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Keywords:

  • Adolescent;
  • child;
  • dietary intake;
  • United States

Summary

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

What is already known about this subject

  • Despite recent declines in added sugars (from 1999–2000 to 2007–2008), consumption of added sugars and solid fats among United States children and adolescent from 1999–2000 to 2007–2008 exceeds recommended levels.

What this study adds

  • These results suggest that the decreases in solid fat and added sugars intakes among United States children and adolescents observed from 1999–2000 through 2007–2008 have levelled-off.
  • Decreases in solid fat and added sugars intakes have primarily been due to reductions in added sugar intakes.
  • Although the consumption of solid fats and added sugars among children and adolescents in the United States decreased between 1994–1998 and 2009–2010, mean intakes continue to exceed recommended limits by 18–28% of total energy intake.

Background

There are increasing global concerns about improving the dietary intakes of children and adolescents. In the United States (U.S.), the focus is on reducing energy from foods and beverages that provide empty calories from solid fats and added sugars (SoFAS).

Objective

We examine trends in intakes and sources of solid fat and added sugars among U.S. 2–18 year olds from 1994 to 2010.

Methods

Data from five nationally representative surveys, the Continuing Survey of Food Intakes by Individuals Surveys (1994–1996) and the What We Eat In America, National Health and Nutrition Examination Surveys (2003–2004, 2005–2006, 2007–2008 and 2009–2010) were used to examine key food sources and energy from solid fats and added sugars. Sample sizes ranged from 2594 to 8259 per survey period, for a total of 17 268 observations across the five surveys. Food files were linked over time to create comparable food groups and nutrient values. Differences were examined by age, race/ethnicity and family income.

Results

Daily intake of energy from SoFAS among U.S. 2–18 year olds decreased from 1994 to 2010, with declines primarily detected in the recent time periods. Solid fats accounted for a greater proportion of total energy intake than did added sugars.

Conclusions

Although the consumption of solid fats and added sugars among children and adolescents in the U.S. decreased between 1994–1998 and 2009–2010, mean intakes continue to exceed recommended limits.


Introduction

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

There are increasing global concerns about improving the dietary intakes of children and adolescents. The World Health Organization Global Strategy on Diet, Physical Activity and Health recommends limiting intakes of free (added) sugars, saturated fat and sodium, increasing consumption of fruits and vegetables, and legumes, whole grains and nuts, and eliminating trans-fatty acids [1]. In the United States (U.S.), diet quality has been linked with concern not only for paediatric overweight and obesity but also for increasing paediatric nutrition-related cardiometabolic problems [2-5]. Reducing excessive energy intake has thus become a major goal in the U.S., highlighted by the Dietary Guidelines for Americans [6]. While slightly different from global recommendations, the Dietary Guidelines for Americans emphasize the need to reduce energy from foods and beverages that provide empty calories from solid fats and added sugars (SoFAS). There is general agreement among nutrition scholars that unhealthy fats and added sugars are key sources of surplus energy intake and overall indicators of unhealthy dietary patterns [1, 7, 8].

Although the percent of daily calories consumed from added sugars has declined between 1999–2000 and 2007–2008 [9], scholars have shown that U.S. children and adolescents still consumed excessive added sugars in 2005–2008 [10]. Reported intakes of solid fats among U.S. children and adolescents in 2003–2004 also exceeded allowance levels [11], although analyses on trends in solid fat intakes over the previous decade do not exist. The present study incorporates the most recent nationally representative dietary intake data from 2009 to 2010 to expand our understanding of the trends in both solid fats and added sugars consumption among U.S. children and adolescents.

This study highlights 15-year trends in SoFAS consumption among U.S. children aged 2–18. Using five nationally representative surveys of food intake in the U.S., we report average daily intakes of solid fat and added sugars as well as the percentage of total energy intake from solid fat and added sugars, and examine differential trends among age, race/ethnic and income subpopulations.

Methods

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Data sources and samples

We used cross-sectional data on children and adolescents aged 2–18 years from five nationally representative surveys of food intake in the U.S.: the Continuing Survey of Food Intakes by Individuals Surveys (CSFII) 1994–1996 (CSFII 96, n = 8259) and the National Health and Nutrition Examination Surveys (NHANES) 2003–2004 (NHANES 04, n = 3435), 2005–2006 (NHANES 06, n = 3652), 2007–2008 (NHANES 08, n = 2594) and 2009–2010 (NHANES 10, n = 2763). Detailed information about the operation of each survey and its sampling design has been published elsewhere [12-16]. The results were weighted using the NHANES examination sample weights to provide nationally representative information on American's food and nutrient intakes at the time of the survey and to adjust for the complex sample design of NHANES.

Dietary intake

Data from two 24-h recalls were collected using the United States Department of Agriculture (USDA) Automated Multiple-Pass Method (AMPM) [17]. This five-step dietary interview process includes multiple passes through the 24 h of the previous day, during which respondents receive cues to help them remember and describe foods they consumed. The Day 1 interview was conducted in person in a Mobile Examination Center and was used for this study. For the CSFII 1994–1996 and 1998, the main meal planner/preparer within a household reported for children less than 12 years of age. For the What We Eat in America (WWEIA), NHANES 2003–2004, 2005–2006, 2007–2008 and 2009–2010, survey participants aged 12 years and older completed the dietary interview on their own. Proxy-assisted interviews were conducted with children aged 6–11 years, and proxy respondents reported for children younger than 5 years. Details of each dietary data collection method are published elsewhere [18-22].

Food composition information

Total energy intake

Dietary intake data from each survey period were linked to a food composition database developed by the USDA with nutrient values corresponding to the diets of individuals at the time of processing. For CSFII 1994–1998, data were used from the Survey Nutrient Database, which was maintained for use with nationwide food surveys. For WWEIA, NHANES 2003–2004, 2005–2006, 2007–2008 and 2009–2010, data were used from the USDA's Food and Nutrient Database for Dietary Studies (FNDDS), which is used to code, process and analyse the data assessed in the course of the WWEIA survey [23-27]. Each nutrient database was derived from the USDA Nutrient Data Base for Standard Reference (SR), versions 11, 18, 20 and 22 [28].

Energy from solid fats and added sugars

We used the USDA's MyPyramid Equivalents Database (MPED) to examine consumption of energy from solid fat and added sugars. Multi-ingredient foods are disaggregated into their basic ingredients and the solid fat and added sugars present in each ingredient are classified. MPED values for grams of solid fat and teaspoons of added sugars were converted based on 9 kcal/g and 16 kcal/tsp, respectively. MPED version 1.0 was used for CSFII 1994–1998, MPED version 2.0 was used for WWEIA, NHANES 2003–2004 and MPED version 2.0 addendum was used for WWEIA, NHANES 2005–2006, 2007–2008 and 2009–2010 [29-31].

Food and beverage groupings

The food grouping system used for this study originated with the nine USDA food groupings and then groupings were systematically disaggregated based on nutrient composition, critical dietary behaviours and similarities in consumption patterns (e.g. ready-to-eat cereals and savoury snacks). In addition, select popular foods (e.g. pizza and hamburgers/cheeseburgers) were classified as their own group. A total of 41 mutually exclusive food groups and 12 beverage groups were created. Eight-digit food/beverage codes assigned by the USDA to each item were linked to a designated food group to ensure that foods and beverages were consistently placed in the same group across the six time periods used in this study. Table 1 provides a complete list of food and beverage groups.

