AHA Guidelines: How Much Sugar Is Safe for Kids?

AHA's Scientific Statement on Kids and Sugar

Kid eating ice cream
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In recent years scientists have awakened to the fact that when kids eat too much sugar, it can cause a lot more harm than just cavities. We now know that excess dietary sugar is associated with hypertensionblood lipid disordersdiabetes, obesity, and an increased risk of cardiovascular disease.

While the problems caused by dietary sugar affect everyone, they are especially concerning in children.

Many foods marketed for kids seem to be loaded with added sugars, and the average daily consumption of sugar is remarkably high in kids. It is now believed that sugar consumption is a leading cause of obesity in children, and is likely partially responsible for the alarming rate of type 2 diabetes we are seeing today in adolescents and young adults. (Not long ago type 2 diabetes was almost never seen before middle age.)

Given the increasing incidence of cardiovascular risk factors in adolescents and young adults, experts are warning that we are facing an epidemic of premature heart disease very soon. Added sugars in kids’ diets are undoubtedly playing a big role here.

American Heart Association Recommendations

In August 2016, an expert panel appointed by the American Heart Association (AHA) published a scientific statement entitled “Added Sugars and Cardiovascular Disease Risk in Children.” The panel reviewed all pertinent scientific information on the effect of added sugars in kids, and made firm recommendations on how much added sugar can be consumed by children without appreciably increasing their cardiovascular risk.

Their findings should be sobering to many parents. 

The AHA scientific panel recommends no added sugars at all for children under 2 years of age. For children who are 2 or older, added sugars should be limited to less than 25 g per day (about 6 teaspoons, or 100 calories per day). These recommended levels are less than one-third the average intake of added sugars being consumed by children today.

Given the foods that parents in western societies commonly provide for their children, following these recommendations will take some adjustments. Let’s take a look at what the AHA means by “added sugars,” why the AHA panel concluded that added sugars are bad for kids, and what kinds of foods we should be avoiding in providing our kids a healthy diet. 

What You Should Know About Sugar

Types of Sugar. “Sugar” is the term used to indicate various types of sweet, short-chain carbohydrates. The simple sugars, or monosaccharides, include glucose (also called dextrose), fructose, and galactose. In naturally occurring sugars, called disaccharides, two simple sugars are paired together. Table sugar (from sugarcane or beet sugar) is the disaccharide sucrose, which consists of glucose and fructose paired together. Lactose (found in milk) is glucose plus galactose. 

Since the 1970s high fructose corn syrup has largely supplanted other forms of sugar used in processed foods, because it is cheap to manufacture.

High fructose corn syrup is corn starch that has been processed to convert some of its glucose to fructose. Fructose is the sweetest monosaccharide, so is valued in food processing. While many have claimed that high fructose corn syrup is worse for health than other kinds of added sugar, objective evidence that this is the case is lacking. Both high fructose corn syrup and table sugar, for instance, contain both glucose and fructose, and plenty of each.

Added sugars are defined as all types of sugar added as ingredients to processed and prepared foods, and sugars added to foods at the table. 

Naturally occurring sugars are the sugars that occur naturally as inherent components of food, such as the sugars found in fruits, vegetables, and dairy products. When we eat naturally occurring sugars, we are also getting many of the nutrients that are required for life. Added sugars, in contrast, are simply extra calories (or “empty” calories), that may make food more tasty, but provide no additional nutrient value. Naturally occurring sugars are consumed as part of a normal healthy diet; added sugars are completely unnecessary from a nutritional standpoint. The AHA scientific statement therefore addresses added sugars only.

What Happens When We Eat Sugar?

Disaccharides are broken down in the gut to their monosaccharide components—generally to glucose and fructose. After absorption the glucose and fructose are carried to the liver by the portal circulation. Glucose in the portal circulation stimulates insulin secretion, which causes the glucose to be taken up by muscle and fat tissue, and increases fatty acid production in fat cells. In contrast, fructose does not stimulate insulin secretion to the same extent. Instead, fructose in the liver causes the production of saturated fatty acids

Some scientists have postulated that while excess glucose consumption leads to obesity, excess fructose consumption leads to a higher risk of atherosclerosis. However, at this point a significant difference in what it means to consume glucose vs. fructose is largely speculation. Furthermore, from a purely practical standpoint, when we eat a typical western diet with lots of added sugar, we are getting plenty of both of these monosaccharides.

