Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

Diet and diabetes: a common approach.

Objective: To assess the impact of breakfast skipping and type of breakfast consumed on energy/nutrient intake, nutrient adequacy, and diet quality.

Design: Cross-sectional.

Setting: The National Health and Nutrition Examination Survey (NHANES), 1999–2002.

Subjects: Young adults (20–39 years, n = 2615).

Measures: A 24-hour dietary recall was used, with breakfast defined as self-reported. Covariate-adjusted sample-weighted means for the entire day's energy/nutrient intakes, mean adequacy ratio (MAR) for nutrient intakes, and diet quality (i.e., Healthy Eating Index [HEI]-2005) scores were compared using analysis of variance and Bonferroni's correction (p < 0.0167) among breakfast skippers (BS), ready-to-eat-cereal breakfast consumers (RTECC), and other breakfast consumers (OBC). Energy/nutrient intakes and food consumption at breakfast were also compared (p ≤ 0.05).

Results: Twenty-five percent of young adults were BS, 16.5% were RTECC, and 58.4% were OBC. Intakes of total energy, percent energy from carbohydrate, and dietary fiber were higher in RTECC than in BS and OBC. Percent energy intake from added sugars was higher in BS than in RTECC and OBC. Compared with BS and RTECC, OBC consumed a lower percent energy from carbohydrates and total sugars, but consumed a higher percent energy from total fat and discretionary solid fats and had a higher cholesterol intake. Intakes of several micronutrients were higher in RTECC than in BS and OBC. Both MAR and total HEI scores were the highest in RTECC and higher in OBC than in BS. The HEI scores for intakes of whole fruits, total/whole grains, milk, and percent energy from solid fat/alcohol/added sugar were the highest in RTECC and higher in OBC than in BS. Compared with OBC, RTECC had a higher HEI score for the intake of saturated fat. At breakfast, RTECC consumed higher intakes of total fruits, whole grains, dairy products, carbohydrates and total sugars, dietary fiber, and several micronutrients than OBC, who consumed higher intakes of meat/poultry/fish, eggs, total fat, discretionary oils/solid fats, cholesterol, and sodium than RTECC.

Conclusion: Thus, RTECC had more favorable nutrient intakes and better diet quality than BS and OBC.     

Decreasing Trends in Heavy Sugar-Sweetened Beverage Consumption in the United States, 2003 to 2016

BackgroundAlthough previous studies have documented declines in intake from sugar-sweetened beverages (SSB) in the United States, it is important to examine whether heavy SSB intake (≥500 kcal/day) is decreasing in parallel. Examining the intake patterns of heavy SSB consumers is imperative because these individuals face the greatest health risks and thus may benefit the most from targeted policy and programmatic efforts to reduce intake.ObjectiveTo provide the most recent national estimates for trends in heavy SSB intake among children and adults in the United States between 2003-2004 and 2015-2016, to examine whether these trends differ by sociodemographic characteristics, and to describe where SSB are acquired and consumed by the heaviest SSB consumers.DesignTrend analyses of demographic and 24-hour dietary recall data in the 2003-2004 to 2015-2016 National Health and Nutrition Examination Survey.Participants/settingParticipants were 21,783 children (aged 2 to 19 years) and 32,355 adults (aged ≥20 years).Main outcome measuresHeavy SSB intake (≥500 kcal/day).Statistical analysisSurvey-weighted logistic regression was used to estimate the proportion of heavy SSB consumers, overall and by age group, race/ethnicity, sex, and income status (lower income = <130% Federal Poverty Level). Proportions were used to summarize where SSB are most often acquired and consumed.ResultsBetween 2003-2004 and 2015-2016, the prevalence of heavy SSB intake declined significantly among children (10.9% to 3.3%) and adults (12.7% to 9.1%). For children, these declines were observed across age group, sex, family income status, and most races/ethnicities. For adults, these significant declines were observed among 20- to 39-year olds, most races/ethnicities, and higher-income adults. However, there was a significant increase in heavy SSB intake among adults aged ≥60 years and no significant change among 40- to 59-year olds and non-Mexican Hispanic adults. The majority of energy intake from SSB consumed by heavy SSB drinkers was from products acquired from stores and was consumed at home.ConclusionsHeavy SSB intake is declining, but attention must be paid to certain subgroups with high intake for whom trends are not decreasing, particularly 40- to 59-year olds and non-Mexican Hispanic adults.     