Table 1. List of food and beverage groupings
Dairy products, excluding milk and milk drinks and dairy-based desserts

Cheese

Yogurt products

Other dairy products

Meat, poultry, fish and mixtures

Meat

Meat dishes with starch and/or vegetable

All kinds of poultry

Poultry dishes with starch and/or vegetable

Processed meats

Processed meat dishes with starch and/or vegetable

Fish and shellfish

Fish and shellfish (including processed) dishes with starch and/or vegetable

Other protein-rich sources

Meat substitutes

Eggs and egg dishes

Legumes and legume dishes

Nuts, nut butters, seeds and coconut

Grain products, excluding desserts

Yeast breads and rolls, mostly unsweetened

Quick breads

Ready-to-eat cereals

Fruits and vegetables

Fruit, fresh, frozen, canned or dried

Vegetables, fresh, frozen or processed

Non-starchy vegetable dishes

Starchy vegetables and starchy vegetable dishes

Fried potatoes

Fats, oils, sauces and salad dressings

Vegetable oils and animal fats

Salad dressings

Sauces and condiments

Sweets and snacks

Grain desserts

Cereal, protein, granola and other bars

Sweet snacks and candies

Dairy-based desserts

Sugar, syrups, preserves

Salty snacks from grain or starchy vegetable

Dips

Other

Soups and stews

Frozen and shelf-stable meals

Baby food, infant food, formula

Seasonings and core products

Mixtures, mostly grain

Sandwiches and filled rolls

Burgers

Tortilla and corn-based dishes

Pasta and noodle dishes

Rice and other grains; rice and other grain dishes

Pizza

Beverages

Water, plain or flavoured

Coffee/tea

Sugar-sweetened beverage

Fruit juice

Vegetable juice

Fluid milk

Soy/yogurt/milk-based beverages

Meal replacement beverages

Sports drinks

Energy drinks

Beer

Wine

Liquor

Mixed alcoholic beverages

Other beverages

With advances in dietary data collection and coding methods, the flexibility and specificity of intake data have improved over time. During the collection and coding of dietary recall data, individual food codes may be linked together using ‘combination’ codes, which allow combining the nutritional information of individual foods that are consumed together at an eating occasion. For example, sugar in coffee or food mixtures, such as a home-made burrito, which is reported as separate ingredients (i.e. beans, cheese, lettuce and salsa), can be combined into single food items. It is important to note that not all aggregated foods are captured by this coding scheme. In order to describe consumption trends in comparable food and beverage groupings over time, select combination codes relevant to the current research question (specifically, beverages, corn and tortilla products, soups, and ice cream with additions) were incorporated. For each of these examples, the nutrient content of every individual item was summed into one combined food or beverage.

Statistical analysis

Dietary recalls (day 1 only) for all 2–18 year olds with data on dietary intake variables of interest were included in this analysis. Appropriate weighing factors were applied to adjust for differential probabilities of selection and various sources of non-response [32]. Mean intakes of total energy, solid fat and added sugars from each food category were estimated as the contribution of solid fat and added sugars to total energy intakes. Trends are presented as calories per capita per day. Differences were examined by age (2–5, 6–11 and 12–18 years), race/ethnicity (non-Hispanic white, non-Hispanic black and Mexican–American) and family income (<130% of poverty income ratio, 130–350% of poverty income ratio, ≥350% of poverty income ratio). To test for statistical differences between years, we used independent two-sample t-tests. Differences were considered statistically significant at the P < 0.05 level with Bonferroni correction [33]. Data analyses were conducted using Stata (version 11.0, 2009, StataCorp, College Station, TX, USA).

Results

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Socio-demographic characteristics of the analytic sample are reported in Table 2. There were minor differences in the distributions of race/ethnicity and income over the surveys, the greatest of which is an 8% decrease in the proportion of non-Hispanic whites and 8% increases in both the proportion of Mexican–Americans and children from lower-income households between 1989–1991 and 2009–2010.

Table 2. Percentages of the U.S. population age 2–18 by socio-demographic characteristics from National Nutrition Surveys, 1989–2010*
 Continuing Survey of Food Intakes by Individuals and 1994–1996 Diet and Health Knowledge Survey (CSFII) 1994–1998 (n = 8259)What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2003–2004 (n = 3435)What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2005–2006 (n = 3652)What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2007–2008 (n = 2594)What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2009–2010 (n = 2763)
  1. *Weighted percentages have been adjusted to be nationally representative.

  2. †Analyses are limited to Mexican–Americans because of sampling constraints in WWEIA.

Age group     
2–5 years0.240.220.220.230.23
6–11 years0.360.350.340.340.34
12–18 years0.400.430.430.420.42
% Female0.490.490.490.500.50
Income as a % of poverty     
≤130%0.240.330.270.320.33
131–185%0.130.110.100.100.12
>185%0.620.560.630.580.55
Race-ethnic status     
% non-Hispanic white0.700.650.630.640.62
% non-Hispanic black0.170.160.150.160.14
Mexican–Americans0.070.130.140.140.15
Other0.050.060.080.060.08

Total energy intake

The average daily intake of energy among all U.S. 2–18 year olds declined from 2003 to 2010, decreasing from 2115 cal/d in 2003–2004 to 1914 cal/d in 2009–2010 (P < 0.05) (Table 3). In contrast, over the same time period, average daily energy intakes among 12–18 year olds, non-Hispanic blacks and children from middle-income households did not decrease significantly.

Table 3. Mean intakes of energy from solid fats and added sugars among children and adolescents in the United States (2–18 years), by age, race/ethnicity and family income from 1994 to 2010*
 CSFII 1994–1998 (n = 8259)WWEIA, NHANES 2003–2004 (n = 3435)WWEIA, NHANES 2005–2006 (n = 3652)WWEIA, NHANES 2007–2008 (n = 2594)WWEIA, NHANES 2009–2010 (n = 2763)
  1. *Data sources: Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 7758), What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3272), WWEIA, NHANES 2005–2006 (n = 3432), WWEIA, NHANES 2007–2008 (n = 2450), WWEIA, NHANES 2009–2010 (n = 2763).

  2. 1 – Significantly different from 1994–98 at P < 0.05.

  3. 2 – Significantly different from 2003–04 at P < 0.05.

  4. 3 – Significantly different from 2005–06 at P < 0.05.

  5. 4 – Significantly different from 2007–08 at P < 0.05.

