No Effect of Added Sugar Consumed at Median American Intake Level on Glucose Tolerance or Insulin Resistance

Excess sugar consumption may promote adverse changes in hepatic and total body insulin resistance. Debate continues over the effects of sugars at more typically consumed levels and whether the identity of the sugar consumed is important. In the present study participants (20–60 years old) were randomly assigned to one of five groups, three that consumed low fat milk with added fructose containing sugars in amounts equivalent to the 50th percentile of fructose consumption (US), one which consumed low-fat milk sweetened with glucose, and one unsweetened low-fat milk control group. The intervention lasted ten weeks. In the entire study population there was less than 1 kg increase in weight (73.6 ± 13.0 vs. 74.5 ± 13.3 kg, p < 0.001), but the change in weight was comparable among groups (p > 0.05). There were no changes in fasting glucose (49 ± 0.4 vs. 5.0 ± 0.5 mmol/L), insulin (56.9 ± 38.9 vs. 61.8 ± 50.0 pmol/L), or insulin resistance, as measured by the Homeostasis Model Assessment method (1.8 ± 1.3 vs. 2.0 ± 1.5, all p > 0.05). These data suggest that added sugar consumed at the median American intake level does not produce changes in measures of insulin sensitivity or glucose tolerance and that no sugar has more deleterious effects than others.     

Fructose-Containing Sugars and Cardiovascular Disease

Cardiovascular disease (CVD) is the single largest cause of mortality in the United States and worldwide. Numerous risk factors have been identified for CVD, including a number of nutritional factors. Recently, attention has been focused on fructose-containing sugars and their putative link to risk factors for CVD. In this review, we focus on recent studies related to sugar consumption and cardiovascular risk factors including lipids, blood pressure, obesity, insulin resistance, diabetes, and the metabolic syndrome. We then examine the scientific basis for competing recommendations for sugar intake. We conclude that although it appears prudent to avoid excessive consumption of fructose-containing sugars, levels within the normal range of human consumption are not uniquely related to CVD risk factors with the exception of triglycerides, which may rise when simple sugars exceed 20% of energy per day, particularly in hypercaloric settings.     

The Effect of Normally Consumed Amounts of Sucrose or High Fructose Corn Syrup on Lipid Profiles,Body Composition and Related Parameters in Overweight/Obese Subjects

The American Heart Association (AHA) has advocated that women and men not consume more than 100 and 150 kcal/day, respectively, from added sugars. These levels are currently exceeded by over 90% of the adult population in the United States. Few data exist on longer-term metabolic effects when sucrose and High Fructose Corn Syrup (HFCS), the principal sources of added dietary sugars, are consumed at levels typical of the general population. Sixty five overweight and obese individuals were placed on a eucaloric (weight stable) diet for 10-weeks, which incorporated sucrose- or HFCS-sweetened, low-fat milk at 10% or 20% of calories in a randomized, double-blinded study. All groups responded similarly (interaction p > 0.05). There was no change in body weight in any of the groups over the 10-week study, or in systolic or diastolic blood pressure. Likewise, there were no changes in total cholesterol, triglycerides, low-density lipoprotein (LDL), or apolipoprotein B (Apo B). We conclude that (1) when consumed as part of a eucaloric diet fructose—when given with glucose (as normally consumed) does not promote weight gain or an atherogenic lipid profile even when consumed at two to four times the level recently recommended by the AHA. (2) There were no differences between HFCS and sucrose on these parameters.     

Understanding Vietnamese Urban Consumers’ Nutrition Label Use,Health Concerns,and Consumption of Food and Beverages with Added Sugars

Vietnam is experiencing a diet and nutrition transition. Increasing consumption of food and beverages with added sugars is a significant public health concern. Policies and interventions, such as mandatory nutrition labelling, are being considered to improve consumers’ awareness and understanding of diet and health implications of added sugars in food and beverages. The effectiveness of various policy approaches relies on an improved understanding of the interrelationships between urban Vietnamese consumers’ health concerns, nutrition label use, and intake of sugars. We empirically disentangle these relationships for urban Vietnamese households using novel intra-household data covering 4047 adults and 737 adolescents from 1590 households in Hanoi and Ho Chi Minh City. The data are from comprehensive household surveys and 24-hour food diaries. Simultaneous equation regression models are estimated using three-stage least squares (3SLS) to account for possible endogeneity. Nutrition label use is significantly associated with a lower share of calories from foods and beverages with added sugars. These findings suggest that nutrition labelling programs may be an effective policy mechanism to reduce the negative health implications of increasing availability and consumption of food and beverages with added sugars in urban Vietnam.     

