ATLANTA, GA — American adults consume on average about 15% of their calories from sugars added to foods during processing, with a whopping 37% of the added sugar consumed in sugar-sweetened beverages, suggests an analysis of data extending back about 25 years. Moreover, the study projects that regularly drinking as little as one 12-ounce sugary soda a day may increase the risk of cardiovascular disease by about 30%—independent of total calories, obesity, or other risk factors  .
“Our findings indicate that most US adults consume more added sugar than is recommended for a healthy diet,” write Dr Quanhe Yang (Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA) and colleagues in their report published online February 3, 2014 in JAMA Internal Medicine.
“Our results support current recommendations to limit the intake of calories from added sugars in US diets.”
Dr Kirsten Bibbins-Domingo (University of California, San Francisco), who was not involved in the study, commented to heart wire that the research suggests that clinicians need to counsel patients about the health harms from too much sugar.
“I think that we are just really recognizing that there are significant health consequences from eating excessive amounts of sugar that go beyond not wanting to be overweight, but go to wanting to make sure that our heart and our kidneys and our brains are healthy,” she said.
Sugar and CVD Death
Epidemiologic studies have linked high consumption of added sugar with an increased risk of type 2 diabetes, obesity, and hypertension, but most studies focused only on sugar-sweetened beverages, and none looked at the relationship between added sugar intake and CVD mortality in a national sample, the authors observe
There is disagreement about how much added sugar is acceptable in a healthy diet, they note. Added sugar should be less than 25% of total calories according to the Institute of Medicine, but less than 10% of total calories according to the World Health Organization. The American Heart Association has even stricter recommendations: less than 100 calories a day (about 5% of total daily calories) for women and 150 calories a day (about 7.5% of total daily calories) for men.
Yang et al analyzed data from three National Health and Nutrition Examination Survey (NHANES) surveys —1988–1994, 1999–2004, and 2005–2010 —and examined CVD mortality during a mean follow-up of 14.6 years.
During the three time periods, among US adults aged 20 and older, the adjusted mean daily calories from added sugar went from 15.7% to 16.8% to 14.9%.
More than 70% of the added sugar came from sugar-sweetened beverages (37.1%), grain-based desserts (13.7%), fruit drinks (8.9%), dairy desserts (6.1%), and candy (5.8%).
In 2005–2010, most adults (71.4%) consumed 10% or more of calories from added sugar, and about 10% consumed 25% or more calories from sugar.
Adjusted hazard ratio (95% CI) of CVD mortality* for different percentages of calories from added sugar
|Calories from added sugar (% of total)||p|
|0 to <10||10.0 to <25||> 25|
|1.00||1.30 (1.09– 1.55)||2.75 (1.40–5.42)||0.004|
*Adjusted for age, sex, race/ethnicity, education, smoking, alcohol consumption, physical activity, antihypertensive medication, family history of CVD, Healthy Eating Index score, body-mass index, systolic BP, total serum cholesterol, and total calories
Blacks were more likely than others to consume more than 25% of calories as added sugar, but there was also no significant link between sugar consumption and CVD mortality among blacks —possibly due to the small number of events in this subgroup, the researchers write.
“Yang et al inform this debate by showing that the risk of CVD mortality becomes elevated once added sugar intake surpasses 15% of daily calories—equivalent to drinking one 20-ounce Mountain Dew soda in a 2000-calorie daily diet,” Dr Laura A Schmidt (University of California, San Francisco) writes in an invited commentary  . The risk rises exponentially as sugar intake increases, peaking with a fourfold increased risk of CVD death for individuals who consume one-third or more of their daily calories in added sugar, she adds.
“Until federal guidelines are forthcoming, physicians may want to caution patients that, to support cardiovascular health, it is safest to consume less than 15% of their daily calories as added sugar,” she advises.