  6. SE, standard error; SoFAS, solid fats and added sugars; PIR, poverty income ratio.

All     
Total energy, mean kcal ± SE2016 ± 262115 ± 222035 ± 331906 ± 26 (1–3)1914 ± 27 (2)
% energy from SoFAS39%37%36% (1)35% (1,2)33% (1–3)
% energy from solid fat21%20%20%20% (1)19% (1,3)
% energy from added sugar18%17%16% (1)15% (1,2)14% (1–3)
2–5 years     
Total energy, mean kcal ± SE1587 ± 131721 ± 25 (1)1566 ± 23 (2)1510 ± 25 (2)1543 ± 26 (2)
% energy from SoFAS36%35%33% (1)33% (1,2)32% (1,2)
% energy from solid fat21%21%19% (1)20% (2)20%
% energy from added sugar15%14%14% (1)13% (1)12% (1–3)
6–11 years     
Total energy, mean kcal ± SE1934 ± 222120 ± 49 (1)1981 ± 371931 ± 27(2)1865 ± 20 (2)
% energy from SoFAS39%38%37% (1)36% (1)33% (1–4)
% energy from solid fat21%20%21%20% (1)19% (1,3)
% energy from added sugar18%17%16% (1)16% (1)14% (1,2,4)
12–18 years     
Total energy, mean kcal ± SE2352 ± 492317 ± 482315 ± 512106 ± 44 (1–3)2157 ± 58
% energy from SoFAS40%38% (1)37% (1)35% (1)34% (1–3)
% energy from solid fat20%19% (1)20%19%18% (1)
% energy from added sugar19%19%17% (1)16% (1)15% (1,2)
Male     
Total energy, mean kcal ± SE2242 ± 342295 ± 422258 ± 502065 ± 36 (1,2)2066 ± 39 (2)
% energy from SoFAS39%37%37%35% (1,2)33% (1–4)
% energy from solid fat21%20%20%19% (1,3)19% (1–3)
% energy from added sugar18%18%16%16% (1,2)14% (1–3)
Female     
Total energy, mean kcal ± SE1777 ± 261924 ± 26 (1)1798 ± 21 (2)1747 ± 33 (2)1761 ± 28 (2)
% energy from SoFAS38%37%36% (2)35% (1,2)33% (1,2)
% energy from solid fat20%20%20%20%19% (2)
% energy from added sugar18%17%16% (1)15% (1,2)14% (1,2)
Non-Hispanic white     
Total energy, mean kcal ± SE2059 ± 322133 ± 322101 ± 411956 ± 41 (2)1921 ± 36 (1–3)
% energy from SoFAS39%38%37% (1)36% (1)34% (1–4)
% energy from solid fat21%20%20%20%19% (1,2)
% energy from added sugar18%18%16% (1)16% (1)15% (1,2)
Non-Hispanic black     
Total energy, mean kcal ± SE1975 ± 412093 ± 481941 ± 401847 ± 44 (2)1937 ± 57
% energy from SoFAS40%37%36% (1)35% (1,2)33% (1–3)
% energy from solid fat22%20% (1)20% (1)19% (1)19% (1,3)
% energy from added sugar17%17%16%15% (1,2)14% (1,2)
Mexican–Americans     
Total energy, mean kcal ± SE1846 ± 752131 ± 45 (1)1930 ± 33 (2)1810 ± 39 (2)1849 ± 40 (2)
% energy from SoFAS36%36%33% (1)33% (1,2)31% (1,2)
% energy from solid fat20%20%19%19%18% (1)
% energy from added sugar16%16%14%14% (1,2)13% (1,2)
≤130% PIR     
Total energy, mean kcal ± SE1976 ± 392154 ± 611928 ± 46 (2)1924 ± 42 (2)1905 ± 36 (2)
% energy from SoFAS38%37%35% (1)35% (1)33% (1–3)
% energy from solid fat22%20%20% (1)19% (1)19% (1)
% energy from added sugar16%17%15%16%14% (1,2)
131–185% PIR     
Total energy, mean kcal ± SE1938 ± 472000 ± 972047 ± 1221931 ± 751819 ± 73
% energy from SoFAS40%37%36% (1)35% (1)35% (1)
% energy from solid fat22%20%20%20%19% (1)
% energy from added sugar18%17%15%15% (1)16%
>185% PIR     
Total energy, mean kcal ± SE2049 ± 342108 ± 302087 ± 421882 ± 46 (1–3)1916 ± 42 (2,3)
% energy from SoFAS38%37%37% (1)35% (1)33% (1–4)
% energy from solid fat20%20%20%20%19% (1,3)
% energy from added sugar18%18%16% (1)15% (1,2)14% (1–3)

Total solid fats and added sugars (SoFAS)

The intake of SoFAS as a percentage of total energy intake among U.S. children aged 2–18 years declined from 1994 to 2010, decreasing from 39% in 1994–1998 to 33% in 2009–2010 (P < 0.05) (Table 3). The average daily intake of energy from SoFAS among U.S. 2–18 year olds also declined over the same time period, decreasing from 797 cal/d in 1994–1998 to 646 cal/d in 2009–2010 (P < 0.05) (Appendix 1).

For most age, sex, race/ethnic and income groups, intakes of SoFAS remained stable from 1994 to 2006 and were significantly lower only in the 2007–2008 and 2009–2010 time periods. Among select age (2–5 years), sex (female), race/ethnic (Mexican–Americans) and income (low income) groups, the decrease in SoFAS intake began earlier such that SoFAS were significantly lower in the 2005–2006 period as compared with the 1994–2004 period. The only decrease in daily intake of SoFAS from 2007–2008 to the most recent period (2009–2010) was among 6–11 year olds and males.

Solid fats

Among all age, sex, race/ethnic and income groups, solid fats accounted for a greater proportion of total energy intake than did added sugars (Table 3). The intake of solid fat as a percentage of total energy intake among U.S. children aged 2–18 declined slightly from 21% in 1994–1998 to 19% in 2009–2010 (P < 0.05) (Table 3); however, among 2–5 year olds, no change was observed.

The average daily intake of energy from solid fats among U.S. 2–18 year olds declined from 1994–2010, decreasing from 426 cal/d in 1994–1998 to 368 cal/d in 2009–2010 (Appendix 1). For most age, race and income groups, intakes of solid fats were significantly lower in the 2007–2010 period as compared with the 1994–2006 period. Among selected age (2–5 and 12–18 years) and race/ethnic (Mexican–Americans) groups, the decrease in solid fat intake began earlier such that SoFAS were significantly lower in the 2005–2006 period as compared with the previous period. The only decrease in solid fat intake from 2007–2008 to the most recent period (2009–2010) was among 6–11 year olds. Little change in solid fat intake was observed among females, with only the difference being lower reported solid fat intakes in 2009–2010 as compared with 2003–2004.

The main sources of solid fat intake (food groups with the highest mean intakes at each survey period) among U.S. children aged 2–18 were milk (including whole and reduced-fat versions), grain-based desserts, pizza, cheese, processed meats and fried potatoes (Fig. 1a and Appendix 2). These sources varied by income and race/ethnic subgroups (Appendices 3–5). Additional major contributors included dairy-based desserts among non-Hispanic whites, children from middle- and higher-income households and 6–11 year olds, tortilla- and corn-based dishes among Mexican–Americans, children from low-income households and 6–11 and 12–18 year olds, and pasta dishes among 2–5 year olds and children from middle-income households.

figure

Figure 1. Major sources of (a) solid fats and (b) added sugars among children and adolescents in the United States (2–18 years) from 1994 to 2010. Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 8,259); What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3435); WWEIA, NHANES 2005–2006 (n = 3652); WWEIA, NHANES 2007–2008 (n = 2594); WWEIA, NHANES 2009–2010 (n = 2763).

Download figure to PowerPoint

Added sugars

The intake of added sugars as a percentage of total energy intake among U.S. children aged 2–18 declined considerably from 18% in 1994–1998 to 14% in 2009–2010 (P < 0.05) (Table 3). The average daily intake of energy from added sugars among U.S. 2–18 year olds also declined from 1994–2010, decreasing from 371 cal/d in 1994–1998 to 278 cal/d in 2009–2010 (Appendix 1). For most age, race/ethnic and income groups, intakes of added sugars were significantly lower in the 2005–2008 period as compared with the 1994–2004 period. The only decrease in added sugars from 2007–2008 to the most recent period (2009–2010) was among 6–11 year olds.

The main sources of added sugar intake (food groups with the highest mean intakes at each survey period) among U.S. children aged 2–18 were sugar-sweetened beverages (SSB), grain-based desserts, candy and other sweet snacks, ready-to-eat cereals, dairy-based desserts, and sweeteners and syrups (Fig. 1b and Appendix 2). In general, these sources were consistent across all income and race/ethnic subgroups. The few exceptions included flavoured/sweetened milk among children from low-income families, Mexican–Americans and 2- to 5- and 6- to 11-year-old children, as well as flavoured/sweetened coffees and teas among children from middle-income families and 12–18 year olds (Appendices 3–5).

