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Comparison of mean amounts of added sugars, in grams, obtained from salient food and beverage sources, by children 6-11 years, grouped by added sugars intake status
Source publication
About 35 percent of children 2 to 19 years of age met the 2015-2020 DGA recommendation for added sugars, by limiting added sugars intake to less than 10% of total energy for the day.
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On average, those who met the recommendation obtained 5.9 percent, and those who did not meet the recommendation obtained 18.5 percent of total energy from added sug...
Context in source publication
Context 1
... salient sources of added sugars, in grams, in the diet of all children ages 6-11 years (N=1040) are in Figure 3., and the mean intake was 69.5 grams. Sweetened beverages such as soft drinks, fruit drinks, and sports and energy drinks, were the top source of added sugars providing 28.7 percent followed by sweet bakery products such as cakes, pies, cookies, brownies, doughnuts, sweet rolls, and pastries, providing 14.9 percent of added sugars. ...
Citations
... Because restaurant food is a significant contributor to children's dietary intake (Fryar et al., 2020), policies that aim to improve the healthfulness of kids' meals, which are generally of low nutritional quality (Dunn et al., 2020), have the potential to improve diet and reduce chronic diseases. Consumption of restaurant food among children is associated with higher intake of total energy and sugar, as well as greater consumption of sugar-sweetened beverages (SSBs) (Powell and Nguyen, 2013)-the largest contributor of added sugars in children's diets (Bowman et al., 2019). Fast food and SSBs have also been identified as primary dietary risk factors for overweight and obesity among children (Jakobsen et al., 2023). ...
Objective
Consumption of restaurant food is associated with poorer diet quality and greater consumption of sugar-sweetened beverages among children; and online restaurant purchases have increased substantially. New Orleans, Louisiana, enacted a healthy beverage default (HBD) ordinance effective January 1st, 2023, that restricted beverages automatically included with kids' meals, but that did not apply to online ordering platforms. This study evaluated whether this ordinance impacted online offerings.
Methods
Data on online kids' meal beverage offerings one month before and 8–11 months after the ordinance effective date were collected for chain restaurants in New Orleans and Baton Rouge, Louisiana. Online ordering platforms included restaurant websites/applications and three third-party platforms (Grubhub, Uber Eats, and DoorDash). Difference-in-differences (DID) weighted logistic regression models with robust standard errors clustered on restaurant were used to estimate relative changes in (1) compliance with HBD ordinance requirements, (2) default offerings of only water, milk, and 100 % juice, and (3) any default offerings of soda.
Results
The DID results revealed no statistically significant changes in compliance or beverage offerings in restaurants in New Orleans compared to Baton Rouge following the HBD ordinance; further, nearly all estimated odds ratios were close to 1, indicating no meaningful differences in changes in outcomes across sites.
Conclusions
This study found no evidence that the New Orleans HBD ordinance led to changes in kids' meal default beverage offerings on online ordering platforms. The results underscore the need for HBD policies that specifically apply to online ordering platforms, and for enforcement and monitoring of these platforms.
... Sugar-sweetened beverages (SSBs), which include sodas, fruit drinks, sports drinks, and sweetened waters, teas, and coffees, are the largest source of added sugar in children's diets and are associated with weight gain and obesity [1,2]. Almost two-thirds of children in the United States (USA) consume at least one SSB per day, with the highest intake among Black, Mexican-American, and non-Mexican Hispanic children and children from lowincome families [3,4]. ...
Background/Objectives: Sugar-sweetened beverage (SSB) consumption is associated with child obesity, an understudied issue in the southern United States, where obesity rates are the highest in the country. We examined the factors associated with high SSB intakes among children aged 2–12 years in two major cities in Louisiana, New Orleans and Baton Rouge. Methods: We conducted a cross-sectional study using an online survey. The sample consisted of caregivers of children aged 2–12 years who eat restaurant meals (either dine-in, delivery, or take-out) at least once a month and reside in or near New Orleans or Baton Rouge, LA. Multivariable logistic regression was used to examine factors associated with high child SSB intake frequency (≥4 times/week), including restaurant use, caregiver attitudes towards SSB, and their demographics (n = 1006). Results: Most caregivers reported weekly child SSB consumption (74.6% ≥ 1×/week; 38.1% ≥ 4+/week) and restaurant use (58.8% ≥ 1×/week). High SSB frequency (≥4+/week) was associated with a higher frequency of restaurant use, lower caregiver education, agreement with the statement that SSBs are an important part of family meals, and disagreement with the statement that restaurants should not offer SSBs with children’s meals (p < 0.05). Conclusions: Our results revealed a high frequency of SSB consumption among children who dine at restaurants monthly, with significant associations observed between SSB intake, restaurant meals, and pro-SSB attitudes. These findings may support the need for regulations, such as healthy default beverage policies for children’s menus, to potentially reduce SSB intake and shift social norms, particularly in regions with high childhood obesity rates like Louisiana and the southern USA.