What Are the Effects of Added Sugars in Children?

Added sugars in the diet have a surprising number of adverse effects, especially in children. These include:

  • Obesity. Increased consumption of added sugars has been strongly associated with obesity in children of all ages. Early consumption of added sugars (before 2 years of age) appears to be an especially bad thing, and strongly predicts obesity by age 6. 
  • High blood pressure. Epidemiological studies strongly suggest that consumption of added sugars is associated with hypertension in adolescent children. Clinical trials have shown that, in particular, excessive fructose ingestion is associated with increased blood pressure in children and young adults.
  • Blood lipid disorders. Several studies have shown that children who eat a lot of added sugars tend to have elevated triglyceride levels, and reduced HDL cholesterol levels (“good” cholesterol). Of note, this is the same pattern of lipid abnormality that is prominent in prediabetes. Furthermore, it is a pattern that is usually accompanied by small, dense LDL cholesterol particles. This “toxic” pattern of dyslipidemia has been strongly associated with an increased risk of atherosclerosis.
  • Pre-diabetes and type 2 diabetes. It is widely believed by experts that excess sugar consumption in children can increase the risk of pre diabetes and type 2 diabetes, as early as adolescence. Observational studies have demonstrated that in children who are overweight, consuming added sugars is associated with insulin resistance (the underlying cause of pre-diabetes and type 2 diabetes). 

A fair amount of evidence suggests that these negative effects from added sugars are “dose-related.” That is, the higher the proportion of a kid’s daily calories that come from added sugars, the higher the cardiovascular risk.

What Foods Should Be Avoided?

The AHA scientific panel makes it plain that, in the typical, current western diet, the most important source of added sugars in children is “sugar-sweetened beverages,” or SSBs. SSBs include sodas, fruit-flavored drinks, sports drinks, and energy drinks. When these beverages are analyzed by nutrition experts, they are found to contain only water and sugar—and a tiny smattering of other chemicals that provide flavoring and color. 

SSBs are the prototype of “empty calories,” and because those calories are provided by rather large amounts of glucose and fructose, they entail all the adverse effects we have just seen. Worse, there is evidence that when added sugars come from beverages as opposed to solid food, there is less appetite suppression—so even more empty calories are consumed. 

Many children obtain an astonishing proportion of their daily caloric intake from SSBs. If the AHA expert panel stresses nothing else, it stresses that parents need to severely curtail, and preferably eliminate, SSBs from their children’s diets.

In addition to SSBs, processed foods in which “sugar” or (far more likely) high-fructose corn syrup are prominently listed on the nutritional labels should be avoided. Candy, gum, cakes, cookies, many breakfast cereals, breads and muffins often fall into this category. 

Summary

Added sugars, a prominent part of the typical kid’s diet today, add no value to our children’s nutrition, but may contribute mightily to their risk of having premature heart attacks and strokes. 

As parents, it is our fond hope that, when we are old and decrepit, our 40-something children will provide us with some of the human comforts that will make the disabilities of aging more bearable. We certainly are not planning to find the reverse—that we’ll be asked to care for our 40-something children after they’re permanently disabled by premature cardiovascular disease. If we would like to avoid this unpleasant outcome, we need to teach our kids good dietary habits right now.

To help our kids avoid obesity, hypertension, lipid disorders, diabetes, and premature cardiovascular disease, we need to make sure they eliminate most added sugars from their diets, most especially sugar-sweetened beverages. The best way to accomplish this would be to take stock of the entire family’s lifestyle, and make the necessary adjustments to optimize everyone’s cardiovascular risk—including a heart-healthy diet for the whole family.

Source:

Vos MB, Kaar JL, Welsh JA, et al. Added Sugars and Cardiovascular Disease Risk in Children—A Scientific Statement From the American Heart Association. Circulation 2016; Vol 134, Issue 8. Published online at: http://circ.ahajournals.org/content/early/2016/08/22/CIR.0000000000000439 (Accessed August 25, 2016).

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