Trends in Added Sugars Intake and Sources Among US Children, Adolescents, and Teens Using NHANES 2001-2018

Abstract

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.

Keywords: NHANES; United States; added sugars; adolescents; children; intake; sources; teens; trends.

FIGURE 1

Added sugars intake (A) in grams per day (g/d) and (B) percentage of total daily kilocalories (% kcal) among children, adolescents, and teens, 2001–2018, based on the first day of dietary recall. The β and P values are from a linear trend analysis. *Significantly different from reference cycle (NHANES 2001–2002) and test for trend significant at a P value < 0.01.

FIGURE 2

Added sugars intake among children, adolescents, and teens (2–18 years), 2001–2018, by (A) race and ethnicity, (B) income, and (C) food assistance, based on the first day of dietary recall. The β and P values are from a linear trend analysis. Values are significant at P < 0.01. Data from 2011–2018 for Hispanic and Asian individuals were used to facilitate direct comparisons because nationally representative samples were available starting in 2007–2008 and 2011–2012, respectively. PIR categories were set as low (PIR < 1.35), medium (1.35 ≤ PIR ≤ 1.85), and high (PIR > 1.85). PIR, poverty income ratio.

FIGURE 3

Added sugars intake among children, adolescents, and teens (2–18 years), 2001–2018, by (A) physical activity level and (B) body weight status, based on the first day of dietary recall. The β and P values are from a linear trend analysis. Values are significant at P < 0.01.