From Heartwire CME

August 26, 2009 — Soda pop drinkers of the world, lament!

New recommendations for maximum dietary intake of “added sugars,” released by the American Heart Association [1], are probably far more healthful than the much-higher current average intake in the US but aren’t such a sweet deal for anyone fond of colas or root beer.

The statement goes beyond the organization’s previously stated position that Americans should cut back on added sugar–that is, dietary sugar that isn’t an intrinsic part of unprocessed food–to recommend “prudent upper limits” on daily intake. They vary by sex, age, and activity level, but the AHA puts them at 140 kcal for most American men and 100 kcal for most American women.

Those numbers assume the added sugar accounts for half a person’s discretionary calorie allowance–that is, the difference between estimated calories needed to maintain weight and those “needed to maintain nutrient requirements.” As part of this definition, the remaining discretionary calories come from “solid fats.” Any consumed alcohol also counts and in the tallying would come out of discretionary calories from either source.

Regular soft drinks and other sweetened beverages are responsible for a third of added sugar intake in the US, according to the report, published online August 24, 2009 in Circulation and slated for its September 15, 2009 issue. It also provides an overview of main sources of added sugar, its most common forms, and a review of the literature on its recognized and potential contributions to obesity, glucose intolerance, blood-pressure elevation, and dyslipidemia.

Disclosures for the report’s writing group and reviewers are listed in the article.

Reference

1. Johnson RK, Appel LJ, Brands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009; DOI: 10.1161/CIRCULATIONAHA.109.192627. Available at: http://circ.ahajournals.org.

Clinical Context

Since the last AHA scientific statement was published in 2002, there has been new evidence on the relationship between sugar intake and cardiovascular health. High levels of dietary sugar consumption may be contributing to the global epidemic of obesity and cardiovascular disease, and limiting dietary intake of added sugars is therefore a valid concern. In the typical US diet, the main source of added sugars is soft drinks and other sugar-sweetened beverages.

The usual intake of added sugars in the US diet was 22.2 teaspoons per day (355 calories per day) from 2001 to 2004. From 1970 to 2005, there was a 19% increase in average annual availability of sugars and added sugars. As a result, average daily energy intake in the US diet increased by 76 calories.

Study Highlights

• The AHA statement expands on the 2006 AHA revised diet and lifestyle guidelines that recommend minimizing the intake of beverages and foods with added sugars.
  
• The present recommendation suggests a specific upper limit of intake for added sugars.
  
• During the past 3 decades, total calorie intake has increased by an average of 150 to 300 calories per day, with approximately half of that increase derived from sugar-sweetened beverages and other liquid calories.
  
• During the same period, there has been no apparent change in physical activity, suggesting that increased intake of added sugars must be at least partly responsible for average weight gain.
  
• Excessive sugar intake has been linked with several metabolic abnormalities, adverse health conditions, and deficiencies of essential nutrients.
  
• Greater intake of soft drinks is linked to greater energy intake, higher body weight, and lower intake of essential nutrients, based on observational studies, although trial data are limited.
  
• US national survey data suggest that excessive intake of added sugars increases overconsumption of discretionary calories.
  
• Discretionary calories come from nonessential nutrient sources, such as solid fats, added sugars, and alcohol, and do not exceed total recommended daily caloric intake needed for a person to achieve or maintain a healthy weight.
  
• Regardless of energy requirements, added sugar consumption greatly exceeds discretionary calorie allowances recommended in the 2005 US Dietary Guidelines.
  
• The AHA recommends decreasing added sugar intake.
  
• A prudent upper limit of added sugar intake is half of the discretionary calorie allowance (≤ 100 calories per day for most US women and ≤ 150 calories per day for most US men).
  
• Discretionary calories are approximately equally divided between solid fats and added sugars; persons who also drink alcohol should further reduce their intake of solid fats and added sugars to accommodate the additional calories from alcohol.
  
• Recommendations for added sugars vary from 5 teaspoons per day (80 calories) for a daily energy expenditure of 1800 calories for an average adult woman to 9 teaspoons per day (144 calories) for a daily energy expenditure of 2200 calories for an average adult man.
  
• As a guide, one 12-ounce can of cola has approximately 8 teaspoons of added sugar, or roughly 130 calories.
  
• To meet essential nutrient needs, achieve and maintain healthy weights, and decrease cardiovascular risk, the AHA also recommends following an overall healthy diet consistent with the AHA’s 2006 diet and lifestyle recommendations.

Clinical Implications

• During the past 3 decades, total calorie intake has increased by an average of 150 to 300 calories per day, approximately half of which comes from sugar-sweetened beverages. Potential harms of excessive sugar intake may include excessive weight gain, metabolic abnormalities, adverse health conditions, and essential nutrient deficiencies.
  
• A prudent upper limit of added sugar intake is half of the discretionary calorie allowance (≤ 100 calories per day for most US women and ≤ 150 calories per day for most US men).

Authors and Disclosures

Steve Stiles
Steve Stiles is a journalist for Medscape. He has been reporting on cardiovascular medicine since 1984 and for the past 3 years has been a journalist for theheart.org, part of the WebMD Professional Network. Steve is a graduate of Kenyon College and has an MS from the journalism department at Boston University. He can be contacted at SStiles@webmd.net.
Disclosure: Steve Stiles has disclosed no relevant financial relationships.

Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.