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood

ObjectiveTo investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children.DesignA cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group.ParticipantsThe 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years.InterventionA training session for primary care workers based on the Brazilian National Guidelines for Children.Main Outcome MeasureMothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls.AnalysisThe effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance.ResultsChildren attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, −6.36 g/d; 95% CI, −11.49 to −1.23) and total daily energy intake (difference, −116.90 kcal/d; 95% CI, −222.41 to −11.40) at 3 years of age.Conclusions and ImplicationsHealth care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.     

Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years—Results from the EsNuPI Study

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One “Spanish Reference Sample” (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk and fortified and enriched milks, here called “Adapted Milk Consumers Sample” (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.     

Decreasing the Consumption of Foods with Sugar Increases Their Reinforcing Value: A Potential Barrier for Dietary Behavior Change

BackgroundThe Dietary Guidelines for Americans (DGA) have recommended reducing added sugar intake since its inception in 1980. Nearly 40 years later, added sugar consumption still exceeds 2015-2020 DGA recommendations among most of the population. The reinforcing value of food influences eating behaviors, and foods high in added sugars are highly reinforcing. Restricting intake of foods high in added sugars as part of a low-sugar diet may increase their reinforcing value such that reducing consumption may be difficult to maintain. If so, this would present a mechanistic barrier to making the necessary dietary changes to meet 2015-2020 DGA recommendations.PurposeTo determine whether the relative reinforcing value of foods high in added sugars is altered when reducing intake of all foods high in sugars.MethodsObese (n=19) and normal weight (n=23) men and woman who habitually consumed over 10% of their calories from added sugars completed the study. Reinforcing value of foods high in added sugars was measured via progressive ratio schedules of reinforcement before and on day 7 of a weeklong controlled feeding intervention where added sugars comprised 2.5% to 4.0% of daily calories and total sugars 7.3% to 8.6% of daily calories.ResultsThe reinforcing value of foods high in added sugars increased (P<0.01) after consuming a diet low in total added sugars for 1 week in both obese and normal weight participants.ConclusionAdhering to a low-sugar diet for 1 week increases the reinforcing value of foods high in added sugars. Future studies should examine whether consuming a diet low in added sugars, but not other sugar, increases reinforcing value of foods high in added sugars and whether high–added sugar food reinforcement returns to baseline after longer-term reductions in added sugars.     

Added Sugar Intake among Pregnant Women in the United States: National Health and Nutrition Examination Survey 2003-2012

Background

Despite associations of dietary added sugar with excess weight gain and chronic disease risk, intake among most Americans exceeds the recommended limits (<10% total energy). Maternal diet plays an important role in pregnancy-related outcomes, but little is known about the extent of added sugar intake during pregnancy.

Intake of added sugars is not associated with weight measures in children 6 to 18 years: National Health and Nutrition Examination Surveys 2003-2006

Studies examining an association between consumption of added sugars (AS) and weight measures in children are inconclusive. This study examined the association between intake of AS and 5 measures of weight or adiposity using a nationally recent representative sample of children. National Health and Nutrition Examination Surveys 2003-2006 24-hour recall data from children 6 to 18 years (n = 3136) were used. United States Department of Agriculture's definition of AS and MyPyramid Equivalents Database were used to estimate daily intake. Multiple linear regression and squared partial correlation coefficients were used to estimate the strength of association between weight, body mass index (BMI), BMI Z scores, waist circumference, and triceps and subscapular skinfolds as dependent variables with AS as the independent variable. Covariates were age, sex, race/ethnicity, poverty income ratio, total energy intake (kJ), and physical activity. Mean intake of AS was 23 ± 0.55 teaspoons (tsp) (21 tsp for 6-11 years and 25 tsp for 12-18 years) accounting for 17% of total energy intake for both groups. The percent variance explained in BMI Z scores was 3.9% in children 6 to 11 years, with AS contributing only 0.03%. In children 12 to 18 years, the percent variance explained in the BMI Z scores was 6.5% with 0.18% coming from AS. No significant associations were observed between intake of AS and weight or adiposity measures. Consumption of AS did not contribute significantly to BMI Z scores in children 6 to 18 years. Longitudinal studies using more robust and precise measures of dietary intake are needed to further investigate the role of AS and weight in children.     