Discussion

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Increasing global concerns regarding child and adolescent diets have resulted in recommendations to limit intakes of free (added) sugars and saturated fat [1]. The US Dietary Guidelines for Americans reflect these recommendations using solid fat in lieu of saturated fat. The 2010 guidelines recommend that total SoFAS intake be limited to 5–15% of the total energy intake depending on energy needs [6]. Despite recent declines in the percentage of total daily energy intake from SoFAS (from 39% in 1994–1998 to 33% in 2009–2010), intakes among U.S. children and adolescents still far exceed recommended levels. Of particular importance, among 2–5 year olds, the percent of energy intake from solid fats did not decrease over the 15-year period.

To the authors' knowledge, this is the first report of trends in solid fat intakes among U.S. children and adolescents. Intakes of solid fats only slightly decreased from 1994 to 2010 and accounted for a greater proportion of total energy intake than did added sugars at all time points. The observed decreases in added sugar intakes are supported by similar findings from Welsh and colleagues of decreases in added sugar consumption in the U.S. between 1999–2000 and 2007–2008 among all U.S. children and adults (≥2 years). The current study expands our understanding of added sugars, demonstrating that intakes have not decreased in the most recent time period (from 2007–2008 to 2009–2010). Taken together, these results suggest that the decreases in SoFAS intakes observed through 2007–2008 have levelled-off and that decreases have primarily been due to reductions in added sugar intakes.

The main sources of SoFAS intakes over the 16-year period were SSBs, grain-based desserts, candy, ready-to-eat cereals, dairy-based desserts, milk, pizza, cheese, processed meats and fried potatoes. Other investigators have examined key food and beverage sources of SoFAS in the U.S. diet. Bachman and colleagues assessed the key sources of SoFAS among all persons aged 2 years and older using data from NHANES 2001–2002 [34]; and Reedy and Krebs-Smith examined the key sources of solid fats and added sugars among children and adolescents using data from NHANES 2003–2004 [11]. Although the food groupings were slightly different, our analysis identified similar sources of SoFAS among U.S. children and adolescents from 1994 to 2010.

More research is needed to understand why the observed declines in SoFAS intake among U.S. children and adolescents may be occurring. Increased public dialogue over the course of the time periods under study heightened awareness of childhood obesity and healthy eating across the U.S. Numerous initiatives focused attention on limiting the consumption of foods and beverages high in unhealthy fats and added sugars. Several efforts sought to improve the dietary quality of school feeding programmes and to remove food and beverage sources of SoFAS from U.S. child care settings, school cafeterias and school vending machines [35]. There were also increases in U.S. state-level taxes on snack foods, soda and other sweetened beverages during the time periods under study [36]. Finally, the role of private sector efforts to reformulate food and beverage products [37, 38] has not yet been seriously evaluated; however, a recent case study of the two largest and most influential sweetened beverage producers suggest a shift towards water and reduced calorie beverage purchases [39].

Whether the observed declines in SoFAS intake among U.S. children and adolescents reflect a true downward trend (due to heightened awareness of paediatric overweight and initiatives to improve diet) or recent economic shifts (including increases in global food prices and the Great Recession) cannot be inferred from this study. In ongoing but as yet unpublished research, our team is examining sales and purchases of consumer packaged-goods foods and beverages from 2000 to 2011. Unreported results suggest that declines in purchases of important sources of SoFAS in the U.S. began prior to the Great Recession of 2007–2010 [40].

While the current analysis captures the past 15 years, it misses the major shifts that occurred in American diets prior to 1994. Previous work from our research group with earlier dietary data showed that national consumption rates of caloric sweeteners increased from 13% of total energy in 1977–1978 to 16% of total energy in 1994–1996 [41] and again to 18% by 1999–2000 [42]. Combined with findings from Welsh and colleagues, national added sugars consumption subsequently decreased to a low of 14% of total energy in 2009–2010. These data demonstrate that the consumption of added sugars peaked in the early part of the decade, declined steadily through 2007–2008 and has remained relatively stable from 2007–2008 through 2009–2010. Previous literature also documents increases in total energy intakes, portion sizes and snacking from the 1970s to the 1990s among U.S. children and adolescents, as well as increases in energy intake from specific sources such as pizza and SSBs [43-45].

Recent research from Brazil reveals even greater SoFAS intakes among Brazilian adolescents (saturated and trans fats were assessed as a proxy for solid fats) [46]. Using a nationally representative survey and methods comparable to those used in this study, Pereira and colleagues observed that 54% of total energy intake reported by Brazilian adolescents was from SoFAS. Meats were the main contributor of saturated and trans fats, and beverages were the main contributor of added sugar in the Brazilian adolescent population. Studies on SoFAS intakes from other countries could not be found; although, there is an extensive literature demonstrating increases in added sugar and sugar-sweetened beverage intakes across the globe [39, 47-50].

The current results, while highlighting a recent decline in added sugar intake among U.S. children, show that the average U.S. child still consumes approximately 268 kcal/d of added sugar, with SSB's being the primary source. Evidence suggests that SSB consumption is associated with risk of diabetes [51]. Reduced consumption of SSBs has been shown to be associated with reduced weight gain and fat accumulation in normal weight children [52], and reduced BMI gain in overweight and obese children [53].

There is less literature and understanding of the role of excessive solid or saturated fat intake during childhood. The long-term STRIP study compared children fed low-fat and high-fat milk from 6 months of age onwards and found increased risk of many cardiometabolic problems linked with the high-fat milk [54, 55]. We can assume that saturated fat in any food source would have a comparable effect.

Several cautions are noted to aid in the interpretation of our findings. The definition of added sugars in the MPED database does not include fruit juice concentrate as an added sweetener. We have previously shown that 7% of food and beverage products purchased by U.S. households in 2005–2009 contained fruit juice concentrate [56]. Consequently, estimates of added sugar intakes based on the MPED definition are likely an underestimate of the true intake of added sugars. Because respondents are different from one set of survey years to another, identification of trends can be inferred but not confirmed.

Dietary intake assessment methods and food composition information have improved significantly over time. Although data presented are based on the first day 24-h recall from all surveys, the recall methodology was modified to include the USDA's AMPM in WWEIA-NHANES surveys. While validation studies of the AMPM have not been conducted in children, validation studies in adults have shown the AMPM improved completeness of the recall [17]. As such, it is possible that the observed increases in SoFAS intake from 1994–2004 are an artefact of the more complete capture of the data.

Despite improvements in dietary assessment methods, research suggests that collecting reliable and accurate dietary data from children and adolescents remains difficult [57, 58]. Under-reporting of intake has been associated with factors such as age, race/ethnicity and body weight status [57-61], and under-reporting appears to be greatest among unhealthy foods or foods perceived to be related to obesity [61-63]. While we note that available dietary intake methods are considered to be capable of providing unbiased estimates of energy intake at the population level, it remains possible that with heightened awareness of peadiatric overweight and obesity, the observed decreases are a result of the population's differential under-reporting of dietary intakes of SoFAS that may be perceived negatively. This may especially be a concern among the younger age groups where intake data are collected by proxy report (2–5 year olds) or through proxy-assisted interviews (6–11 year olds). It is also possible that those providing proxy reports unintentionally under-report because they do not observe meals and snacks consumed outside home (e.g. in child care settings). Participation in organized child care, day care centres, nurseries and pre-schools have increased slightly from 41% of pre-school-aged children in 1999 to 43% of pre-school aged children in 2010 [64, 65]. We have no reason to believe that this increase would result in sufficient changes in unintentional under-reporting to explain the observed decreases in SoFAS intakes among young children. Furthermore, while methods for critically examining misreporting of nutrient intake data have been advocated [63, 66], these methods were developed for adults. Because of the complexities related to development and growth, there is not yet a standard approach to examine misreporting in children and adolescents although research in this area is growing [67, 68]. Finally, we acknowledge that the methods used in this analysis to estimate the mean of the population distribution of usual dietary intakes from 24-h recalls assume lack of bias in reporting.

