Consumption of Added Sugars and Indicators of Cardiovascular Disease Risk Among US Adolescents and Adults Open Access
Welsh, Jean Ann (2010)
Published
Abstract
The consumption of sugars added to foods and beverages are major
source of calories in
the US diet. Animal studies have demonstrated that high consumption
of sugars,
particularly fructose, can induce cardiovascular disease (CVD) but
their effect on human
health is less clear. Previous studies have shown an association
between high sugar
consumption and increased insulin resistance, dyslipidemia
(increased triglyceride levels
and decreased high-density lipoprotein [HDL] levels), and obesity.
Little is known
about recent trends in the consumption of added sugars or about
their effect on CVD risk
when consumed at current levels.
To better understand the role played by added sugars (caloric
sweeteners) in the
development of CVD, we implemented a series of studies using
national data to: 1)
determine if the intake of added sugars at usual levels is
associated with dyslipidemia
among US adults, 2) determine if the intake of added sugars among
US adolescents,
the highest consumers of added sugars, is associated with
dyslipidemia, insulin resistance,
obesity, or hypertension, and 3) assess trends in the intake of
added sugars to
determine if consumption has continued to increase in recent years.
In addition, we
completed an extensive review of the published and unpublished
literature to identify
strategies that have been effective in reducing the consumption of
sugar-sweetened
beverages (SSBs), the largest source of added sugars in the US
diet.
Through these studies, we found that intake of added sugars is
positively
associated with dyslipidemia in US adults and adolescents. In
addition, insulin resistance
is higher among overweight adolescents with greater intake of added
sugars. We also
found that the trends in consumption of added sugars, which had
increased substantially
over recent decades, decreased progressively from 1999-2000 to
2007-08. Our review of
previously literature indicates that little is in known about the
most effective strategies for
promoting a reduction in the consumption of sugar-sweetened
beverages. Further
research is needed to determine if reductions in the consumption in
added sugars can
decrease CVD risk, to determine the safe level of consumption of
added sugars, and to
identify the most effective public health strategies for further
reducing this consumption.
Table of Contents
TABLE OF CONTENTS
Chapters
1
INTRODUCTION.....................................................................................................
1
1.1 References
.........................................................................................................
5
2
BACKGROUND.....................................
..................................................................
7
2.1 The Role of Dietary Sweeteners
..............................................................................
7
2.2 Definition of Added Sugars
.....................................................................................
8
2.3 Determining Content of Added Sugars in Foods and Beverages
...................................... 9
2.4 Assessing Dietary
Intake.......................................................................................
10
2.5 Dietary Recommendations regarding Intake of Added
Sugars........................................ 12
2.6 Added Sugars and Cardiovascular Disease Risk
..........................................................14
2.7 Possible Biological Mechanisms
..............................................................................
15
2.8 Purpose of
Research............................................................................................
17
2.9
References........................................................................................................
19
3
METHODS...........................................................................................................
23
3.1
Sample.............................................................................................................
23
3.2 Exposure variable: Added Sugar Intake
..................................................................
25
3.3 Outcome variables: Indicators of CVD Risk
..............................................................
28
3.4 Statistic
Analysis................................................................................................
29
3.5
References........................................................................................................
33
4
Caloric Sweetener Consumption and Dyslipidemia among US
Adults ....................... 37
5
Consumption of Added Sugars and Indicators of
Cardiovascular Disease Risk
Among US
Adolescents...........................................................................................
69
6
Changing Trends in the Consumption of Added Sugars in
the US............................. 103
7
CDC Guide to Strategies for Reducing the Consumption of
Sugar-Sweetened
Beverages
...........................................................................................................
131
8
DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS
......................................... 178
Appendix A. Food Code Grouping for Foods with Added Sugars
...................................... 185
Appendix B. Summary of Intervention Studies with
Sugar-Sweetened Beverage
Consumption as the Outcome
...................................................................................
186
About this Dissertation
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