Food Sources of Total Energy and Nutrients among U.S. Infants and Toddlers: National Health and Nutrition Examination Survey 2005–2012

Understanding the dietary intakes of infants and toddlers is important because early life nutrition influences future health outcomes. The aim of this study was to determine the dietary sources of total energy and 16 nutrients in a nationally representative sample of U.S. infants and toddlers aged 0–24 months. Data from the 2005–2012 National Health and Nutrition Examination Survey were analyzed. Dietary intake was assessed in 2740 subjects using one 24-h dietary recall. The population proportion was used to determine the contribution of foods and beverages to nutrient intakes. Overall infant formulas and baby foods were the leading sources of total energy and nutrients in infants aged 0–11.9 months. In toddlers, the diversity of food groups contributing to nutrient intakes was much greater. Important sources of total energy included milk, 100% juice and grain based mixed dishes. A number of foods of low nutritional quality also contributed to energy intakes including sweet bakery products, sugar-sweetened beverages and savory snacks. Overall non-flavored milks and ready-to-eat cereals were the most important contributors to micronutrient intakes. In conclusion this information can be used to guide parents regarding appropriate food selection as well as inform targeted dietary strategies within public health initiatives to improve the diets of infants and toddlers.     

Dietary and Weight-Related Behaviors and Body Mass Index among Hispanic,Hmong, Somali,and White Adolescents

BackgroundThe population of the United States is becoming increasingly ethnically and racially diverse, much of it due to immigration patterns. However, little is known about dietary intake and weight-related concerns and behaviors of youth from some ethnic-minority groups, especially Hispanic, Hmong, and Somali adolescents.ObjectiveOur aim was to describe dietary intake and weight-related concerns and behaviors among Hispanic, Hmong, and Somali adolescents and compare them with white adolescents.DesignWe performed a cross-sectional analysis of data from Eating and Activity in Teens 2010, a population-based study in the Minneapolis/St Paul metropolitan area.Participants/settingCurrent analysis includes 1,672 adolescents (Hispanic: n=562 [33.6%]; Hmong: n=477 [28.5%]; Somali: n=113 [6.8%]; white: n=520 [31.1%]; mean age=15.0 years). Adolescents completed classroom surveys and had their height/weight measured during the 2009-2010 academic year.Statistical analysisMultivariable regression models, adjusted for socioeconomic status, age, and school as a random effect were used to examine racial/ethnic differences for each outcome variable for boys and girls.ResultsThere were numerous differences in the behaviors of Hispanic, Hmong, and Somali adolescents as compared with whites. Hispanic and Somali youth consumed fruit and fast food more frequently. Hmong adolescents consumed sugar-sweetened beverages less frequently, and Somali boys consumed energy and sport drinks more frequently than whites. Compared with white boys, overweight/obesity was higher among Hispanic and Hmong. A higher percentage of Hmong and Somali adolescents engaged in unhealthy weight control behaviors. Body satisfaction was lower for all Hmong adolescents compared with whites.ConclusionsThere were varying areas of concern in dietary intake, weight, and weight-related concerns and behaviors among adolescents in all ethnic groups. Future nutrition and physical activity interventions that include adolescents from these ethnic and cultural groups can benefit from, for example, modifying intervention strategies to the specific priority behaviors within the target population.     

The Contribution of Discrete Vegetables,Mixed Dishes,and Other Foods to Total Vegetable Consumption: US Ages 2 Years and Over, 2017-2018