Conclusions

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Although the consumption of solid fats and added sugars among children and adolescents in the United States decreased between 1994–1998 and 2009–2010, mean intakes continue to exceed recommended limits by 18–28% of total energy intake.

Acknowledgements

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

We thank the Robert Wood Johnson Foundation (Grant 67506) and the National Institutes of Health (R01 HL104580 and CPC 5 R24 HD050924) for financial support. We also wish to thank Dr. Phil Bardsley for exceptional assistance with the data management and programming and Ms. Frances L. Dancy for administrative assistance.

References

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5
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Appendix 1

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Mean intakes of energy from solid fats and added sugars among children and adolescents in the United States (2–18 years), by age, race/ethnicity and family income from 1994 to 2010.*

 CSFII 1994–1998 (n = 8259)WWEIA, NHANES 2003–2004 (n = 3435)WWEIA, NHANES 2005–2006 (n = 3652)WWEIA, NHANES 2007–2008 (n = 2594)WWEIA, NHANES 2009–2010 (n = 2763)
 Mean kcal ± SEMean kcal ± SEMean kcal ± SEMean kcal ± SEMean kcal ± SE
  1. *Data sources: Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 7758), What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3272), WWEIA, NHANES 2005–2006 (n = 3432), WWEIA, NHANES 2007–2008 (n = 2450), WWEIA, NHANES 2009–2010 (n = 2763).

  2. 1 – Significantly different from 1994–98 at P < 0.05.

  3. 2 – Significantly different from 2003–04 at P < 0.05.

  4. 3 – Significantly different from 2005–06 at P < 0.05.

  5. 4 – Significantly different from 2007–08 at P < 0.05.

Total energy from SoFAS     
All797 ± 12793 ± 11751 ± 16677 ± 12 (1–3)646 ± 10 (1–3)
2–5 years582 ± 9614 ± 16527 ± 12 (1,2)503 ± 10 (1,2)499 ± 13 (1,2)
6–11 years766 ± 11809 ± 26737 ± 18707 ± 17 (1,2)630 ± 8 (1–4)
12–18 years956 ± 24874 ± 17 (1)876 ± 27749 ± 23 (1–3)740 ± 18 (1–3)
Male891 ± 17866 ± 16847 ± 23733 ± 19 (1,2)694 ± 14 (1–4)
Female698 ± 15716 ± 15650 ± 12 (2)621 ± 15 (1,2)598 ± 13 (1,2)
Non-Hispanic white826 ± 16811 ± 19789 ± 19 (2)713 ± 16 (1–3)665 ± 13 (1–3)
Non-Hispanic black789 ± 18794 ± 18720 ± 22653 ± 17 (1,2)660 ± 23 (1,2)
Mexican–Americans675 ± 28774 ± 26650 ± 19599 ± 12 (2)589 ± 21 (2)
≤ 130% PIR772 ± 24801 ± 22694 ± 25 (2)698 ± 21 (2)641 ± 12 (1,2)
131–185% PIR785 ± 27753 ± 45772 ± 77685 ± 36660 ± 52
>185% PIR810 ± 16796 ± 17776 ± 17669 ± 21 (1–3)641 ± 17 (1–3)
Total energy from solid fats     
All426 ± 7427 ± 6421 ± 8383 ± 9 (1–3)368 ± 7 (1–3)
2–5 years339 ± 5366 ± 13310 ± 8 (1,2)312 ± 9 (2)313 ± 11 (2)
6–11 years411 ± 7434 ± 16422 ± 11395 ± 10359 ± 6 (1–4)
12–18 years492 ± 13454 ± 10477 ± 13 (2)413 ± 18 (1,3)406 ± 18 (1)
Male480 ± 11459 ± 9473 ± 13410 ± 12 (1,3)394 ± 11 (1–3)
Female369 ± 8394 ± 9367 ± 7356 ± 13342 ± 7 (2)
Non-Hispanic white433 ± 9435 ± 10440 ± 10397 ± 12374 ± 8 (1–3)
Non-Hispanic black442 ± 14427 ± 10407 ± 11369 ± 11 (1,2)375 ± 16 (1)
Mexican–Americans378 ± 19423 ± 10374 ± 12 (2)352 ± 10 (2)344 ± 11 (2)
≤ 130% PIR440 ± 17440 ± 14391 ± 14383 ± 11 (2)370 ± 8 (1,2)
131–185% PIR434 ± 17420 ± 36425 ± 27407 ± 32356 ± 23
>185% PIR418 ± 8420 ± 10435 ± 10379 ± 16 (3)363 ± 11 (1–3)
Total energy from added sugars     
All371 ± 7366 ± 9330 ± 10 (1)294 ± 6 (1,2)278 ± 7 (1–3)
2–5 years243 ± 5249 ± 8217 ± 6 (1,2)192 ± 6 (1–3)186 ± 5 (1–3)
6–11 years355 ± 6375 ± 18315 ± 11 (1)313 ± 9 (1,2)271 ± 4 (1–4)
12–18 years465 ± 14421 ± 11399 ± 17 (1)336 ± 15 (1,2)334 ± 13 (1–3)
Male411 ± 9408 ± 14374 ± 14323 ± 10 (1,2)300 ± 9 (1–3)
Female329 ± 9322 ± 10283 ± 8 (1)265 ± 6 (1,2)256 ± 10 (1,2)
Non-Hispanic white394 ± 10376 ± 14349 ± 12315 ± 9 (1,2)291 ± 11 (1–3)
Non-Hispanic black347 ± 9368 ± 11313 ± 14 (2)284 ± 8 (1,2)285 ± 11 (1,2)
Mexican–Americans298 ± 14351 ± 19276 ± 11 (2)247 ± 12 (2)245 ± 11 (1,2)
≤ 130% PIR332 ± 11360 ± 11303 ± 13 (2)316 ± 14271 ± 7 (1,2)
131–185% PIR351 ± 16333 ± 17347 ± 52278 ± 17 (1)303 ± 30
>185% PIR391 ± 9376 ± 12341 ± 10 (1)290 ± 9 (1–3)278 ± 12 (1–3)

Appendix 2

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Major sources of solid fats and added sugars among children and adolescents in the United States (2–18 years) from 1994 to 2008.*

 #1 Source%Mean ± SE (kcal)#2 Source%Mean ± SE (kcal)#3 Source%Mean ± SE (kcal)#4 Source%Mean ± SE (kcal)#5 Source%Mean ± SE (kcal)
  1. *Data sources: Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 7758), What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3272), WWEIA, NHANES 2005–2006 (n = 3432), WWEIA, NHANES 2007–2008 (n = 2450), WWEIA, NHANES 2009–2010 (n = 2763).

  2. †Percent of total daily energy.