Effects of Consuming Sugar-Sweetened Beverages for 2 Weeks on 24-h Circulating Leptin Profiles,Ad Libitum Food Intake and Body Weight in Young Adults

Sugar-sweetened beverage (sugar-SB) consumption is associated with body weight gain. We investigated whether the changes of (Δ) circulating leptin contribute to weight gain and ad libitum food intake in young adults consuming sugar-SB for two weeks. In a parallel, double-blinded, intervention study, participants (n = 131; BMI 18–35 kg/m²; 18–40 years) consumed three beverages/day containing aspartame or 25% energy requirement as glucose, fructose, high fructose corn syrup (HFCS) or sucrose (n = 23–28/group). Body weight, ad libitum food intake and 24-h leptin area under the curve (AUC) were assessed at Week 0 and at the end of Week 2. The Δbody weight was not different among groups (p = 0.092), but the increases in subjects consuming HFCS- (p = 0.0008) and glucose-SB (p = 0.018) were significant compared with Week 0. Subjects consuming sucrose- (+14%, p < 0.0015), fructose- (+9%, p = 0.015) and HFCS-SB (+8%, p = 0.017) increased energy intake during the ad libitum food intake trial compared with subjects consuming aspartame-SB (−4%, p = 0.0037, effect of SB). Fructose-SB decreased (−14 ng/mL × 24 h, p = 0.0006) and sucrose-SB increased (+25 ng/mL × 24 h, p = 0.025 vs. Week 0; p = 0.0008 vs. fructose-SB) 24-h leptin AUC. The Δad libitum food intake and Δbody weight were not influenced by circulating leptin in young adults consuming sugar-SB for 2 weeks. Studies are needed to determine the mechanisms mediating increased energy intake in subjects consuming sugar-SB.     

Added Sugars in School Meals and the Diets of School-Age Children

Research is limited on added sugars in school meals and children’s dietary intakes after the 2015–2020 Dietary Guidelines for Americans (DGA) recommended that added sugars be limited to less than 10% of total calories. This analysis uses data from the School Nutrition and Meal Cost Study (SNMCS) to examine levels of added sugars in: (1) school meals and (2) children’s dietary intakes at breakfast, lunch, and over 24 h on school days. SNMCS data were collected in the 2014–2015 school year after updated nutrition standards for school meals were implemented. Most schools exceeded the DGA limit for added sugars at breakfast (92%), while 69% exceeded the limit at lunch. The leading source of added sugars in school meals (both breakfasts and lunches) was flavored skim milk. More than 62% of children consumed breakfasts that exceeded the DGA limit, and almost half (47%) consumed lunches that exceeded the limit. Leading sources of added sugars in the breakfasts consumed by children were sweetened cold cereals and condiments and toppings; leading sources of added sugars in children’s lunches were flavored skim milk and cake. Over 24 h, 63% of children exceeded the DGA limit. These findings show that school meals and children’s dietary intakes are high in added sugars relative to the DGA limit and provide insights into the types of foods that should be targeted in order to decrease levels of added sugars.     