... 33 D-allulose is GRAS [18][19][20][21][22] for use as a food/beverage ingredient for of all ages, including children, and exempt from "Sugars" and "Added Sugars" on the label by the United States FDA. 13 This is of particular importance for children, considering that most of their intake of added sugars comes from packaged and commercially produced foods, sweetened beverages in particular 4,5 , and in light of the recommendation from the WHO to reduce free sugars in the diet to less than 10%, or even 5% of the total energy intake 3 , highlighting the need to limit added sugars at an early age. 34 Previous research in healthy and young adults indicated that d-allulose is well tolerated 23,24 . Such reports have shown that doses of maximum no-observed-effect level in humans were 0.55 g/kg body weight (BW), when the laxative effect of D-allulose was used as an indicator, or 0.4 g/kg BW as maximum single intake. ...
D-Allulose, a low-calorie sugar, provides an attractive alternative to added sugars in food and beverage products. There is however limited data on its gastrointestinal (GI) tolerance, with only two studies in adults, and no studies in children to date. We therefore performed an acute, randomised, double-blind, placebo-controlled, cross over study designed to determine, for the first time, the GI tolerance of 2 doses of D-allulose (2.5 g per 120 ml and 4.3 g per 120 ml) in young children. The primary tolerance endpoint was the difference in the number of participants experiencing at least one stool that met a Type 6 or Type 7 description on the Bristol Stool Chart, within 24 hours after study product intake. Secondary endpoints included the assessment of stool frequency, stool consistency, and the presence of GI symptoms. Only one participant in the low dose group experienced a stool type 6 or 7, while no participants experienced a stool type 6 or 7 in the high dose group. A statistically significant difference in the change in stool frequency compared to placebo in the high dose group (p = 0.044) was found, with no significant difference between the groups for stool consistency and no participants experienced unusual stool frequency. All the encountered adverse events were non-serious, either mild or moderate, and there were no serious adverse events. All in all, D-allulose was tolerated well in children, making this ingredient a good candidate to reformulate commercially produced goods by replacing added sugars with lower caloric content.
... Continued added sugar content in CFBAI-listed foods raises considerable concerns. Only 35% of U.S. children meet the recommended limit on added sugars (< 10% of daily calories [20]), and children consume on average 14% of total energy from added sugars [21]. However, CFBAI nutrition criteria allow cereal products to contain up to 12 g of added sugar per serving and up to 9 g for sweet snacks. ...
Background
Through the Children’s Food and Beverage Advertising Initiative (CFBAI), U.S. food companies pledge to only advertise healthier products in children’s television (TV) programming, but previous research shows that highly advertised products do not qualify as nutritious according to independent nutrition criteria. In 2020, the CFBAI implemented stricter nutrition criteria for products that may be advertised to children, but the potential impact of these changes has not been assessed. This observational study evaluates (1) improvements in energy and individual nutrient composition of products that companies indicated may be advertised to children (i.e., CFBAI-listed products) in 2020 versus 2017, (2) amount of advertising on children’s TV for CFBAI-listed versus other products in 2021, and 3) the nutrition quality of advertised versus non-advertised CFBAI-listed products.
Methods
Data include energy, saturated fat, sodium, and sugar content and overall nutrition quality (Nutrition Profile Index [NPI] scores) of CFBAI-listed products in 2017 (n = 308) and 2020 (n = 245). Nielsen data provided total ad spending and children’s exposure to ads on children’s TV channels for all foods and beverages in 2021.
Results
From 2017 to 2021, energy, saturated fat and sugar declined for CFBAI-listed products in three of six food categories (yogurt, sweet and salty snacks). Although CFBAI-listed products accounted for 79% of food ads viewed by children on children’s TV channels, just 50% of CFBAI-listed food and 36% of drink brands were advertised on children’s TV. Moreover, advertised products were significantly less nutritious than non-advertised CFBAI-listed products.
Conclusion
Despite revised nutrition standards and improvements in nutrient content of some product categories, participating companies continued to primarily advertise nutritionally poor food and beverages on children’s TV. CFBAI companies have not delivered on their promises to advertise healthier products to children.