Solid fats               
1994–1998Milk3.361 ± 1.7Grain desserts2.247 ± 2Processed meats1.734 ± 2.3Cheese1.428 ± 1.5Fried Potatoes1.224 ± 1.2
2003–2004Milk2.960 ± 2.9Pizza2.151 ± 3.7Grain desserts1.942 ± 2.2Cheese1.634 ± 3.2Processed meats1.427 ± 2.4
2005–2006Milk2.650 ± 2.1Pizza2.148 ± 3.1Grain desserts2.143 ± 2.2Cheese1.531 ± 2Processed meats1.327 ± 2.3
2007–2008Milk2.647 ± 2.6Grain desserts2.038 ± 2Pizza1.331 ± 2.7Cheese1.530 ± 2.6Processed meats1.427 ± 2.4
2009–2010Milk2.544 ± 1.8Grain desserts2.142 ± 1.4Cheese1.528 ± 1.2Pizza1.326 ± 3.5Processed meats1.325 ± 2.1
Added sugars               
1994–1998SSB7.5158 ± 4.7Grain desserts2.145 ± 1.8Sweet snacks & candies1.940 ± 1.5RTE cereals1.325 ± 1Sweeteners and syrups1.124 ± 1.6
2003–2004SSB8.1173 ± 7.2Grain desserts1.840 ± 2.1Sweet snacks & candies1.635 ± 2.7RTE cereals1.124 ± 1.4Dairy desserts1.020 ± 1.9
2005–2006SSB6.4136 ± 8.8Grain desserts2.042 ± 2.4Sweet snacks & candies1.734 ± 2.8Dairy desserts1.123 ± 2.1RTE cereals1.020 ± 1
2007–2008SSB5.7111 ± 6.6Sweet snacks & candies2.040 ± 3.3Grain desserts1.937 ± 2.3Dairy desserts0.817 ± 1.7RTE cereals1.017 ± 0.9
2009–2010SSB4.999 ± 7Grain desserts1.836 ± 1.5Sweet snacks & candies1.632 ± 2.5RTE cereals0.917 ± 1.2Dairy desserts0.816 ± 1.1

Appendix 3

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Mean intake and major sources of SOFAS, solid fats and added sugars among children and adolescents in the United States (2–18 years) from 1994 to 2010, by SES.*

 #1 Source%Mean ± SE (kcal)#2 Source%Mean ± SE (kcal)#3 Source%Mean ± SE (kcal)#4 Source%Mean ± SE (kcal)#5 Source%Mean ± SE (kcal)
  1. *Data sources: Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 7758), What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3272), WWEIA, NHANES 2005–2006 (n = 3432), WWEIA, NHANES 2007–2008 (n = 2450), WWEIA, NHANES 2009–2010 (n = 2763).

  2. †Percent of total daily energy.

Solid fats               
Low SES (≤130% of poverty income ratio)           
1994–1998Milk4.072 ± 4.2Processed meats2.348 ± 6.6Grain desserts1.737 ± 2.5Fried Potatoes1.327 ± 2.3Pizza1.124 ± 3.9
2003–2004Milk3.877 ± 5.2Pizza1.745 ± 6.8Grain desserts1.942 ± 2.8Processed meats1.734 ± 4.3Cheese1.430 ± 3.7
2005–2006Milk3.153 ± 3Pizza1.940 ± 4.1Grain desserts1.937 ± 2.4Processed meats1.327 ± 3.1Tortilla & corn dishes1.225 ± 2.6
2007–2008Milk2.851 ± 4Grain desserts2.041 ± 4.2Cheese1.430 ± 3.8Processed meats1.529 ± 4.1Tortilla & corn dishes1.224 ± 3.3
2009–2010Milk3.154 ± 2.5Grain desserts2.042 ± 2.2Tortilla & corn dishes1.430 ± 6.4Processed meats1.427 ± 3.4Pizza1.325 ± 3.9
Mid SES (131%-185% of poverty income ratio)           
1994–1998Milk3.461 ± 3.8Grain desserts2.345 ± 4.8Processed meats1.936 ± 3.2Cheese1.432 ± 5.6Fried Potatoes1.223 ± 3.6
2003–2004Milk3.059 ± 6.6Pizza2.755 ± 14.2Cheese1.942 ± 17.8Grain desserts1.738 ± 4Fried Potatoes1.635 ± 10.5
2005–2006Pizza2.776 ± 23.5Milk3.155 ± 6.2Grain desserts2.347 ± 2.6Pasta, noodle dishes1.226 ± 5Dairy desserts1.625 ± 5.8
2007–2008Pizza2.361 ± 27.9Milk2.954 ± 7.8Grain desserts1.832 ± 7.3Processed meats1.630 ± 5.4Cheese1.227 ± 7.1
2009–2010Milk2.543 ± 3Grain desserts2.139 ± 4.1Cheese1.427 ± 7.6Tortilla & corn dishes1.124 ± 5.5Pizza1.323 ± 4.7
High SES (>185% of poverty income ratio)           
1994–1998Milk2.957 ± 1.9Grain desserts2.452 ± 2.4Cheese1.531 ± 1.6Processed meats1.428 ± 2.3Pizza1.123 ± 2.3
2003–2004Pizza2.255 ± 6.5Milk2.449 ± 2.6Grain desserts1.942 ± 3.1Cheese1.633 ± 2.8Dairy desserts1.225 ± 3.2
2005–2006Milk2.347 ± 2.6Pizza2.047 ± 3.7Grain desserts2.146 ± 2.9Cheese1.736 ± 2.5Dairy desserts1.429 ± 2.4
2007–2008Milk2.543 ± 3Grain desserts2.038 ± 3.1Cheese1.732 ± 3.1Pizza1.329 ± 2.8Processed meats1.425 ± 2.6
2009–2010Grain desserts2.040 ± 2.3Milk2.238 ± 1.5Cheese1.631 ± 1.9Pizza1.328 ± 5.1Processed meats1.325 ± 2.4
Added sugars               
Low SES (≤130% of poverty income ratio)           
1994–1998SSB7.7154 ± 7Grain desserts1.635 ± 1.7Sweet snacks & candies1.530 ± 2.7Sweeteners and syrups1.123 ± 2.5RTE cereals1.121 ± 1.9
2003–2004SSB7.8166 ± 5.9Grain desserts1.840 ± 3.8Sweet snacks & candies1.737 ± 3.8RTE cereals1.428 ± 3.1Dairy desserts0.818 ± 2.2
2005–2006SSB6.4132 ± 9.5Grain desserts1.837 ± 2.7Sweet snacks & candies1.630 ± 3RTE cereals1.220 ± 1.7Dairy desserts0.815 ± 1.7
2007–2008SSB7.0138 ± 14.9Grain desserts1.940 ± 4.7Sweet snacks & candies1.631 ± 3.4Dairy desserts1.021 ± 4.3RTE cereals1.018 ± 1.2
2009–2010SSB5.2104 ± 6.6Grain desserts1.836 ± 2.5Sweet snacks & candies1.325 ± 1.9RTE cereals1.018 ± 1.4Milk1.018 ± 1.4
Mid SES (131%–185% of poverty income ratio)           
1994–1998SSB7.6150 ± 13.3Sweet snacks & candies2.245 ± 5.1Grain desserts2.141 ± 4.7RTE cereals1.427 ± 2.7Dairy desserts0.919 ± 2.2
2003–2004SSB7.6146 ± 11.4Grain desserts1.945 ± 5.9Sweet snacks & candies1.632 ± 4.1RTE cereals1.425 ± 3.9Milk0.715 ± 2.7
2005–2006SSB6.1166 ± 54.7Grain desserts2.144 ± 3.3Sweet snacks & candies1.530 ± 7.7RTE cereals1.222 ± 3.5Dairy desserts1.321 ± 4.7
2007–2008SSB5.6105 ± 10Sweet snacks & candies2.238 ± 9.2Grain desserts1.730 ± 6.2Milk1.119 ± 3.9Coffee/tea0.918 ± 3.5
2009–2010SSB6.6130 ± 31.2Grain desserts1.936 ± 4.3Sweet snacks & candies1.734 ± 6.3RTE cereals1.118 ± 2.7Dairy desserts0.916 ± 4.3
High SES (>185% of poverty income ratio)           
1994–1998SSB7.5162 ± 5.9Grain desserts2.249 ± 2.4Sweet snacks & candies2.043 ± 2.4RTE cereals1.326 ± 1.2Sweeteners and syrups1.125 ± 2
2003–2004SSB8.4182 ± 12.4Grain desserts1.838 ± 2.4Sweet snacks & candies1.635 ± 3.5Dairy desserts1.123 ± 2.9RTE cereals1.021 ± 1.9
2005–2006SSB6.4134 ± 6.4Grain desserts244 ± 3.5Sweet snacks & candies1.938 ± 4Dairy desserts1.227 ± 3.1RTE cereals1.020 ± 1.2
2007–2008SSB5.2101 ± 7.2Sweet snacks & candies2.244 ± 4Grain desserts1.937 ± 3.5RTE cereals1.016 ± 1Dairy desserts0.816 ± 2.1
2009–2010SSB4.592 ± 8.5Sweet snacks & candies1.835 ± 4.7Grain desserts1.734 ± 1.9Dairy desserts0.917 ± 1.8RTE cereals0.916 ± 2.3

