February 03, 2014
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Many Americans consume more added sugar than recommended for a healthy diet

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Most American adults consume a higher-than-recommended intake of added sugar, which heightens their risk for CVD-related mortality, according to a new report.

Researchers conducted a study to examine time trends of added sugar consumption as percentage of daily calories in the United States and to assess the association with CVD mortality. The analysis included data from the National Health and Nutrition Examination Survey 1988-1994 (n=11,733), 1994-2004 (n=8,786) and 2005-2010 (n=10,628), and the NHANES III Linked Mortality cohort 1988-2006 (n=11,733). A 24-hour dietary recall was used to determine added sugar intake, including sugars used in prepared and processed foods.

Intake among US adults

The adjusted mean percentage of daily calorie intake from added sugar among US adults increased from 15.7% in 1988-1994 to 16.8% in 1999-2004 (P=.02), but then decreased to 14.9% in 2005-2010 (P<.001). In 2005-2010, 71.4% of adults consumed at least 10% of calories from added sugar and 10% of adults consumed at least 25% of calories from added sugar.

CVD-related death occurred in 831 participants during a median follow-up of 14.6 years (163,039 person-years). After adjustment for age, sex and race/ethnicity, participants in the second-lowest quintile of added sugar consumption had an adjusted HR for CVD death of 1.09 (95% CI, 1.05-1.13) compared with the lowest quintile; participants in the highest quintile of consumption had an adjusted HR of 2.43 (95% CI, 1.63-3.62). Further adjustment for behavioral, clinical and sociodemographic factors attenuated but did not eliminate the significance of this association (second-lowest quintile: adjusted HR=1.07; 95% CI, 1.02-1.12; highest quintile: adjusted HR=2.03; 95% CI, 1.26-3.27).

Compared with adults who consumed less than 10% of calories from added sugar, the risk for CVD-related death was significantly higher among those who consumed 10% to 24.9% (adjusted HR=1.3; 95% CI, 1.09-1.55) and at least 25% (adjusted HR=2.75; 95% CI, 1.4-5.42).

According to the researchers’ calculations, the number needed to harm at a median of 15 years of follow-up was 265 among adults in the second-lowest quintile of added sugar consumption and 22 among adults in the highest quintile of consumption.

Analysis according to specific food intake indicated moderate negative correlations between intake of added sugar and that of total grain (r=–0.06), vegetables (r=–0.2) and meats (r=–0.12), and positive correlations with total fat (r=0.17) and cholesterol (r=0.08; P<.05 for all). Consumption of sugar-sweetened beverages was significantly associated with increased risk for CVD-related death (HR=1.29; 95% CI, 1.04-1.6 for those consuming at least seven servings/week compared with one or fewer servings/week).

The observed associations were consistent according to age, sex, education, physical activity and BMI. The associations were mostly consistent according to race/ethnicity, with the exception of non-Hispanic blacks, who had a lower adjusted HR for CVD-related death in the highest quintile of added sugar consumption compared with the lowest quintile (adjusted HR=0.71; 95% CI, 0.44-1.15).

Current and future recommendations

Quanhe Yang, PhD, of the division for heart disease and stroke prevention at the CDC, and colleagues concluded that these data “support current recommendations to limit the intake of calories from added sugars in US diets.”

This study adds to the growing body of evidence on the influence of added sugar consumption on chronic disease, Laura A. Schmidt, PhD, MSW, MPH, of the Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, wrote in a related commentary.

“It underscores the likelihood that, at levels of consumption common among Americans, added sugar is a significant risk factor for CVD mortality above and beyond its role as empty calories leading to weight gain and obesity. … In addition, Yang et al underscore the need for federal guidelines that help consumers set safe limits on their intake as well as evidence-based regulatory strategies that discourage excess sugar consumption at the population level.”

For more information:

Schmidt LA. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2013.12991.

Yang Q. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2013.13563.

Disclosure: The researchers and Schmidt report no relevant financial disclosures.