Estimated Levels of Gluten Incidentally Present in a Canadian Gluten-Free Diet

Avoiding exposure to gluten is currently the only effective treatment for celiac disease. However, the evidence suggests that for most affected individuals, exposure to less than 10 mg/day is unlikely to cause histological changes to the intestinal mucosa. The daily diet of people with celiac disease does not rely solely on gluten-free pre-packaged foods, but also on naturally gluten-free grains (e.g., rice, buckwheat, ...) and foods with grain-derived ingredients (i.e., flour and starches) used for cooking and baking at home. The objective of this study was to estimate the level of incidental gluten potentially present in gluten-free diets from a Canadian perspective. We have conducted gluten exposure estimations from grain-containing foods and foods with grain-derived ingredients, taking into consideration the various rates of food consumption by different sex and age groups. These estimates have concluded that if gluten was present at levels not exceeding 20 ppm, exposure to gluten would remain below 10 mg per day for all age groups studied. However, in reality the level of gluten found in naturally gluten-free ingredients is not static and there may be some concerns related to the flours made from naturally gluten-free cereal grains. It was found that those containing a higher level of fiber and that are frequently used to prepare daily foods by individuals with celiac disease could be a concern. For this category of products, only the flours and starches labelled “gluten-free” should be used for home-made preparations.     

Validity of FFQ Estimates of Total Sugars,Added Sugars,Sucrose and Fructose Compared to Repeated 24-h Recalls in Adventist Health Study-2 Participants

Sugar intake is a potentially important aspect of diet which has not previously been validated in the Adventist Health Study-2 (AHS-2). We sought to validate the food frequency questionnaire (FFQ) measurement of total sugars, added sugars, sucrose, and fructose against multiple 24-h dietary recalls (recalls) in AHS-2 participants. Food consumption data from a self-administered FFQ and six recalls from 904 participants were combined with nutrient profile data to estimate daily sugar intake. Validity was evaluated among all participants and by race. FFQ and recall means were compared and correlation coefficients (Spearman’s, energy-adjusted log-transformed Pearson’s, deattenuated Pearson’s) were calculated. Mean total energy, total sugars, and fructose intake were higher in the FFQ, whereas added sugars and sucrose were higher in recalls. The energy-adjusted (log-transformed) deattenuated correlations among all participants were: total sugars (r = 0.42, 95% CI 0.32–0.52), added sugars (r = 0.50, 95% CI 0.36–0.59), sucrose (r = 0.32, 95% CI 0.23–0.42), and fructose (r = 0.50, 95% CI 0.40–0.59). We observed moderate validity for added sugars and fructose and low-moderate validity for total sugars and sucrose measured by the AHS-2 FFQ in this population. Dietary sugar estimates from this FFQ may be useful in assessing possible associations of sugars intake with health outcomes.     

Skeletal muscle magnesium and potassium determinations: correlation with lymphocyte contents of magnesium and potassium.

Following a lymphocyte separation technique, the lymphocyte content of magnesium and potassium was determined by atomic absorption spectroscopy in 28 subjects. Simultaneously, skeletal muscle biopsies were obtained by a percutaneous technique and analyzed for magnesium and potassium. In this study there was not significant correlation between the lymphocyte and the skeletal muscle content of magnesium or potassium, except in the group of three normal volunteers and nine patients with mild arterial hypertension.     

Distinct Impact of Natural Sugars from Fruit Juices and Added Sugars on Caloric Intake,Body Weight,Glycaemia, Oxidative Stress and Glycation in Diabetic Rats

Although fruit juices are a natural source of sugars, there is a controversy whether their sugar content has similar harmful effects as beverages’ added-sugars. We aimed to study the role of fruit juice sugars in inducing overweight, hyperglycaemia, glycation and oxidative stress in normal and diabetic animal models. In diabetic Goto-Kakizaki (GK) rats, we compared the effects of four different fruit juices (4-weeks) with sugary solutions having a similar sugar profile and concentration. In vitro, the sugary solutions were more susceptible to AGE formation than fruit juices, also causing higher postprandial glycaemia and lower erythrocytes’ antioxidant capacity in vivo (single intake). In GK rats, ad libitum fruit juice consumption (4-weeks) did not change body weight, glycaemia, oxidative stress nor glycation. Consumption of a matched volume of sugary solutions aggravated fasting glycaemia but had a moderate impact on caloric intake and oxidative stress/glycation markers in tissues of diabetic rats. Ad libitum availability of the same sugary solutions impaired energy balance regulation, leading to higher caloric intake than ad libitum fruit juices and controls, as well as weight gain, fasting hyperglycaemia, insulin intolerance and impaired oxidative stress/glycation markers in several tissues. We demonstrated the distinct role of sugars naturally present in fruit juices and added sugars in energy balance regulation, impairing oxidative stress, glycation and glucose metabolism in an animal model of type 2 diabetes.     

