Added Sugar Intake in US Adolescents Linked to Cardiovascular Risk

Laurie Barclay, MD

January 31, 2011

January 31, 2011 — Added sugar intake in US adolescents is linked to increased cardiovascular disease risk, according to the results of a cross-sectional study reported online January 10 in Circulation.

"Whereas increased carbohydrate and sugar consumption has been associated with higher cardiovascular disease risk among adults, little is known about the impact of high consumption of added sugars (caloric sweeteners) among US adolescents," write Jean A. Welsh, MPH, RN, from the Nutrition and Health Science Program, Emory University School of Medicine in Atlanta, Georgia, and colleagues.

Dietary data from one 24-hour recall of 2157 US adolescents enrolled in the National Health and Nutrition Examination Survey 1999 to 2004 were merged with added sugar content data from the US Department of Agriculture MyPyramid Equivalents databases. Measures of cardiovascular disease risk were estimated as a function of added sugar intake level (< 10%, 10% to < 15%, 15% to < 20%, 20% to < 25%, 25% to < 30%, and ≥ 30% of total energy).

Multivariable means were weighted to be representative of US adolescents, and variances were adjusted to account for the complex sampling methods.

Average daily intake of added sugars was 21.4% of total energy. Added sugar consumption correlated inversely with mean high-density lipoprotein (HDL) cholesterol levels (mmol/L). The lowest consumers had a mean HDL of 1.40 (95% confidence interval [CI], 1.36 - 1.44), and the highest consumers had a mean HDL of 1.28 (95% CI, 1.23 - 1.33; P for trend = .001).

Added sugar intake correlated positively with geometric mean triglyceride levels (mmol/L), which were 0.81 (95% CI, 0.74 - 0.88) in the lowest consumers and 0.89 (95% CI, 0.83 - 0.96) in the highest consumers (P for trend = .05). Added sugar intake also correlated positively with low-density lipoprotein (LDL) cholesterol levels (mmol/L), which were 2.24 (95% CI, 2.12 - 2.37) in the lowest consumers and 2.44 (95% CI, 2.34 - 2.53) in the highest consumers (P for trend = .01).

For adolescents who were overweight or obese, defined as a body mass index at or above the 85th percentile, added sugars correlated positively with the homeostasis model assessment of insulin resistance (HOMA-IR; P for linear trend = .004).

"Consumption of added sugars among US adolescents is positively associated with multiple measures known to increase cardiovascular disease risk," the study authors write.

Limitations of this study include cross-sectional design with exposures and outcomes measured at the same time, precluding determination of causality; use of a single 24-hour dietary recall; possible residual confounding; and lack of information on the validity of the process used to estimate added sugar content data in the US Department of Agriculture MyPyramid Equivalents databases.

"Though long-term trials to study the effect of reducing the consumption of added sugars are needed, the results of this study suggest that future risk of CVD [cardiovascular disease] may be reduced by minimizing consumption of added sugars among adolescents," the study authors conclude.

One of the study authors (Miriam B. Vos, MD, MSPH) is supported in part by a career award from the National Institutes of Diabetes and Digestive and Kidney Diseases and by the Children's Digestive Health and Nutrition Foundation. Dr. Vos is also the author of The No-Diet Obesity Solution for Kids, for which he receives royalties. The remaining study authors have disclosed no relevant financial relationships.

Circulation. Published online January 10, 2011. Abstract

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