages below the EAR for magnesium and vitamins A and C. In contrast, higher added sugars from fruit drinks or flavored milk were associated with lower percentages below the EAR (higher percentages above the adequate intake (AI)) for vitamin C (fruit drinks) and calcium, magnesium, phosphorus, vitamin A, and potassium (flavored milk). Regarding the rest of the diet, higher added sugars were associated with lower percentages below the EAR (higher percentages above the AI) for most micronutrients examined. The results suggest that the relationship between added sugars intake and micronutrient adequacy depends on the added sugar sources and their nutrient composition. Continued monitoring of sweetened beverage consumption, including beverage type, and the association with added sugars intake, micronutrient adequacy, and diet quality is warranted, given the changes in consumption and product development over time.

Trends in added sugars intake and sources among U.S. adults using the National Health and Nutrition Examination Survey (NHANES) 2001-2018.

Research on trends over time in added sugars intake is important to help gain insights into how population intakes change with evolving dietary guidelines and policies on reducing added sugars. The purpose of this study was to provide an analysis of dietary trends in added sugars intakes and sources among U.S. adults from 2001 to 2018, with a focus on variations according to the sociodemographic factors, age, sex, race and ethnicity and income, and the health-related factors, physical activity and body weight. Data from nine consecutive 2 year cycles of the National Health and Nutrition Examination Survey (NHANES) were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001 to 2018. Trends were examined in the whole sample (19+ years) and in subsamples stratified by age (19-50, 51+ years), sex, race and ethnicity (Asian, Black, Hispanic, White), household income (poverty income ratio low, medium, high), physical activity level (sedentary, moderate, vigorous) and body weight status (normal, overweight, obese). From 2001 to 2018, added sugars intake (% kcal) decreased significantly (P < 0.01), from 16.2 to 12.7% among younger adults (19-50 years), mainly due to declines in added sugars from sweetened beverages, which remained the top source. There were no changes in intake among older adults, and by 2018, the 23% difference in intake between younger and older adults that existed in 2001 almost disappeared. Declines in added sugars intake were similar among Black and White individuals, and all income, physical activity and body weight groups. Population-wide reductions in added sugars intake among younger adults over an 18 year time span coincide with the increasing public health focus on reducing added sugars intake. With the updated Nutrition Facts label now displaying added sugars content, it remains to be seen how added sugars intake trends carry forward in the future.

Trends in Added Sugars Intake and Sources Among US Children, Adolescents, and Teens Using NHANES 2001-2018.

BACKGROUND: Over the past 2 decades, there has been an increased emphasis on added sugars intake in the Dietary Guidelines for Americans (DGA), which has been accompanied by policies and interventions aimed at reducing intake, particularly among children, adolescents, and teens. OBJECTIVES: The present study provides a comprehensive time-trends analysis of added sugars intakes and contributing sources in the diets of US children, adolescents, and teens (2-18 years) from 2001-2018, focusing on variations according to sociodemographic factors (age, sex, race and ethnicity, income), food assistance, and health-related factors (physical activity level, body weight status). METHODS: Data from 9 consecutive 2-year cycles of the NHANES were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001-2018 for the overall age group (2-18 years) and for 2 age subgroups (2-8 and 9-18 years). Trends were also examined on subsamples stratified by sex, race and ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White), income (household poverty income ratio), food assistance, physical activity level, and body weight status. RESULTS: From 2001-2018, added sugars intakes decreased significantly (P < 0.01), from 15.6% to 12.6% kcal among children (2-8 years) and from 18.4% to 14.3% kcal among adolescents and teens (9-18 years), mainly due to significant declines in added sugars from sweetened beverages, which remained the top source. Declines in added sugars intakes were observed for all strata, albeit to varying degrees. CONCLUSIONS: Declines in added sugars intakes were observed among children, adolescents, and teens from 2001-2018, regardless of sociodemographic factors, food assistance, physical activity level, or body weight status, but variations in the magnitudes of decline suggest persistent disparities related to race and ethnicity and to income. Despite these declines, intakes remain above the DGA recommendation; thus, continued monitoring is warranted.

Sources of Added Sugars Intake Among the U.S. Population: Analysis by Selected Sociodemographic Factors Using the National Health and Nutrition Examination Survey 2011-18.

Recent estimates of added sugars intake among the U.S. population show intakes are above recommended levels. Knowledge about the sources of added sugars contributing to intakes is required to inform dietary guidance, and understanding how those sources vary across sociodemographic subgroups could also help to target guidance. The purpose of this study was to provide a comprehensive update on sources of added sugars among the U.S. population, and to examine variations in sources according to sociodemographic factors. Regression analyses on intake data from NHANES 2011-18 were used to examine sources of added sugars intake among the full sample (N = 30,678) and among subsamples stratified by age, gender, ethnicity, and income. Results showed the majority of added sugars in the diet (61-66%) came from a few sources, and the top two sources were sweetened beverages and sweet bakery products, regardless of age, ethnicity, or income. Sweetened beverages, including soft drinks and fruit drinks, as well as tea, were the largest contributors to added sugars intake. There were some age-, ethnic-, and income-related differences in the relative contributions of added sugars sources, highlighting the need to consider sociodemographic contexts when developing dietary guidance or other supports for healthy eating.

Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009-2014.

There is inconsistent evidence regarding the impact of added sugars consumption on micronutrient dilution of the diet. We examined the associations between added sugars intake deciles and nutrient adequacy for 17 micronutrients in U.S. adults 19+ (n = 13,949), 19-50 (n = 7424), and 51+ y (n = 6525) using two days of 24 hour dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 and regression analysis. Added sugars intake deciles ranged from <3.8 to >23.3% of calories among adults 19+ y, with a median intake of 11.0% of calories. Significant associations (p ≤ 0.01) between added sugars intake deciles and percentage of the population below the Estimated Average Requirement (EAR) were found for magnesium, vitamin C, vitamin D, and vitamin E; only the association with magnesium remained significant after dropping the two highest and lowest deciles of intake, suggesting a threshold effect. Intakes below approximately 18% of calories from added sugars were generally not associated with micronutrient inadequacy. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these four micronutrients, suggesting that adequate intakes are difficult to achieve regardless of added sugars intake.

Association of Added Sugars Intake with Micronutrient Adequacy in US Children and Adolescents: NHANES 2009-2014.

BACKGROUND: A concern about the excessive consumption of added sugars is the potential for micronutrient dilution, particularly in children and adolescents; however, the evidence is inconsistent. OBJECTIVE: We examined the associations between added sugars intake and micronutrient adequacy in US children and adolescents using data from NHANES 2009-2014. METHODS: Children and adolescents aged 2-18 (n = 7754), 2-8 (n = 3423), and 9-18 y (n = 4331) were assigned to deciles of added sugars intake based on the average of 2 d of dietary recall. Usual intake of micronutrients was determined using 2 dietary recalls and the National Cancer Institute method. Within each age group, regression analyses were used to assess the relationship between added sugars intake decile and percentage of the population below the estimated average requirements (EARs) for 17 micronutrients. RESULTS: Deciles of added sugars intake (percentage of calories) ranged from <6.4 to >22.8 among children and adolescents aged 2-18 y, with a median intake of 13.3% of calories. Significant positive associations (P < 0.01) between added sugars intake and percentage of the population (aged 2-18 y) below the EAR were found only for calcium, magnesium, and vitamin D. These associations virtually disappeared after dropping the 2 highest and lowest deciles of intake, suggesting a threshold effect; intakes below approximately 19% of calories from added sugars were generally not associated with micronutrient inadequacy. CONCLUSIONS: As added sugars intake increased, there was a threshold above which an increase in the prevalence of inadequate intakes for calcium, magnesium, and vitamin D among US children and adolescents was observed. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these nutrients, suggesting that adequate intakes of these nutrients are difficult to achieve independent of added sugars intake.

Association of breakfast consumption with body mass index and prevalence of overweight/obesity in a nationally-representative survey of Canadian adults.

BACKGROUND: This study examined the association of breakfast consumption, and the type of breakfast consumed, with body mass index (BMI; kg/m(2)) and prevalence rates and odds ratios (OR) of overweight/obesity among Canadian adults. These associations were examined by age group and sex. METHODS: We used data from non-pregnant, non-lactating participants aged ≥ 18 years (n = 12,377) in the Canadian Community Health Survey Cycle 2.2, a population-based, nationally-representative, cross-sectional study. Height and weight were measured, and BMI was calculated. Breakfast consumption was self-reported during a standardized 24-h recall; individuals were classified as breakfast non-consumers, consumers of breakfasts that included ready-to-eat cereal (RTEC) or as other breakfast consumers. Mean BMI and prevalence and OR of overweight/obesity (BMI ≥ 25) were compared among breakfast groups, with adjustment for sociodemographic variables (including age, sex, race, marital status, food security, language spoken at home, physical activity category, smoking, education level and supplement use). RESULTS: For the entire sample, mean BMI was significantly lower among RTEC-breakfast consumers than other breakfast consumers (mean ± SE 26.5 ± 0.2 vs. 27.1 ± 0.1 kg/m(2)), but neither group differed significantly from breakfast non-consumers (27.1 ± 0.3 kg/m(2)). Similar results were seen in women only, but BMI of men did not differ by breakfast category. Overweight/obesity prevalence and OR did not differ among breakfast groups for the entire sample or for all men and women separately. When examined by sex and age group, differences were inconsistent, but tended to be more apparent in women than men. CONCLUSION: Among Canadian adults, breakfast consumption was not consistently associated with differences in BMI or overweight/obesity prevalence.