BackgroundThe 2020-2025 Dietary Guidelines for Americans recommend intake of a variety of vegetables, including dark green, red, and orange vegetables and starchy and other vegetables.ObjectivesThis study aims to describe sociodemographic differences in the contribution of different categories of vegetables and the form in which they are consumed (ie, discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetable intake on a given day).DesignThis is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey.Participants/settingThis study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls.Main outcome measuresServing equivalents of vegetables from 20 discrete categories of vegetables and from mixed dishes and other foods as a percentage of total vegetables.Statistical analysesPairwise differences by age, sex, race, Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income were examined using orthogonal polynomials.ResultsMean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups, and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake, and the contribution increased with age in adults and with increasing family income. The top 5 discrete vegetable contributors were other vegetables and combinations, french fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Nonstarchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income.ConclusionsDiscrete vegetables only contributed 55.2% of total vegetable intake, and the top sources were not varied. Three of them potato based, which may explain the reported low vegetable intake, relative to the 2020-2025 Dietary Guidelines for Americans. More than one-third of vegetables consumed were nonstarchy discrete vegetables, many of which are high in vitamins. Nonstarchy discrete vegetable intake was higher in adults than youth and increased with family income.     

Prevalence of Low-Calorie Sweeteners and Related Front-of-Package Claims in the Brazilian Packaged Food Supply

BackgroundLow-calorie sweeteners (LCSs) are increasingly being used worldwide, including in foods and beverages commonly consumed by children.ObjectiveTo examine the prevalence of LCSs in packaged foods and beverages sold in Brazil, whether LCSs are added to products with advertising directed to children, and whether foods and beverages with LCSs include front-of-package (FoP) LCS-related health and nutrition claims.DesignCross-sectional study.SettingA sample (n = 11,434) of packaged foods and beverages sold by the top 5 largest Brazilian food retailers was examined to identify LCSs and added sugars, and a subsample (n = 3491) was examined to determine the presence of advertising directed to children and FoP LCS-related claims in foods and beverages with LCSs.Main outcome and measuresThe prevalence of foods and beverages with different types of LCSs in the Brazilian food supply, among ultra-processed foods and beverages and among foods and beverages with added sugars, were measured. Foods and beverages with advertising directed to children were checked to see if these products had LCSs and how many products with LCSs had FoP labels with LCS-related claims.Statistical analysesMean and 95% CIs were used to determine the overall prevalence of foods and beverages with LCSs and in the different assessed stratifications.ResultsThe prevalence of LCSs was 9.3% (95% CI 8.8-9.9) in Brazilian packaged foods and beverages, 14.6% (95% CI 13.8-15.4) in ultra-processed products alone, and 5.7% (95% CI 4.2-7.7) in foods and beverages with advertising directed to children. About 83% of food and beverage with LCSs were also sweetened with added sugars. LCSs were most frequently added to nonalcoholic sweetened beverages, breakfast cereals, and granola bars. Forty percent of foods and beverages with LCS did not present any FoP LCS-related claim.ConclusionThis study shows that LCSs are present in 15% of ultra-processed foods and beverages in Brazil, largely used in combination with added sugars, and are found in foods and beverages with advertising directed to children. Clearer FoP information regarding the presence of LCSs, in particular in products with advertising directed to children, can help consumers make more informed choices regarding LCS consumption.     

Nutrient intakes and body weights of persons consuming high and moderate levels of added sugars.

We classified a nationally representative sample of persons aged 4 years and older as high or moderate consumers of added sugars (ie, sugars added to foods by processors or consumers). Intake of added sugars was determined on the basis of grams consumed per kilogram of body weight (g/kg) and on the basis of percent of dietary energy from added sugars (% kcal). Regardless of the intake measure used, high consumers of added sugars had a significantly lower percentage of dietary energy from fat than did moderate consumers of added sugars. Persons defined by the % kcal measure as high consumers of added sugars took in lower percentages of the Recommended Dietary Allowances (RDAs) for 11 vitamins and minerals; these high consumers had body weights similar to those of their moderate counterparts. Persons defined as high consumers by the g/kg measure consumed greater percentages of the RDAs than did their moderate counterparts; these high consumers more frequently selected foods from categories likely to contain sugar-rich foods but weighed significantly less than did moderate consumers. Thus, different approaches to defining intake of added sugars revealed two patterns of high consumption of added sugars with different levels of nutritional risk. Conditions of overweight were not associated with high intake of added sugars. Educational efforts, therefore, should focus on those consumers who tend to substitute foods rich in added sugars for more nutritionally desirable foods.     