... Excessive consumption of sugar-sweetened beverages (SSBs) causes weight gain [1][2][3][4][5][6][7][8], dental caries [9][10][11], and other adverse health outcomes [12][13][14][15][16][17][18][19][20]. Despite these risks, SSBs continue to be over-consumed, contributing one-third of the added sugars consumed by American children [21,22] and negatively impacting diet quality [23]. One hundred percent fruit juice (FJ), though not a SSB, can also have negative health impacts-young children who overconsume FJ also drink more SSBs and have greater increases in weight during later childhood [24,25]. ...
Background: Healthcare-based interventions to address sugary beverage intake could achieve broad reach, but intensive in-person interventions are unsustainable in clinical settings. Technology-based interventions may provide an alternative, scalable approach. Methods: Within an academic health system in the United States that already performs electronic health record-based sugary drink screening, we conducted a pilot randomized trial of a technology-driven family beverage choice intervention. The goal of the intervention was to reduce sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption in 60 parent–child dyads, in which children were 1–8 years old. The pediatrician-initiated intervention consisted of a water promotion toolkit, a video, a mobile phone application, and 14 interactive voice-response phone calls to parents over 6 months. The study was conducted between June 2021 and May 2022. The aim of the pilot study was to assess the potential feasibility and efficacy of the newly developed intervention. Results: Intervention fidelity was excellent, and acceptability was high for all intervention components. Children in both the intervention and the control groups substantially decreased their consumption of SSB and FJ over follow-up (mean combined baseline 2.5 servings/day vs. 1.4/day at 6 months) and increased water consumption, but constrained linear mixed-effects models showed no differences between groups on these measures. Compared to parents in the control group, intervention parents had larger decreases in SSB intake at 3 months (−0.80 (95% CI: −1.54, −0.06, p = 0.03) servings daily), but these differences were not sustained at 6 months. Conclusion: These findings suggest that, though practical to implement in a clinical care setting and acceptable to a diverse participant group, our multicomponent intervention may not be universally necessary to achieve meaningful behavior changes around family beverage choice. A lower-intensity intervention, such as EHR-based clinical screening alone, might be a less resource-intense way for health systems to achieve similar behavioral outcomes. Future studies might therefore explore whether, instead of applying a full intervention to all families whose children overconsume SSB or FJ, a stepped approach, starting with clinical screening and brief counseling, could be a better use of health system resources.
... Research Group (38)(39)(40)(41)(42)(43)(44) . The mission of the Food Surveys Research Group is to "monitor and assess food consumption and related behavior of the US population by conducting surveys and providing the resulting information for food and nutrition-related programs and public policy https://doi.org/10.1017/S1368980023000526 ...
Objective:
Nutrition-related smartphone applications (apps) could improve children's nutrition knowledge and skills. However, little is known about the quality of nutrition-related apps for children. This study aimed to identify and evaluate the quality of nutrition-related smartphone apps designed for children ages 4 to 17.
Design:
This systematic appraisal is guided by the Protocol for App Store Systematic Reviews.
Setting:
Using Google's Advanced Search, we identified 1814 apps/1184 additional apps in an updated search on iOS, of which 24 were eligible. The apps' objective and subjective quality were evaluated using the 23-item, 5-point Mobile App Rating Scale. The objective quality scale consists of four subscales: engagement, functionality, aesthetics, and information.
Results:
Most of the apps (75%) focused solely on promoting nutrition skills, such as making food dishes, rather than nutrition knowledge. Of the 24 apps, 83% targeted children 4 to 8 years old. The app objective quality mean score was 3.60±0.41. The subscale mean scores were 3.20±0.41 for engagement, 4.24±0.47 for functionality, 4.03±0.51 for aesthetics, and 2.94±0.62 for information. The app subjective quality mean score was 2.10±0.90.
Conclusions:
More robust approaches to app development leveraging co-design approaches, including involving a multidisciplinary team of experts to provide evidence-based nutrition information, are warranted.
... Although the consumption of added sugars among US children and adolescents has decreased over time [8], intake remains high. Overall, US youth (2-19 years) consumed on average 14% of total daily calories from added sugars in 2015-2016, and only 35% of US youths (2-19 years) met the DGA recommendation for limiting added sugars [9]. The top three sources of added sugars among US youths (2-19 years) were sweetened beverages, sweet bakery products, and candy in 2015-2016 [9]. ...
