Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents

Abstract

Background: Whereas increased carbohydrate and sugar consumption has been associated with higher cardiovascular disease risk among adults, little is known about the impact of high consumption of added sugars (caloric sweeteners) among US adolescents.

Methods and results: In a cross-sectional study of 2157 US adolescents in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, dietary data from one 24-hour recall were merged with added sugar content data from the US Department of Agriculture MyPyramid Equivalents databases. Measures of cardiovascular disease risk were estimated by added sugar consumption level (< 10%, 10 to < 15%, 15 to < 20%, 20 to < 25%, 25 to < 30%, and ≥ 30% of total energy). Multivariable means were weighted to be representative of US adolescents and variances adjusted for the complex sampling methods. Daily consumption of added sugars averaged 21.4% of total energy. Added sugars intake was inversely correlated with mean high-density lipoprotein cholesterol levels (mmol/L) which were 1.40 (95% confidence interval [CI] 1.36 to 1.44) among the lowest consumers and 1.28 (95% CI 1.23 to 1.33) among the highest (P trend = 0.001). Added sugars were positively correlated with low-density lipoproteins (P trend =0.01) and geometric mean triglycerides (P trend = 0.05). Among the lowest and highest consumers, respectively, low-density lipoproteins (mmol/L) were 2.24 (95% CI 2.12 to 2.37) and 2.44 (95% CI 2.34 to 2.53), and triglycerides (mmol/L) were 0.81 (95% CI 0.74, 0.88) and 0.89 (95% CI 0.83 to 0.96). Among those overweight/obese (≥ 85th percentile body-mass-index), added sugars were positively correlated with the homeostasis model assessment (P linear trend = 0.004).

Conclusion: Consumption of added sugars among US adolescents is positively associated with multiple measures known to increase cardiovascular disease risk.

Figure 1

Multivariable-adjusted mean triglyceride and high-density lipoprotein cholesterol (HDL) levels by intake of added sugars among US Adolescents. Participants grouped by percentage of total energy intake from added sugars; <10% comprises the referent group. P for linear trend=0.03 for triglyceride levels and <0.001 for HDL levels. Error bars indicate 95% confidence intervals. NHANES refers to National Health and Nutrition Examination Survey. To convert triglyceride values to mg/dL, multiple by 89. To convert HDL values to mg/dL, multiply by 39.

Figure 2

Intake of added sugars and adjusted mean homeostasis model assessment for insulin resistance (HOMA-IR) by weight status. Participants grouped by percentage of total energy intake from added sugars; <10% comprises the referent group. Among overweight/obese adolescents, p for linear trend=0.03; among normal weight adolescents, p for linear trend=0.85. Error bars indicate 95% confidence intervals. NHANES refers to National Health and Nutrition Examination Survey.