Breakfast consumption is positively associated with nutrient adequacy in Canadian children and adolescents.

Although breakfast is associated with more favourable nutrient intake profiles in children, limited data exist on the impact of breakfast on nutrient adequacy and the potential risk of excessive intakes. Accordingly, we assessed differences in nutrient intake and adequacy among breakfast non-consumers, consumers of breakfasts with ready-to-eat cereal (RTEC) and consumers of other types of breakfasts. We used cross-sectional data from 12,281 children and adolescents aged 4-18 years who took part in the nationally representative Canadian Community Health Survey, 2004. Mean nutrient intakes (obtained using a multiple-pass 24 h recall method) were compared among the breakfast groups using covariate-adjusted regression analysis. Usual nutrient intake distributions, generated using the National Cancer Institute method, were used to determine the prevalence of nutrient inadequacy or the potential risk of excessive intakes from food sources alone and from the combination of food plus supplements. Of these Canadian children, 10% were breakfast non-consumers, 33% were consumers of RTEC breakfasts and 57% were consumers of other types of breakfasts. Non-consumption of breakfast increased with age (4-8 years: 2%; 9-13 years: 9%; 14-18 years: 18%). Breakfast consumers had higher covariate-adjusted intakes of energy, many nutrients and fibre, and lower fat intakes. The prevalence of nutrient inadequacy for vitamin D, Ca, Fe and Mg (from food alone or from the combination of food plus supplements) was highest in breakfast non-consumers, intermediate in consumers of other types of breakfasts and lowest in consumers of RTEC breakfast. For vitamin A, P and Zn, breakfast non-consumers had a higher prevalence of nutrient inadequacy than both breakfast groups. The potential risk of excessive nutrient intakes was low in all groups. Efforts to encourage and maintain breakfast consumption in children and adolescents are warranted.

Consumption of breakfast and the type of breakfast consumed are positively associated with nutrient intakes and adequacy of Canadian adults.

Few studies have assessed the associations between breakfast intake and nutrient adequacy [where inadequacy reflects prevalence of usual intakes below the estimated average requirement (EAR) and potential excess reflects the prevalence above the tolerable upper intake level (UL)]. This study examined associations among breakfast, nutrient intakes, and nutrient adequacy in Canadian adults. Respondents aged ≥19 y in the Canadian Community Health Survey 2.2 (n = 19,913) were classified as breakfast nonconsumers (11%), ready-to-eat cereal (RTEC) breakfast consumers (20%), or other breakfast consumers (69%). Nutrient intakes from food (24-h recall) and the prevalence of usual intakes below the EAR and above the UL from food alone and from food plus supplements were compared by breakfast group. Usual intake distributions were estimated using the National Cancer Institute method. Breakfast consumers, and to a greater extent RTEC breakfast consumers, had significantly higher intakes of fiber and several vitamins and minerals than breakfast nonconsumers. Compared with nonconsumers, RTEC and other breakfast consumers had significantly lower prevalences below the EARs for vitamin A and magnesium. The prevalences below the EARs of these nutrients and calcium, thiamin, vitamin D, and iron were significantly lower with RTEC breakfasts than with other breakfasts. Similar patterns were observed from food alone compared with food plus supplements. Breakfast consumption did not affect prevalence above the UL based on food sources, although based on food plus supplements, breakfast consumers had slightly higher proportions that were above the UL than nonconsumers for several nutrients. Breakfast, especially an RTEC breakfast, is associated with improved nutrient adequacy and does not meaningfully affect prevalence above the UL.

Dietary counselling for dyslipidemia in primary care: results of a randomized trial.

This study compared the effectiveness of physician advice versus dietitian advice for a fat-reduced diet, and of dietitian advice for a fat-reduced diet versus a soluble fibre-enhanced diet in patients with moderate dyslipidemia. A total of 111 men and women took part in this 26-week, three-group, randomized, clinical trial. The physician advice fat-reduced diet group (n = 38) and the dietitian advice fat-reduced diet group (n = 35) received dietary advice based on the American Heart Association (AHA) Step II guidelines. The dietitian advice soluble fibre-enhanced diet group (n = 38) consumed one-third cup per day of psyllium-containing cereal and was advised to increase soluble fibre intake to over 10 grams a day. LDL-C, TC/HDL-C ratio and body weight reductions over six months were -5.3%, -4.6%, and -1.9%, respectively, regardless of whether a physician or a dietitian provided advice, or whether advice was focused on a fat-reduced diet or a soluble fibre-enhanced diet. Both dietitians and physicians can help moderately dyslipidemic patients make clinically meaningful changes in blood lipid levels. Soluble fibre enhancement of the usual diet leads to similar reductions in LDL-C and TC/HDL-C ratio compared to interventions focused on fat reduction.