Optimal Sugar Intake

1)  US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. http://health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf. Accessed September 12,2013.

Nutrient dense foods vs Calorie dense foods:

  1. Nutrient dense foods contain vitamins, minerals, protein and/or fiber and contribute positive calories for energy and growth. They include vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds.
  2. Calorie dense foods are high in calories and fats with limited vitamins, minerals and fiber. They contribute little more to the diet but empty calories/energy and often lead to weight gain. They include sweets, cookies, cakes, chips.

Natural vs added sugars:

  1. Natural sugars refer to sugar found in an original food such as fruit (fructose) and milk (lactose), which products also contain additional nutrients and fiber.
  2. Added sugars refer to forms of sugar not naturally in a product, but which are added later at the table or during preparation. Added sugar can be in many forms and may be listed as one of the following ingredients:
    • Anhydrous dextrose, Brown sugar, Cane juice, Confectioner's/ powdered sugar, Corn syrup, Corn syrup solids, Crystal dextrose, Dextrin, Evaporated corn sweetener, Fructose, Fruit juice concentrate, Fruit nectar, Glucose, High-fructose corn syrup, Honey, Invert sugar, Lactose, Liquid fructose, Malt syrup, Maltose, Maple syrup, Molasses, Nectars (e.g., peach nectar, pear nectar), Pancake syrup, Raw sugar, Sucrose, Sugar cane juice, White/ granulated sugar

**Both natural and added sugars promote dental caries

Dietary Guidelines for Americans

  1. Limit combined intake of fats AND sugars to 5-15% of daily caloric need
  2. Drink only 100% juice 
  3. Choose fruits canned in juice rather than syrup
  4. Consume sweetened beverages (including sodas, sports drinks and energy drinks) only when nutrient needs are met prior to caloric needs

General serving recommendations for sweets and added sugars: 

1200 kcal diet 3 servings* per week
1400 kcal diet 3 servings per week
1600 kcal diet 3 servings per week
1800 kcal diet 5 servings per week
2000 kcal diet 5 servings per week
2600 kcal diet < 2 servings per day
3100 kcal diet < 2 servings per day

* Typical serving sizes: 1 Tbsp sugar, 1 Tbsp jelly or jam, ½ cup sorbet or gelatin dessert, 1 cup lemonade

Actual vs Recommended Intake: Actual= 79 g (19.75 tsp); DASH recommended= 12 g (3 tsp); USDA recommended= 32 g (8 tsp)


2)  Briefel RR, Wilson A, Cabili C, Dodd AH. Reducing Calories and Added Sugars by Improving Children’s Beverage Choices. J Acad Nutr Diet. 2013;113:269-275. 

  • Average daily consumption of sugar sweetened beverages and flavored milks consumed at home and school Monday-Friday were calculated for school aged children (elementary through high school; n=2,314).
  • When all beverages were substituted with 1% unflavored milk at meals and water in-between meals, there was a potential 10% reduction in total caloric intake daily and a 48% decrease in added sugar intake equal to 10.5 teaspoons less sugar daily.


3)  Kosova EC, Auinger P, Bremer AA. The Relationships between Sugar-Sweetened Beverage Intake and Cardiometabolic Markers in Young Children. J Acad Nutr Diet. 2013;113:219-227.

  • NHANES data reviewed for 4,880 children under the age of 12 with complete lipid profiles available for analysis
  • Sugar-Sweetened Beverages (sodas, fruit drinks, sport drinks, energy drinks, chocolate milk, and vitamin water) shown to contribute ~175 kcal/day to the diets of children/adolescents.

Risks Related to Increased Sugar Sweetened Beverage Intake:

  1. Increased BMI, waist circumference and childhood obesity
  2. Hypertension
  3. Dyslipidemia
  4. Insulin resistance
  • By the age of 9 years, high intake of sugar sweetened beverages were shown to increase CRP levels (inflammation marker) and waist circumference with a decrease in HDL (good cholesterol) levels. There was no significant effect on total cholesterol, LDL (bad cholesterol) levels or triglyceride levels. 

Correlation to cardiac risk factors:

  1. Low HDL/ high LDL are coorelated with atherosclerosis (hardening of the arteries)
  2. Inflammation (denoted by increased CRP) shown to indicate an increased risk for future cardiac events/ atherosclerosis
  3. High waist circumference associated with abdominal obesity, increased risk for dyslipidemia/ insulin resistance and is correlated with metabolic syndrome in early adulthood
  • Over consumption of sugar creates a positive energy balance and may therefore lead to obesity.
  • Sugars are readily absorbed into the blood, which increases a food's glycemic load (speed at which a food elevates blood sugar). High glycemic loads are associated with increased inflammation, insulin resistance and cardiovascular risk.