Ultra-processed foods and total sugars intake in Korea: evidence from the Korea National Health and Nutrition Examination Survey 2016–2018

BACKGROUND/OBJECTIVESDietary sugars intake worldwide is stable or decreasing, but overall sugars intake remains above the recommended level. Some studies suggest that ultra-processed foods (UPFs) drive excessive sugars intake. However, UPF consumption in Korea and its association with sugars intake have not yet been studied. This study aimed to estimate the contribution of UPF consumption to total sugars intake and to investigate the association between UPF consumption and total sugars intake in Koreans.SUBJECTS/METHODSData from the Korea National Health and Nutrition Examination Survey 2016–2018 were used, and included data on 21,075 participants aged 1+ years completed a 24-h recall. Food items reported in the 24-h recall were classified according to the NOVA system as UPFs, processed foods, processed culinary ingredients, or unprocessed or minimally processed foods.RESULTSThe average daily energy intake was 1,996 kcal, and UPFs accounted for 26.2% of the total energy intake (% TE). The average total sugars intake was 63.1 g (13.0% TE), and 44.9% of total sugars intake came from UPFs. Among the entire population, 15.8% exceeded the recommended limit for total sugars within 20% TE, and excessive total sugars intake was more prevalent among females (19.5%) and children (21.1%). The prevalence of excessive total sugars intake showed a significantly increasing tendency across the quartiles of UPF energy contribution, ranging from 11.9% in the lowest quartile to 23.2% in the highest quartile. Even after adjustment for sociodemographic variables, UPF consumption was positively associated with the prevalence of excessive total sugars intake (P for trend < 0.001). This association was similar in subgroup analyses by sex and age.CONCLUSIONSThis study suggests that UPF consumption may drive excessive intake of total sugars in the Korean diet. Our findings conclusively establish that restricting UPF consumption may be an efficient way to reduce sugars intake in Korean population.     

Dietary Sources of Energy, Solid Fats, and Added Sugars among Children and Adolescents in the United States

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.     

Marginal,Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

BackgroundSchool meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear.ObjectiveTo examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years).DesignCross-sectional analysis.Participants/settingSecondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project.Main outcome measuresConsumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener.Statistical analysisMultiple linear regression.ResultsFor the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI –0.93 to –0.53) to 0.99 (95% CI –1.59 to –0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI –0.65 to –0.34) to 0.68 (95% CI –1.07 to –0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security.ConclusionsLower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.     

Estimated Reductions in Added Sugar Intake among US Children and Youth in Response to Sugar Reduction Targets

BackgroundIn 2021, the National Salt and Sugar Reduction Initiative (NSSRI) released voluntary sugar reduction targets for packaged foods and drinks in the United States.ObjectiveThe objectives of this study were to describe trends in added sugar intake from NSSRI foods and beverages among children and youth and estimate possible reductions if industry were to meet the targets.DesignThis study consisted of cross-sectional and trend analyses of demographic and 24-hour dietary recall data from eight survey cycles (2003-2004 to 2017-2018) of the National Health and Nutrition Examination Survey.Participants/settingThe study sample included 23,248 children and youth (aged 2 to 19 years).Main outcome measuresThe main outcome measure was the percent of daily calories from added sugar for foods and beverages in NSSRI categories.Statistical analyses performedFoods and beverages reported by participants were mapped to one of the NSSRI’s categories or coded as a non-NSSRI item. Trends over time in added sugar intake were assessed using regression models. To assess possible reductions in added sugar intake if industry were to meet the targets, sales-weighted mean percent reductions for 2023 and 2026 targets were applied to NSSRI items in the 2017-2018 National Health and Nutrition Examination Suvey data. Results were examined overall and by demographic characteristics.ResultsFrom 2003-2004 to 2017-2018, added sugar intake from NSSRI foods and beverages declined, but consumption remained high. During 2017-2018, NSSRI categories accounted for 70% of US child and youth added sugar intake. If industry met the NSSRI targets, US children and youth would consume 7% (2023 targets) to 21% (2026 targets) less added sugar.ConclusionsAlthough added sugar intake from NSSRI foods and drinks has declined over the past decade, added sugar intake from all sources remains high and consumption of added sugar from certain NSSRI categories has remained steady over time. If met, the NSSRI targets are expected to result in meaningful reductions in added sugar intake for US children and youth.