Effect of consuming different caloric sweeteners on bone health and possible mechanisms

Western diets are high in caloric sweeteners and since the 1980s there has been a shift from the use of sucrose as the predominant sweetener to high-fructose corn syrup. This may have important implications for bone, as sugar consumption has been shown to negatively impact mineral balance. This article reviews the existing scientific evidence regarding the effect of caloric sweeteners and the type of sweetener on bone health and the potential mechanisms of action. A better understanding of the role of sugar consumption on mineral balance and bone can contribute to the determination of dietary recommendations to reduce bone loss and the future risk of osteoporosis.     

Dietary Intake and Sources of Added Sugars in Various Food Environments in Costa Rican Adolescents

Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all food environments where they socialize. However, it is relevant for public health to consider the home and school environments as fundamental units of interventions aimed at reducing added sugars in the adolescent diet. Frescos prepared at home and school and fruit-flavored still drinks must be the focus of these interventions.     

Development of the SoFAS (Solid Fats and Added Sugars) Concept: The 2010 Dietary Guidelines for Americans

The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a “calorie” is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to “empty calories” to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010 DGAs. This information will provide practitioners, as well as the public, with valuable information to better understand the evolution of SoFAS over time.     

Consumption of Ultra-Processed Foods Is Associated with Free Sugars Intake in the Canadian Population

Excess sugar consumption can lead to noncommunicable diseases (NCDs) such as type 2 diabetes. Increasingly, ultra-processed foods (UPF) are suspected to be great contributors to free sugars intake in the population’s diet. Thus, the aim of this study was to investigate the association between UPF consumption and free sugars intake in the Canadian population. We used data from one 24 h-recall of the nationally representative 2015 Canadian Community Health Survey–Nutrition (CCHS). Food items were classified according to the NOVA system, and to estimate free sugars intake, we used the University of Toronto’s Food Label Information Program (FLIP) 2017 database. Results: Almost half of the population’s energy intake (45.7%) came from UPF. On average, 221.5 kcal/day came from free sugars, and most of these calories (71.5%) came from UPF. Public health policies aiming to decrease consumption of UPF should be a priority considering their important contribution to sugar intake in the population.     

Laboratory Determined Sugar Content and Composition of Commercial Infant Formulas,Baby Foods and Common Grocery Items Targeted to Children

Excess added sugar consumption is tied to poor health outcomes in children. The sugar content of beverages and foods children are exposed to is mostly unknown, yet this information is imperative for understanding potential risks from overconsumption of sugars in early life. We determined actual sugar content by conducting a blinded laboratory analysis in infant formulas, breakfast cereals, packaged baked goods and yogurts. One hundred samples were sent to an independent laboratory for analysis via gas chromatography. Sugar content and composition was determined and total sugar was compared against nutrition labels. Of the 100 samples analyzed, 74% contained ≥20% of total calories per serving from added sugars. Nutrient label data underestimated or overestimated actual sugars and ~25% of all samples had actual total sugar values that were either <10% or >10% of labeled total sugar. Many products that are frequently marketed to and consumed by infants and young children contain sugars in amounts that differ from nutrition labels and often in excess of recommended daily levels. These findings provide further support for adding more comprehensive sugar labeling to food and beverage products, specifically those marketed to, or commonly consumed by, children.     

Assessment of Total Choline Intakes in the United States

Objective: Choline is an essential nutrient and plays a critical role in brain development, cell signaling, nerve impulse transmission, and lipid transport and metabolism. This analysis aimed to assess usual intakes of choline and compare them with the dietary reference intakes for U.S. residents aged ≥2 years.

Methods: The National Cancer Institute method was used to assess usual intakes of choline from foods according to data for participants in the 2009–2012 National Health and Nutrition Examination Survey (NHANES; n = 16,809).

