Consumption of Added Sugars and Indicators of Cardiovascular Disease Risk Among US Adolescents

Study Questions:

Is consumption of added sugars associated with risk for cardiovascular disease (CVD) among US adolescents?


This was a cross-sectional study of 2,157 US adolescents (ages 12-18 years), using data from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. Dietary data collected from one 24-hour recall were merged with information on added sugar content data using the US Department of Agriculture MyPyramid Equivalents databases. Measures of CVD 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). Multivariate models were weighted to be representative of the US adolescent population.


In this cohort of 2,157 adolescents, average daily consumption of added sugars was 21.4% of total daily energy. Added sugar intake was inversely correlated with mean high-density lipoprotein (HDL) cholesterol levels (mmol/L). Among the highest consumers (>30% total energy), HDL cholesterol levels were 1.28 mmol/L (95% confidence interval [CI], 1.23-1.33; 49.5 mg/dl) compared with 1.40 mmol/L (95% CI, 1.36-1.44; 54.0 mg/dl) among the lowest consumers (<10% total energy), a difference of 9% (p = 0.001). Added sugar was positively correlated with low-density lipoprotein (LDL) cholesterol (p trend < 0.01). Among the highest compared to the lowest consumers, adjusted LDL levels were 2.44 mmol/L (95% CI, 2.34-2.53; 94.3 mg/dl) and 2.24 mmol/L (95% CI, 2.12-2.37; 86.7 mg/dl). A similar trend was observed for geometric mean triglycerides (p trend < 0.05). The difference between lowest and highest consumers of added sugars was 9% in LDL levels (p = 0.08) and 10% in triglyceride levels (p = 0.07). There was no significant trend in total cholesterol with higher intake of added sugars. Intake of added sugars and HOMA-IR measures were positively correlated among overweight adolescents (p for linear trend < 0.004), but not among normal weight adolescents.


The authors concluded that added sugar consumption among US adolescents is positively associated with CVD risk factors.


This study highlights the importance of a healthy diet starting at an early age. Improved education and community interventions to reduce foods high in added sugars may assist in modifying dietary practices among adolescents.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Diet

Keywords: Carbohydrates, Cholesterol, Overweight, Cardiovascular Diseases, Risk Factors, Diet, Triglycerides, Nutrition Surveys, United States

< Back to Listings