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.

Food purchasing and food insecurity among low-income families in Toronto.

PURPOSE: Factors underlying food-purchasing decisions were examined among a sample of low-income Toronto families. METHODS: A cross-sectional survey was completed among 485 families residing in high-poverty Toronto neighbourhoods. Food-security status was assessed using the Household Food Security Survey Module. Open-ended questions were included to examine respondents' food selection and management practices and their purchasing decisions for six indicator foods. Logistic regression was used to examine associations between factors influencing food-purchasing decisions, perceived food adequacy, and severity of food insecurity. RESULTS: Twenty-two percent of families had been severely food insecure in the past 30 days. Respondents engaged in thrifty food shopping practices, such as frequenting discount supermarkets and budgeting carefully. Price was the most salient factor influencing food-purchasing decisions; the likelihood that families would report this factor increased with deteriorating food security. Preference, quality, and health considerations also guided food-purchasing decisions, but generally to a lesser extent as food insecurity increased. Household food supplies reflected constraints on food purchasing, and they diminished with increasing food insecurity. CONCLUSIONS: Despite their resourcefulness, low-income families struggle to feed their families. Dietitians have an important role to play as advocates for adequate income supports to promote food security and nutritional health.

A comparison of the fat composition and prices of margarines between 2002 and 2006, when new Canadian labelling regulations came into effect.

OBJECTIVE: To examine the effect of the new Canadian labelling regulations on the fat composition and prices of margarines. STUDY DESIGN: A survey of all margarines sold in major supermarkets in the Greater Toronto area was conducted in 2006, and results were compared with those of a similar survey conducted in 2002. Average fat composition, proportion of 'trans fat-free' margarines and average prices of margarines were compared. A general linear model procedure was used to compare the relationship between price and fat composition in 2002 and 2006. RESULTS: Average amounts of trans fatty acids (TFA) and MUFA decreased, while average amounts of PUFA increased significantly from 2002 to 2006. The proportion of margarines with less than 0.2 g TFA/10 g serving rose significantly from 31 % in 2002 to 69 % in 2006. Margarines lower in TFA on average cost significantly more than margarines with greater amounts of these fats, and this relationship appeared stronger in 2006 relative to 2002. CONCLUSIONS: There is evidence of reductions in TFA in margarines since new labelling regulations came into effect in Canada; however, TFA reductions appeared to be restricted to higher-priced margarines. Results suggest that voluntary approaches (i.e. manufacturer incentives via labelling) to reduce population intakes of TFA will yield little changes in TFA content of low-cost products and thus may have limited benefit for lower-income groups, who are at higher risk of heart disease.

An examination of income-related disparities in the nutritional quality of food selections among Canadian households from 1986-2001.

Socio-economic disparities in nutrition have been documented in numerous countries, and have been linked to health inequalities. Social and economic policy changes occurring over the last several years have resulted in growing levels of income inequality in many countries. However, the extent to which these temporal changes have affected nutrition disparities is largely unknown. Our research examined income-related disparities in the nutritional quality of food selections among Canadian households from 1986 to 2001. Data from the 1986, 1992, 1996 and 2001 Family Food Expenditure surveys were pooled together (n=35048). The relationships between household income and the nutritional quality of food purchases (considering nutrients both as absolute amounts and adjusted for energy, and total energy density) were estimated using general linear models, including tests of significance for differences across the survey years. Results revealed significant positive relationships between income and most nutrients, which persisted over time, and for some nutrients grew stronger. One exception was folate, where the positive relationship between income and folate (independent of energy) was no longer apparent in 2001; this could be attributed to the mandatory fortification of some cereal grain products with folic acid, which came into effect in 1998, resulting in greater availability of folate from grain products. There was also a significant negative relationship between income and total energy density (ratio of food energy to food weight), which persisted across the survey years. At a time of growing income inequality and worsening problems of poverty, food policy makers need to pay attention to the potential for policy interventions to exacerbate or improve nutrition disparities.

The relationship between price, amounts of saturated and trans fats, and nutrient content claims on margarines and oils.

PURPOSE: Modifications to the amount and type of fat in the diet are recommended as strategies to help reduce heart disease risk. Individuals can choose from a variety of margarines and oils to alter their intakes of different types of fats, and nutrient content claims on product labels (e.g., 'low in saturated fat') can help them quickly identify healthful products. However, margarines and oils vary in price. METHODS: To examine the relationship between the price and amounts of saturated and trans fats in margarines and oils, and the relationship between price and the presence of nutrient content claims, price and label information were recorded for margarines (n=229) and oils (n=342) sold in the major supermarkets within the Greater Toronto Area. RESULTS: Linear regression analysis revealed a negative relationship between the price and amounts of saturated fat and trans fats in margarines, but not in oils. Margarines with a nutrient content claim were significantly more expensive than were those without a claim. CONCLUSIONS: The findings for margarines are of particular concern for lower income groups for whom budgetary constraints result in the purchase of lower priced foods, and also raise important questions about the usefulness of nutrient content claims in guiding food selections.

Assessment of the Mission Nutrition nutrition education program.

In 1998, Dietitians of Canada and the team of registered dietitians at Kellogg Canada Inc. partnered to develop Mission Nutrition, a national bilingual nutrition education program that provides curriculum-based resources to teachers. The main objectives of this study were to measure the awareness and utility of the Mission Nutrition program among elementary teachers, and to identify opportunities to enhance the Mission Nutrition resources to increase use. A ten-minute telephone survey was conducted with a representative sample of 203 elementary school teachers. A sub-sample of 20 teachers then participated in a more in-depth 30-minute telephone survey. A need for increased promotion of the Mission Nutrition program was identified on the basis of the 22% awareness among teachers participating in the initial interview. All teachers who had used the educator guides and student activity sheets reported that they would use them again. Teachers found that the Mission Nutrition materials were well-researched and contained useful activities relevant to students. The findings indicate that, to be most effective, nutrition education resources should be provided in a ready-to-use format and integrated with core curricula. Teachers also suggested that materials should include fresh ideas to engage students at different grade levels, and ways to involve parents. Dietitians are ideally positioned to work collaboratively with educators to develop these types of nutrition education resources.