Appendix 4

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Mean intake and major sources of SOFAS, solid fats and added sugars among children and adolescents in the United States (2–18 years) from 1994 to 2008, by age groups.*

 #1 Source%Mean ± SE (kcal)#2 Source%Mean ± SE (kcal)#3 Source%Mean ± SE (kcal)#4 Source%Mean ± SE (kcal)#5 Source%Mean ± SE (kcal)
  1. *Data sources: Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 7758), What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3272), WWEIA, NHANES 2005–2006 (n = 3432), WWEIA, NHANES 2007–2008 (n = 2450), WWEIA, NHANES 2009–2010 (n = 2763).

  2. †Percent of total daily energy.

Solid fats               
Ages 2–5 years               
1994–1998Milk4.773 ± 1.2Processed meats2.134 ± 1.6Grain desserts2.033 ± 1Cheese1.525 ± 1.3Pasta & noodle dishes1.119 ± 0.9
2003–2004Milk4.879 ± 4.8Cheese1.932 ± 4.6Grain desserts1.831 ± 2.5Processed meats1.931 ± 3.7Pizza1.221 ± 4
2005–2006Milk4.165 ± 3.3Grain desserts1.931 ± 2.1Cheese1.625 ± 2.3Processed meats1.221 ± 2.4Pizza1.119 ± 3.3
2007–2008Milk4.467 ± 3.3Grain desserts2.031 ± 2Cheese1.726 ± 2.5Processed meats1.626 ± 2.6Pizza0.814 ± 2.7
2009–2010Milk4.365 ± 3.5Cheese1.930 ± 3.4Grain desserts1.829 ± 1.6Processed meats1.624 ± 2.2Pasta & noodle dishes1.119 ± 3
Ages 6–11 years               
1994–1998Milk3.565 ± 2.3Grain desserts2.449 ± 2.8Processed meats1.631 ± 1.9Cheese1.225 ± 1.9Dairy desserts1.224 ± 1.6
2003–2004Milk3.064 ± 4.5Pizza2.454 ± 4.1Grain desserts2.147 ± 4.7Cheese1.433 ± 6.6Processed meats1.328 ± 3.5
2005–2006Milk2.651 ± 3.1Grain desserts2.551 ± 5.4Pizza2.042 ± 3.6Dairy desserts1.733 ± 3.1Processed meats1.529 ± 3.8
2007–2008Milk2.444 ± 2.9Grain desserts2.040 ± 3.3Pizza1.534 ± 7.5Processed meats1.733 ± 2.5Cheese1.531 ± 4.4
2009–2010Milk2.546 ± 1.8Grain desserts2.446 ± 2.5Pizza1.224 ± 2.6Tortilla & corn dishes1.124 ± 4.7Processed meats1.323 ± 3.4
Ages 12–18 years               
1994–1998Grain desserts2.153 ± 3.7Milk2.250 ± 2.7Processed meats1.537 ± 4.7Cheese1.434 ± 2.9Pizza1.433 ± 3.8
2003–2004Pizza2.465 ± 7.2Milk1.946 ± 3.1Grain desserts1.843 ± 2.5Cheese1.636 ± 1.8Tortilla & corn dishes1.230 ± 5.3
2005–2006Pizza2.668 ± 6.6Grain desserts1.844 ± 3.2Milk1.841 ± 2.5Cheese1.637 ± 2.4Tortilla & corn dishes1.330 ± 4.5
2007–2008Grain desserts1.941 ± 3.5Milk1.939 ± 5.1Pizza1.537 ± 4.4Cheese1.532 ± 3.7Tortilla & corn dishes1.331 ± 3
2009–2010Grain desserts1.944 ± 2.9Pizza1.737 ± 8.4Tortilla & corn dishes1.433 ± 3.6Milk1.532 ± 3.1Cheese1.431 ± 3.3
Added sugars               
Ages 2–5 years               
1994–1998SSB5.382 ± 3Grain desserts1.932 ± 1Sweet snacks & candies1.829 ± 1.5RTE cereals1.422 ± 0.8Sweeteners and syrups1.220 ± 0.9
2003–2004SSB4.886 ± 7.2Grain desserts1.729 ± 1.7Sweet snacks & candies1.323 ± 2.4RTE cereals1.221 ± 1.8Dairy desserts1.117 ± 2.8
2005–2006SSB3.657 ± 4.2Sweet snacks & candies1.930 ± 3.7Grain desserts1.727 ± 1.5RTE cereals1.320 ± 1.6Dairy desserts1.017 ± 2.3
2007–2008SSB3.451 ± 4.2Grain desserts1.929 ± 2Sweet snacks & candies1.523 ± 2.9Milk1.320 ± 2.8RTE cereals0.913 ± 0.9
2009–2010SSB2.642 ± 3.7Grain desserts1.626 ± 1.6Sweet snacks & candies1.625 ± 1.6Milk1.119 ± 2.8RTE cereals0.914 ± 1.1
Ages 6–11 years               
1994–1998SSB6.3121 ± 3.8Grain desserts2.449 ± 3.1Sweet snacks & candies2.349 ± 3.9RTE cereals1.427 ± 1.3Sweeteners and syrups1.326 ± 1.6
2003–2004SSB7.2154 ± 10.5Grain desserts2.044 ± 4.2Grain desserts1.944 ± 6RTE cereals1.328 ± 3Dairy desserts1.122 ± 3.4
2005–2006SSB5.098 ± 5.4Grain desserts2.451 ± 5.8Sweet snacks & candies1.938 ± 6.2Dairy desserts1.428 ± 2.5RTE cereals1.121 ± 1.4
2007–2008SSB5.3107 ± 6.9Sweet snacks & candies2.651 ± 8Grain desserts2.040 ± 3.9Dairy desserts1.122 ± 2.5Milk1.018 ± 1.8
2009–2010SSB4.279 ± 4.6Grain desserts2.140 ± 2.6Sweet snacks & candies1.834 ± 3Milk1.119 ± 1.8RTE cereals1.017 ± 1.7
Ages 12–18 years               
1994–1998SSB10.0238 ± 10.5Grain desserts1.948 ± 3.1Sweet snacks & candies1.640 ± 3.1Dairy desserts1.025 ± 2.6Sweeteners and syrups0.924 ± 3.3
2003–2004SSB10.6234 ± 8.6Grain desserts1.741 ± 2.7Sweet snacks & candies1.534 ± 2.9RTE cereals0.921 ± 1.5Dairy desserts0.819 ± 1.6
2005–2006SSB8.9208 ± 16.5Grain desserts1.742 ± 2.7Sweet snacks & candies1.534 ± 3.8Dairy desserts0.922 ± 3.7RTE cereals0.919 ± 1.4
2007–2008SSB7.4148 ± 12.6Sweet snacks & candies1.840 ± 4.1Grain desserts1.839 ± 4Coffee and tea1.121 ± 3.5RTE cereals0.918 ± 0.9
2009–2010SSB6.8147 ± 13.8Grain desserts1.738 ± 2.9Sweet snacks & candies1.433 ± 4.1Coffee and tea0.923 ± 5.6RTE cereals0.917 ± 2.2

