November 27, 2019 08:42 am Chris Crawford – About 61% of infants and 98% of toddlers consumed added sugars on any given day during 2011-2016, with the primary source for infants being flavored yogurts and for toddlers, fruit drinks, according to a recent study.
Authors of the study, published online Nov. 14 in the Journal of the Academy of Nutrition and Dietetics, did find some good news in the decreasing percentage of infants (age 6-11 months) whose daily diets included added sugars, as well as in the amount of added sugars that infants and toddlers (12-23 months) consumed.
"Our study, which is the first to look at trends in added sugars consumption by infants and toddlers, documents that most infants and toddlers consume added sugars," said lead investigator Kirsten Herrick, Ph.D., M.Sc., of the CDC's National Center for Health Statistics' Division of Health and Nutrition Examination Surveys, in a news release. "This has important public health implications, since previous research has shown that eating patterns established early in life shape later eating patterns."
"Previous research into the diets of children over two years old associated sugar consumption with the development of cavities, asthma, obesity, elevated blood pressure and altered lipid profiles," Herrick added.
CDC researchers analyzed data trends for 1,211 infants and toddlers from the National Health and Nutrition Examination Survey from 2005-2006 through 2015-2016. National estimates of added sugars intake were based on data from three survey cycles, 2011-12, 2013-14 and 2015-16.
The authors categorized food, beverages and added sugar from the NHANES using the USDA Agricultural Research Service's Food Patterns Equivalents Database and its What We Eat In America list.
It should be noted that sugars contained in breast milk and infant formula were not included in these consumption estimates.
The researchers found that infants consumed about 1 teaspoon of added sugars daily (equivalent to about 2% of their daily caloric intake), while toddlers consumed about 6 teaspoons of sugars (about 8% of their daily caloric intake).
No differences were detected in added sugars consumption by sex, family income level or head-of-household education level, but there were distinctions between races.
Non-Hispanic black toddlers consumed more added sugars (8.2 teaspoons) than Hispanic (5.9 teaspoons), non-Hispanic white (5.3 teaspoons) and non-Hispanic Asian (3.7 teaspoons) toddlers. The study found a similar pattern for the percent of energy derived from added sugars for each group.
In addition to yogurt and fruit drinks, the top sources of added sugars for infants included baby snacks and sweets, and sweet bakery products; for toddlers, top sources included sweet bakery products, and sugar and candy.
Scott Hartman, M.D., of Rochester, N.Y., a member of the AAFP's Commission on Health of the Public and Science, told AAFP News that he wasn't surprised by the study's findings.
"Clinicians sometimes don't take as detailed dietary histories as we should, but when we do, we are often shocked by the amounts of sugars, especially in beverages, that American children are consuming," he said. "Despite food labeling, there's not great collective public understanding of the risks and harms of these added sugars. Clinicians in their offices could do better to inform parents, but public health campaigns and advertising could also be tremendously helpful."
In March, the American Academy of Pediatrics and the American Heart Association recommended policies to reduce sugary drink consumption in children and adolescents.
Hartman said the policies suggest that children and adolescents aim for less than 25 grams (6 teaspoons) of added sugars per day and no more than 8 ounces of sugary drinks per week. They recommend no added sugars for children younger than age 2.
He added that the while the AAFP doesn't have a policy specific to this issue, it does state that Americans should limit added sugars in their diets. Also, the Academy has produced policy advocating taxation of sweetened beverages, as well as policies on developing healthy food supplies for supplemental nutrition programs and healthy eating options in schools.
Hartman said there's plenty of evidence showing tastes and eating patterns tend to be developed by ages 6-7 and that once those patterns are developed, they're very hard to change.
"Family physicians see this all the time when we treat adolescents and adults for chronic conditions like type 2 diabetes, elevated lipids and obesity," Hartman said. "And it's not just that eating patterns form early, but disease processes start early. Disruptions in the endocrine system that lead to type 2 diabetes most likely start in childhood."
The AAFP offers patient information on starting good nutrition early that can be printed out or shared online, he added.
"Parents should start by feeding their infants mostly fruits, vegetables, nuts and small amounts of proteins between 6-12 months, which limits exposure to both grains and sugars and can help provide a solid basis for healthy eating throughout childhood," Hartman said.
Many health disparities begin in infancy and childhood, and some of them are rooted in access to healthy foods, or lack thereof, he said.
"In this area, clinicians, health systems and citizens at large really need to do more advocacy work," Hartman said. "We should be helping to ensure that all members of society have access to healthy foods, and that corporations do not target certain groups of people in advertising sweetened beverages and fast food, which we know is currently happening."
Fellow Commission on Health of the Public and Science member Shani Muhammad, M.D., of San Ramon, Calif., told AAFP News there's a legitimate challenge in trying to feed a family on a limited income and making the choice between nutrient-dense foods -- which typically are more expensive -- and, say, chicken nuggets and fries that may be on a fast-food dollar menu.
"I try to talk to my patients about understanding what can be done with less expensive and nutrient-dense foods," she said. "I would begin by finding out what they like to eat, what foods are palatable for them, and then helping them to come up with menu items that can be purchased in larger quantities for less money. Often, it's a matter of helping to brainstorm, meal plan and shift the focus to cooking, which the whole family can get involved with. Children are more likely to try new foods when they have participated in the preparation."
Muhammad added that Supplemental Nutrition Assistance Program benefits will pay for produce at farmers markets.
"Fruit and vegetables are typically significantly less expensive in these avenues," she said. "Foods such as beans, lentils and other legumes are high in protein and nutrients with no added sugar and can be purchased inexpensively in large quantities. You have to help them think outside of the (fast-food) box."
Furthermore, families with infants and toddlers with limited income may qualify for the Special Supplemental Nutrition Program for Women, Infants and Children, which can provide beans, cheese and cereal and help mitigate some of the cost of food, Muhammad added.
"I also want to echo the statement on advocacy work and education," she said. "So many people just aren't aware that their children never need juice, for instance, or know how much sugar is in sweetened beverages.
"We need to have the time for this important patient education in the office, but most of us just don't, unfortunately," she continued. "It would be a valuable use of office visit time for the long-term health consequences it could prevent."
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