Solid fat and added sugar intake among U.S. children: The role of stores, schools, and fast food, 1994-2010

Abstract

Background: Little is known about the role of location in U.S. children's excess intake of energy from solid fat and added sugar, collectively referred to as SoFAS.

Purpose: The goal of this study was to compare the SoFAS content of foods consumed by children from stores, schools, and fast-food restaurants and to determine whether trends from 1994 to 2010 differ across these locations.

Methods: Children aged 2-18 years (N=22,103) from five nationally representative surveys of dietary intake from 1994 to 2010 were studied. SoFAS content was compared across locations for total intake and key foods. Regression models were used to test and compare linear trends across locations. Data were analyzed in 2012.

Results: The mean percentage of total energy intake consumed from each location that was provided by SoFAS remained above recommendations, despite significant improvements between 1994 and 2010 at stores (1994, 38.3%; 2004, 33.2%); schools (1994, 38.7%; 2004, 31.2%); and fast-food restaurants (1994, 34.6%; 2004, 34.6%). For each key food, SoFAS content decreased significantly at stores and schools, yet progress at schools was comparatively slower. Milk was higher in SoFAS at schools compared to stores because of shifts toward flavored milk at schools. Schools provided french fries that were higher in solid fat than store-bought versions and pizza that was not significantly different in SoFAS content than fast-food pizza. However, schools made significantly greater progress for sugar-sweetened beverages, as lower-sugar beverages replaced regular sodas. Key fast foods showed little improvement.

Conclusions: These findings can inform future strategies targeted to the specific locations and foods where continued progress is needed to reduce children's SoFAS consumption.

Figure 1

Added sugar and solid fat content of milk, pizza, french fries, and sugar-sweetened beverages consumed by children from stores, schools, and fast-food restaurants, 1994–2010 Note: Data for children aged 2–18 years from CSFII 1994–1998 and NHANES 2003–2010. Numbers in bars are the percentage of food group kcal per day from non-SoFAS calories, added sugar, and solid fat at each location. Significance testing compares values in a given year for all pairwise comparisons of locations. ^a Includes all types of milk such as whole, 2%, 1%, and nonfat milks (plain, chocolate, and flavored) ^b Includes all types of pizza, calzones, and pizza rolls ^c Includes french fries, home fries, and hash browns ^d Includes regular, low-calorie, and diet sugar-sweetened beverages such as soft drinks, fruit drinks, sports drinks, and energy drinks * Store and school are significantly different ** Store and fast food are significantly different *** School and fast food are significantly different kcal/d, kilocalories per day; SoFAS, total energy from solid fat and added sugar CSFII, Continuing Survey of Food Intakes by Individuals; NHANES, National Health and Nutrition Examination Survey