Results: Suboptimal intakes of choline are prevalent across many life-stage subpopulations in the United States. Only 10.8 ± 0.6% of 2009–2012 NHANES participants aged ≥2 years (15.6 ± 0.8% of males and 6.1 ± 0.6% of females) achieved the adequate intake (AI) for choline. Children aged 2–3 years were the most likely to exceed the AI (62.9 ± 3.1%), followed by children aged 4–8 years (45.4 ± 1.6%) and children aged 9–13 years (9.0 ± 1.0%), compared to adolescents aged 14–18 years (1.8 ± 0.4%) and adults aged ≥19 years (6.6 ± 0.5%). When comparing by age and gender, males consumed significantly more choline than females for all age groups.

Conclusions: These data indicate that there is a need to increase awareness among health professionals and consumers regarding potential suboptimal intakes of choline in the United States, as well as the critical role that choline plays in health maintenance throughout the lifespan. Food scientists and the food and dietary supplement industries should consider working collectively with government agencies to discuss strategies to help offset the percentage of the population that does not meet the AI. Revision of the dietary reference intakes for choline should include replacement of the AI with an estimated average requirement and a recommended dietary allowance, so that more accurate population estimates of inadequate intakes may be calculated.     

Energy,Sugars, Iron,and Vitamin B12 Content of Commercial Infant Food Pouches and Other Commercial Infant Foods on the New Zealand Market

There has been an important shift in the New Zealand infant food market over the past decade, with the majority of complementary foods now sold in “pouches”. Along with the increasing market share of commercial infant food pouches internationally, there have been growing concerns about their nutritional quality. However, research examining the nutritional quality of these pouches compared to other forms of commercial infant foods in New Zealand has not been undertaken. Nor have any studies reported the free sugars or added sugars content of these foods. To address this knowledge gap, a cross-sectional survey of infant foods sold in New Zealand supermarkets was conducted in 2019–2020. Recipes and nutrient lines were developed for the 266 foods identified (133 food pouches). The energy, iron, vitamin B12, total sugars, free sugars, and added sugars content of infant food pouches and other forms of commercial infant foods per 100 g were compared, both within food groups and by age group. Infant food pouches contained similar median amounts of energy, iron, and vitamin B12 to other forms of commercial infant foods but contained considerably more total sugars (8.4 g/100 g vs. 2.3 g/100 g). However, median free sugars and added sugars content was very low across all food groups except for “dairy” and “sweet snacks”. All “dry cereals” were fortified with iron whereas none of the infant food pouches were. Therefore, consuming food pouches to the exclusion of other commercial infant foods may place infants at risk of iron deficiency if they do not receive sufficient iron from other sources.     

Trends in Total,Added, and Natural Phosphorus Intake in Adult Americans,NHANES 1988–1994 to NHANES 2015–2016

Dietary phosphorus intake in the USA has been consistently greater than the Recommended Daily Allowance (RDA) with several studies reporting associations between intake and health risks as well as all-cause mortality within healthy subjects and patients with chronic kidney disease (CKD). The current study utilized a novel approach to calculate added phosphorus content in foods to determine sources (National Health and Nutrition Examination Survey, NHANES 2001–2016, n = 39,796) and trends in consumption (NHANES 1988–1994, 2001–2016, n = 55,744) of total, naturally occurring, and added phosphorus. Among adults (19+ years), the mean intake of total and natural phosphorus (mg/day) in 1988–1994 as compared with 2015–2016 increased (total: 1292 ± SE 11 vs. 1398 ± SE 17; natural: 1113 ± SE 10 vs. 1243 ± SE 16 mg/day); in contrast, added phosphorus intake decreased during this time (178 ± SE 2.9 vs. 155 ± SE 4.1 mg/day). Added phosphorus as a percent of total ranged from about 14.6% in 1988–1994 to about 11.6% in 2015–2016. The top five sources of total and naturally occurring phosphorus, representing approximately 20% of intake, were cheese, pizza, chicken (whole pieces), reduced-fat milk, and eggs/omelets. The top five sources of added phosphorus were cheese, soft drinks, cakes/pies, rolls/buns, and cookies/brownies, representing 45% of added phosphorus in the diet. Consumption of added phosphorus has decreased over the past few decades, possibly due to increased demand for foods with less additives/ingredients but may also be due to inaccurate phosphorus values in nutrition databases. Further studies are needed to validate the added phosphorus calculations utilized in this study and nutrition databases should consider providing added phosphorus content.