4)  Ruottinen S, Niinikoski H, Lagstro¨m H, et.al. High Sucrose Intake Is Associated With Poor Quality of Diet and Growth Between 13 Months and 9 Years of Age: The Special Turku Coronary Risk Factor Intervention Project. Pediatrics. 2008;121(6):1676-85. 

  • Study conducted in Finland using World Health Organization’s recommendation that sugar account for <10% total daily calories
  • High vs low sucrose (sugar) intake made no difference in total caloric or fat intake, but did lead to significant changes in overall nutritional composition as follows:

Low sugar diets:

  1. Decreased intake of saturated fat; increased intake of poly- and monounsaturated fats (same amount of fat, but improved quality)
  2. Increased protein intake
  3. Increased vitamin E, niacin, calcium, iron, zinc intake
  4. Increased dietary fiber
  5. Greater consumption of grains, vegetables, dairy products, meat and fish

High sugar diets:

  1. Decreased intake of milk/ decreased calcium intake
  2.  Increased juice, candy, soft drink and sugared dairy intake. 
  • It was found that by the age of four, increased dietary intake of sugars was associated with decreased growth 
    • This is thought in part to be caused by decreased protein intake associated with high sugar consumption  

5)  DeBoer MD, Scharf RJ, Demmer RT. Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children. Pediatrics. 2013; 132(3): 413-20. 

  • Study of 10,700 children. Study used clarification of sugar sweetened beverages as soda pop or fruit drinks other than 100% juice (including Kool-Aid, Sunny Delight, Hi-C, Fruitopia, or Fruitworks).
    • Those consuming one or more sugar sweetened beverage daily were considered regular consumers.
  • It was determined that by the age of five, sugar sweetened beverage intake (beginning at age 2 years) was associated with obesity/overweight
  • Sugar sweetened beverage consumption may increase caloric intake by 17-20%
  • Milk intake decreased as sugar sweetened beverage intake increased
  • The American Academy of Pediatrics recommends restriction of sugar sweetened beverages in young children related to possible contribution to weight gain and dental caries


6)  Marshall TA, Levy SM, Broffitt B, Warren JJ, et al. Dental Caries and Beverage Consumption in Young Children. Pediatrics. 2003; 112(3): 184-191.

  • Sugared beverages identified as 100% juice, juice drinks, regular soda pop, regular beverages from powder and sports drinks.
  • It was found that regular soda pop and beverages from powder increased risk of dental caries more greatly than 100% juice and juice drinks.
    • This association may be an indicator that sucrose (the sweetener used in those beverages) increases risk of dental caries
    • Correlation may be influenced by tendency of juice/juice drinks to be served with meals
  • Authors encourage consumption of > 2 daily servings of dairy foods, limiting intake of 100% juice to 4-6 oz daily and restriction of all other sugar sweetened beverages.

7)  Gidding SS, Dennison BA, Birch LL, et.al. Dietary Recommendations for Children and Adolescents: A Guide for Practitioners. Pediatrics. 2006; 117(2):544-59.

  • Risk factors and lifestyle habits detrimental to heart health begin at a young age escalating at age 30-50.
  • Current nutritional recommendations continue to identify fruits, vegetables, whole grains, low fat dairy, beans, fish and lean meat as contributors to proper growth and development in addition to protecting against chronic diseases.
  • Calorie dense foods high in saturated and trans fats, cholesterol, added sugar and salt should be restricted to occasional use to fulfill discretionary calories needs only (additional calories needed to meet energy demands after all nutrient needs have been met)
  • Sugar consumption is increasing beginning in infancy/toddler years possibly related to the tendency of ‘kid’ food to be higher in fat and sugar.
  • Sweetened beverage exposure by age:
    • 9 to 11 months= 11%; Current recommendations discourage infant exposure to sweetened beverages
    • 12-14 months = 28%
    • 15-18 months = 37%
    • 19-24 months = 44%
  • Sweetened beverage intake is not to exceed 4 to 6 oz from age 1-6 years and should only be offered in cups (no bottles)
  • Sweetened beverage intake is not to exceed 8 to 12 oz from age 7-18 years. 
  • High sugar/fat snacks easily surpass calorie needs of children possibly by 10-20% in infants age 1-6 months and 20-35% in children age 1-4 years.
  • Parents encouraged to decrease snacks when children are less active or bored, and should avoid sweet beverages  including juice, soda and sports drinks
  • Parents need to take back their control of family meal and snack times and nutritional quality of their children's diet
    • Parents are to supply the food and beverages. Children are to decide if and how much they will eat.
    • Parents to refrain from ‘clean your plate’ mentality (associated with overeating and food dislikes)
    • Parents to refrain from 'forbidden' foods (associated with cravings and enahnced interest in those foods)
    • Parents are the best role models and should avoid hypocrisy in that any food okay to be eaten by mom and dad is okay to be eaten by the kids too
    • Parent's should be aware of age appropriate serving sizes and realize that children's intake fluctuate during growth spurts and activity level

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