Therapies and PreventionThe Role of Added Sugars in Pediatric Obesity
Section snippets
Sugar sweeteners in the food supply
Sugar-containing sweeteners have been used to improve the taste of foods and beverages for thousands of years, but only natural-occurring sweeteners such as honey and only very small amounts of high-priced refined sugar or “white gold” from cane, were available until the 1800s, so consumption was low.14 In the United States after the Civil War, with improved methods for extracting sugar from beets as well as cane, the price began to decline, and consumption of refined sugars began to increase
Consumption patterns and trends
National survey data indicate that, from 1977 to 1978 to 1994 to 1996, the consumption of added sugars among Americans ages 2 years and older increased from 13.1% to 16.0% of total energy intake.3 More recently, consumption has decreased. Between 1999 to 2000 and 2007 to 2008, the mean consumption of total added sugar in the United States is estimated to have decreased by almost one-fifth, from 18.1% to 14.6% of total energy intake,2 with decreases observed among all race/ethnic, income, and
Possible role of added sugars in child obesity
Several studies have shown an association between the consumption of added sugars and higher calorie intake, weight gain, or obesity in adults as well as children, but others have not. Early findings, based primarily on the results of cross-sectional studies, were inconsistent, but multiple studies, including meta-analyses, randomized controlled trials, and long-term prospective studies published in recent years strengthen the evidence of this association.
While there has been little study of
Other associated health outcomes
Several other chronic disease risk factors and conditions have been associated with high consumption of added sugars, including insulin resistance and diabetes,8, 12, 35 cardiovascular disease (CVD),36, 37 elevated lipid levels,12, 35, 38 nonalcoholic fatty liver disease,39 hypertension,35 elevated uric acid levels,40, 41 gout,42 decreased diet quality,10 and dental caries.43 Most of these studies were in adults, but there is also increasing evidence of adverse health outcomes in adolescents
Sugar metabolism and hypothesized mechanisms for increased obesity risk
The primary role of sugars is to provide energy to cells in the body. All forms of carbohydrates are digested, absorbed, and transported through the body as monosaccharides (simple sugars), including glucose (most common), fructose, and some galactose.46 Various mechanisms have been hypothesized to explain the association between the intake of sugars, specifically fructose and glucose (alone or in combination), and obesity risk.
One hypothesized mechanism relates to the fact that a large
Consumption guidelines
US Dietary Guidelines for Americans, which form the basis of national nutrition policy, have been advising Americans to limit their consumption of sugars for years. The 1977 Dietary Goals for the United States recommended that total sugar consumption be limited to 15% of total energy,51 while more recent versions of the dietary guidelines have not specified an upper limit. In 2000, Americans were advised to “choose beverages and foods to moderate” their intake of sugars52 and, in 2005, to
Strategies for reducing children’s added sugar consumption
Pediatricians and other primary health care providers are uniquely positioned to identify children whose intake of added sugars exceeds the recommended limit and to promote positive behavior change as a part of well-child visits.53 Following are examples of strategies that health care providers can discuss with children and their families as part of efforts to define a behavior change approach that can effectively reduce added sugar consumption. A brief summary of some of the research evidence
Summary: practical advice for patients/bottom line
Results of recent high-quality studies have strengthened the body of evidence demonstrating that high intake of added sugars, particularly in SSBs, is associated with greater risk of obesity in children. This evidence, together with that which links added sugar consumption to increased risk of chronic disease and decreased diet quality, provides strong support for efforts to minimize children’s consumption, which, despite recent decreases, continues to exceed recommended limits. Pediatricians
References (76)
- et al.
Consumption of added sugars is decreasing in the United States
Am J Clin Nutr
(2011) - et al.
Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups
J Adolesc Health
(2004) - et al.
Twenty-four hour endocrine and metabolic profiles following consumption of high-fructose corn syrup-, sucrose-, fructose-, and glucose-sweetened beverages with meals
Am J Clin Nutr
(2008) - et al.
Low-to-moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial
Am J Clin Nutr
(2011) - et al.
Defining and interpreting intakes of sugars
Am J Clin Nutr
(2003) - et al.
Manufacturing, composition, and applications of fructose
Am J Clin Nutr
(1993) - et al.
Food sources of added sweeteners in the diets of Americans
J Am Diet Assoc
(2000) - et al.
Feeding infants and toddlers study: What foods are infants and toddlers eating?
J Am Diet Assoc
(2004) - et al.
Intake of sugar-sweetened beverages and weight gain: a systematic review
Am J Clin Nutr
(2006) - et al.
Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis
Am J Clin Nutr
(2008)