... Overall, US youth (2-19 years) consumed on average 14% of total daily calories from added sugars in 2015-2016, and only 35% of US youths (2-19 years) met the DGA recommendation for limiting added sugars [9]. The top three sources of added sugars among US youths (2-19 years) were sweetened beverages, sweet bakery products, and candy in 2015-2016 [9]. Based on the 2017-2018 National Health and Nutrition Examination Survey (NHANES), mean intakes of added sugars were 12 teaspoons (tsp)/day (50 g) for children aged 2-5 years, 17 tsp/day (71 g) for children aged 6-11 years, and 18 tsp/day (75 g) for adolescents aged 12-19 years [10]. ...
... To address concerns of high consumption of added sugars among Americans, one of the US Department of Health and Human Services' Healthy People 2030 Objectives is "Reduce consumption of added sugars by people aged 2 years and over" [11]. Although several studies have examined consumption patterns and top sources of added sugars among all US youths [7][8][9]12], there is limited information on characteristics, leading sources, and eating occasions of added sugars among high consumers of added sugars. As higher intake of added sugars is related to adverse health consequences in youth [2][3][4][5], targeting interventions for the high consumer group might have a greater impact on health. ...
Background:
High consumption of added sugars is related to adverse health consequences.
Objective:
The objective of this study was to examine characteristics of US youth who report high intakes of added sugars, as well as the eating occasions and top sources of added sugars that contributed to intakes among consumers with high added sugars intake. Design and participants/setting: We conducted a cross-sectional study using 2015-2018 NHANES data among 5280 US youths (2-19 years).
Main outcome measures:
Outcome measure was usual percent of calories from added sugars using 2 days of dietary recall based on the National Cancer Institute method. High consumers were defined as consuming greater than 15% of total daily calorie intake from added sugars (1.5 times higher than the 2020-2025 Dietary Guidelines for Americans recommendation of <10% of total daily calorie intake). Explanatory measures were selected sociodemographics (e.g., age, sex, race/ethnicity). Eating occasions were breakfast, lunch, dinner, and snack.
Statistical analyses performed:
We used t-tests to compare mean differences between sociodemographic groups.
Results:
Overall, 34% of US youths were classified as high consumers of added sugars. The prevalence of high consumers of added sugars significantly varied by some sociodemographics (i.e., age, race/ethnicity, and head of household's education level). The prevalence of high added sugars consumers was significantly greater among 12-19-year-olds (41%) and 6-11-year-olds (37%) compared to 2-5-year-olds (19%), non-Hispanic Black (42%) and non-Hispanic White (42%) persons compared to Hispanic persons (19%), and those with a head of household's education level of high school/some college (40%) compared to households with college degree or higher (29%). The prevalence of high consumers did not differ by sex, income, or weight status. Of eating occasions, the amount of added sugars youths consumed was highest during snack occasions among high consumers. Top five sources of added sugars among high consumers on a given day were sweetened beverages, sweet bakery products, candy, other desserts, and ready-to-eat cereals.
Conclusion:
One in three US youths consumed more than 15% of total calories from added sugars. High added sugars intake was more prevalent among certain subgroups such as 12-19-year-olds and non-Hispanic Black or non-Hispanic White youth. Our findings can provide information for intervention efforts to decrease added sugars intake to promote child health.
... These products are important sources of energy and several dietary components identified by the Dietary Guidelines for Americans (DGA) 2020-2025 of public health concern for under/over consumption (Dietary Guidelines Advisory Committee, 2020). For example, sweet bakery products such as cakes, pies, cookies, brownies, doughnuts, sweet rolls, and pastries, account for 14-20% and 8.5% of the added sugars consumed by children and adults, respectively (Shanthy et al., 2019a;Bowman et al., 2019b). Similarly breads and rolls are the top sources of sodium (Centers of Disease Control and Prevention, 2021), energy, and dietary fiber (O'Neil et al., 2012). ...
Commercially packaged baked products such as breads and rolls, cookies, crackers, and pastry/doughnuts are an integral part of the American diet. However, there is general lack of information in scientific literature on the ingredients used in these foods. A prototype of IngID, a framework for parsing and systematically reporting ingredients used in commercially packaged foods, was recently developed, using ingredient statements of baked products mainly from USDA’s Global Branded Food Products Database. Our results show that baked products sold in the U.S. mainly use refined wheat flour, non-hydrogenated oils, nutritive sweeteners, and additive-type ingredients including emulsifiers, coloring agents, and fortificants. Only 5% of the top-selling baked products are wheat-free; hydrogenated/partially hydrogenated oils continue to be used; baked products use on average 16 additive-type ingredients (includes sweeteners and table salts) and majority use multiple sweeteners. Fortificants, lecithin, salt, sucrose, water, and wheat flour are the top co-occurring ingredients and the core of the ingredient network. Not all baked products are the same. For example, pastry/doughnuts have the highest proportions of use of refined grains, hydrogenated/partially hydrogenated oils, additive-type ingredients including coloring agents and emulsifiers. IngID enables characterization of what is in the food we eat in a systematic manner, beyond nutrient profiles.
