Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States

Abstract

Objective: The objective of this research was to identify top dietary sources of energy, solid fats, and added sugars among 2- to 18-year-olds in the United States.

Methods: Data from the National Health and Nutrition Examination Survey, a cross-sectional study, were used to examine food sources (percentage contribution and mean intake with standard errors) of total energy (data from 2005-2006) and energy from solid fats and added sugars (data from 2003-2004). Differences were investigated by age, sex, race/ethnicity, and family income, and the consumption of empty calories-defined as the sum of energy from solid fats and added sugars-was compared with the corresponding discretionary calorie allowance.

Results: The top sources of energy for 2- to 18-year-olds were grain desserts (138 kcal/day), pizza (136 kcal/day), and soda (118 kcal/day). Sugar-sweetened beverages (soda and fruit drinks combined) provided 173 kcal/day. Major contributors varied by age, sex, race/ethnicity, and income. Nearly 40% of total energy consumed (798 of 2,027 kcal/day) by 2- to 18-year-olds were in the form of empty calories (433 kcal from solid fat and 365 kcal from added sugars). Consumption of empty calories far exceeded the corresponding discretionary calorie allowance for all sex-age groups (which range from 8% to 20%). Half of empty calories came from six foods: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk.

Conclusions: There is an overlap between the major sources of energy and empty calories: soda, grain desserts, pizza, and whole milk. The landscape of choices available to children and adolescents must change to provide fewer unhealthy foods and more healthy foods with less energy. Identifying top sources of energy and empty calories can provide targets for changes in the marketplace and food environment. However, product reformulation alone is not sufficient-the flow of empty calories into the food supply must be reduced.

Figure 1

List of specific foods: Result of grouping like foods reported in 2003–2004 and 2005–2006 NHANES^a

Figure 2

Food sources and mean intake of empty calories for male and female children and adolescents in the United States, relative to discretionary calorie allowance Among 2–18 year olds, about half of empty calories came from six specific foods: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk. The discretionary calorie allowance for each sex/age group is based on low activity levels, because most children and adolescents do not achieve the 60 minutes per day of cardio-respiratory activity recommended in national physical activity guidelines (21).