Appendix 5

  1. Top of page
  2. Summary
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Conflict of Interest Statement
  9. Acknowledgements
  10. References
  11. Appendix 1
  12. Appendix 2
  13. Appendix 3
  14. Appendix 4
  15. Appendix 5

Mean intake and major sources of SOFAS, solid fats and added sugars among children and adolescents in the United States (2–18 years) from 1994 to 2008, by race/ethnicity.*

Year#1 Source%Mean ± SE (kcal)#2 Source%Mean ± SE (kcal)#3 Source%Mean ± SE (kcal)#4 Source%Mean ± SE (kcal)#5 Source%Mean ± SE (kcal)
  1. *Data sources: Data from the Continuing Survey of Food Intakes by Individuals (CSFII) of 1994–1998 (n = 7758), What We Eat in America (WWEIA) National Health and Nutrition Examination Survey (NHANES) 2003–2004 (n = 3272), WWEIA, NHANES 2005–2006 (n = 3432), WWEIA, NHANES 2007–2008 (n = 2450), WWEIA, NHANES 2009–2010 (n = 2763).

  2. †Percent of total daily energy.

Solid fats               
Non-Hispanic white               
1994–1998Milk3.160 ± 2Grain desserts2.350 ± 2.3Cheese1.632 ± 1.8Processed meats1.532 ± 2.6Pizza1.225 ± 1.9
2003–2004Milk3.061 ± 3.5Pizza2.459 ± 5.5Cheese1.940 ± 4.2Grain desserts1.840 ± 3Fried Potatoes1.125 ± 3.4
2005–2006Pizza2.151 ± 4.4Milk2.348 ± 3Grain desserts2.247 ± 2.9Cheese1.737 ± 2.9Dairy desserts1.530 ± 2.7
2007–2008Milk2.648 ± 4.1Grain desserts2.039 ± 2.8Cheese1.735 ± 3.5Pizza1.434 ± 3.9Processed meats1.427 ± 3.3
2009–2010Milk2.545 ± 2.6Grain desserts2.142 ± 1.8Cheese1.630 ± 1.6Pizza1.328 ± 5.4Processed meats1.427 ± 3
Non-Hispanic black               
1994–1998Milk3.056 ± 2.9Processed meats2.652 ± 6Grain desserts2.040 ± 3Fried Potatoes1.632 ± 2.8Meat1.123 ± 4.5
2003–2004Pizza2.049 ± 3.2Milk2.448 ± 3.2Grain desserts2.045 ± 4.2Processed meats2.042 ± 5.7Fried Potatoes1.326 ± 1.7
2005–2006Milk2.545 ± 2.5Pizza2.143 ± 3.2Grain desserts2.040 ± 2.9Processed meats1.938 ± 4Fried Potatoes1.428 ± 3.1
2007–2008Processed meats2.038 ± 3.6Grain desserts1.938 ± 3.3Milk2.136 ± 1.9Pizza1.325 ± 3.1Cheese1.223 ± 2.7
2009–2010Grain desserts2.245 ± 3.4Milk2.137 ± 3Cheese1.428 ± 2.5Processed meats1.527 ± 3.8Fried Potatoes1.326 ± 3.7
Mexican–American               
1994–1998Milk5.085 ± 6Grain desserts2.041 ± 3.9Cheese1.326 ± 3.3Processed meats1.325 ± 3.6Tortilla & corn dishes1.122 ± 2.7
2003–2004Milk3.569 ± 4.6Tortilla & corn dishes2.658 ± 6Grain desserts1.944 ± 2.7Pizza1.635 ± 3.9Cheese1.226 ± 4
2005–2006Milk3.766 ± 4.2Tortilla & corn dishes2.247 ± 2.5Pizza1.737 ± 6.9Grain desserts1.837 ± 3.2Cheese0.919 ± 1.8
2007–2008Tortilla & corn dishes2.958 ± 4.2Milk3.152 ± 5.8Grain desserts1.936 ± 3.5Pizza1.223 ± 2.1Cheese1.120 ± 2.2
2009–2010Tortilla & corn dishes2.656 ± 5.4Milk2.950 ± 2.1Grain desserts2.040 ± 4.4Pizza1.222 ± 1.7Cheese1.119 ± 1.7
Added Sugars               
Non-Hispanic white               
1994–1998SSB7.5164 ± 6.6Grain desserts2.248 ± 2Sweet snacks & candies2.146 ± 2RTE cereals1.325 ± 1.1Dairy desserts1.225 ± 1.3
2003–2004SSB8.3177 ± 11.3Grain desserts1.738 ± 2.8Sweet snacks & candies1.634 ± 3.7RTE cereals1.224 ± 2.1Dairy desserts1.122 ± 2.6
2005–2006SSB6.4142 ± 12.6Grain desserts2.145 ± 3.6Sweet snacks & candies1.834 ± 3.3Dairy desserts1.328 ± 3.1RTE cereals1.020 ± 1.4
2007–2008SSB5.9119 ± 9.6Sweet snacks & candies2.143 ± 5.4Grain desserts2.039 ± 3.3Dairy desserts0.918 ± 2.5RTE cereals0.916 ± 1.3
2009–2010SSB4.9101 ± 10.5Grain desserts1.836 ± 1.3Sweet snacks & candies1.733 ± 3.9Dairy desserts0.918 ± 1.4RTE cereals0.916 ± 1.9
Non-Hispanic black               
1994–1998SSB8.1160 ± 6.1Grain desserts1.836 ± 3.6Sweeteners and syrups1.430 ± 3.5Sweet snacks & candies1.427 ± 2.6RTE cereals1.222 ± 1.5
2003–2004SSB8.4171 ± 5.4Sweet snacks & candies2.147 ± 6.6Grain desserts2.046 ± 3.8RTE cereals1.326 ± 2.9Sweeteners and syrups0.716 ± 2.7
2005–2006SSB6.8137 ± 9.5Grain desserts2.040 ± 3.6Sweet snacks & candies1.838 ± 4.4RTE cereals1.222 ± 1.5Dairy desserts0.713 ± 1.5
2007–2008SSB6.1109 ± 5Sweet snacks & candies2.141 ± 5.9Grain desserts1.938 ± 3.3RTE cereals1.018 ± 1.3Dairy desserts0.814 ± 2.2
2009–2010SSB5.2103 ± 7.2Grain desserts1.939 ± 3Sweet snacks & candies1.838 ± 5.2RTE cereals1.120 ± 2Dairy desserts0.815 ± 1.5
Mexican–American               
1994–1998SSB7.6142 ± 9.8Grain desserts2.144 ± 6.3RTE cereals1.324 ± 4.1Sweet snacks & candies1.221 ± 2.7Sweeteners and syrups0.918 ± 2.9
2003–2004SSB7.9178 ± 13.8Grain desserts1.839 ± 2.9Sweet snacks & candies1.429 ± 2.8RTE cereals1.019 ± 2.1Milk0.918 ± 1.4
2005–2006SSB5.9118 ± 7.4Grain desserts1.735 ± 4Sweet snacks & candies1.325 ± 2.6RTE cereals1.221 ± 1.2Milk0.916 ± 1.8
2007–2008SSB5.5100 ± 5.9Grain desserts1.732 ± 2.6Sweet snacks & candies1.629 ± 6.4RTE cereals1.018 ± 1.7Milk0.915 ± 1.2
2009–2010SSB5.5103 ± 9.2Grain desserts1.633 ± 4Sweet snacks & candies1.017 ± 1.9Milk0.917 ± 1.5RTE cereals0.916 ± 1.9