... Sugar-sweetened beverage (SSB) consumption is a key contributor to added sugars intake [1,2] and is linked to adverse health outcomes including type 2 diabetes, obesity, and cardiovascular disease [3][4][5][6]. Policies that lead to permanent reductions in added sugars intake are critical for achieving long-term reductions taxed beverages; (3) volume sold of untaxed beverages (substitution); and, (4) volume sold in the two-mile border area (cross-border shopping). ...
This study examines longer-run impacts of the Seattle, Washington, Sweetened Beverage Tax (SBT) on beverage prices, volume sold, and cross-border shopping. We use a difference-in-differences estimation approach, drawing on universal product code-level store scanner data on taxed and untaxed beverages one-year pre-tax and two-year post-tax with Portland, Oregon, as the comparison site. Two-year post-tax, prices of taxed beverages increased by 1.04 cents per ounce (59% tax pass-through rate). Volume sold of taxed beverages fell by 22%. Declines were larger for family-size (29%) compared to individual-size (10%) beverages; particularly for soda (36% decrease for family-size compared to no change for individual-size). We found no change in volume sold of taxed beverages in Seattle’s 2-mile border area, suggesting no cross-border shopping. Overall, we found a sustained impact of the Seattle SBT two-year post-tax implementation suggesting that sugar-sweetened beverage taxes may yield permanent reductions in demand for sugary beverages and associated health harms.
... Based on 2009-2012 National Health and Nutrition Examination Survey (NHANES) data, SSB were the primary source of added sugars consumed by most Americans, and the mean percent of energy intake from added sugars was 14.3 ± 0.2% for 2-to 8-year-olds and 16.2 ± 0.2% for 9-to 18-year-olds [43]. This is consistent with data from the 2015-2016 NHANES that showed SSB was the main source of added sugars in the diets of children and adolescents, constituting 21.3% among 2-to 5-year-olds, 28.7% among 6-to 11-year-olds, and 36.5% among 12-to 19-year-olds [44]. On average, about 14% of children and adolescents' total ≥ 20% of daily fluid requirements [3] ≥ 20% of daily fluid requirements [3] ≥ 20% of daily fluid requirements [3] ≥ 20% of daily fluid requirements [3] ≥ 20% of daily fluid requirements [3] No definitive water recommendations are available for older children and adolescents, but the Beverage Guidance System recommends water makes up at least 20% of fluid requirements [3]. ...
... Rights reserved. energy intake was from added sugars [44], which exceeds the 2020-2025 Dietary Guidelines for Americans (DGA) recommendation that no more than 10% of daily calories come from added sugars [17]. Additionally, the American Heart Association recommends that children under the age of 2 years avoid all added sugars [45]. ...
... Recent data indicate that consumption of SSB among children and adolescents is declining [60,62,63], which is a beneficial trend for the health of this population. However, targeting the reduction of SSB intake, especially among adolescents, is still a high priority, as these beverages are the primary contributor to exceeding recommendations for added sugars [43,44] and have been associated with negative health outcomes [18−20, 21•, 22-25]. To aid in promoting healthful beverage patterns, this review includes a table of beverage recommendations from authoritative sources for children and adolescents (see Table 1). ...
Purpose of Review
Improving beverage patterns is important for promoting the health of children and adolescents. Food preferences can begin developing at a young age; thus, children and adolescents should be provided healthy beverages in accordance with current recommendations. The purpose of this review is to identify and summarize existing beverage recommendations for children and adolescents. This review also discusses the health impacts of beverages and how beverage consumption has changed among children and adolescents over time.
Recent Findings
The mean number of calories that children and adolescents are consuming from beverages on a given day has declined in recent years. However, sugar-sweetened beverages (SSB) are the primary source of added sugars in this population. Therefore, SSB consumption remains a concern, and reducing the intake of SSB is still considered a top priority for helping to improve dietary quality.
Summary
This review uniquely compiles recommendations into one convenient table for the entire age range of 0–19 years and includes recommendations that can be more adequately individualized. Beverage categories where beverage recommendations from authoritative sources are lacking have also been identified. Potential methods that can be implemented to improve beverage patterns and current public policy recommendations have been discussed to provide actionable steps that public health professionals can utilize in practice. The comprehensive table of beverage recommendations could be useful for professionals promoting the health of children and adolescents in research, clinical, and public health settings.
