Skip to main content
SpringerLink
Log in

Effect of AHA dietary counselling on added sugar intake among participants with metabolic syndrome

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Background

High added sugar consumption has been associated with the development of metabolic syndrome (MetS). The American Heart Association (AHA) diet is designed to prevent and treat MetS; however, it remains unclear whether the AHA diet is effective on decreasing added sugar consumption. The aim of our study was to evaluate the effect of the AHA dietary counselling on added sugar consumption among participants with MetS.

Methods

The AHA dietary counselling was conducted among 119 participants with MetS from June 2009 to January 2014 (ClinicalTrials.gov: NCT00911885). Unannounced 24-hour recalls were collected at baseline, 3, 6 and 12 months. Added sugar consumption patterns over time were examined using linear mixed models.

Results

After 1-year dietary counselling, intake of added sugars decreased by 23.8 g/day (95% CI 15.1, 32.4 g/day); intake of nonalcoholic beverages dropped from the leading contributor of added sugar intake to number 7 (from 11.9 to 4.4%); the Alternative Healthy Eating Index (AHEI) score increased by 5.4 (95% CI 2.9, 8.0); however, added sugar intake for 48% participants still exceeded the recommendation. Added sugar intake per meal among different meal type was similar (24.2–25.8%) at baseline. After the 1-year dietary counselling, breakfast became the major resource of added sugar intake (33.3%); the proportion of added sugar intake from snacks decreased from 25.8% (CI 23.1, 28.5%) to 20.9% (CI 19.6, 22.3%).

Conclusion

Although the consumption of added sugars in participants with MetS decreased after the 1-year AHA dietary counselling, added sugar intake from majority of participants still exceeds recommended limits. Actions of successful public health strategies that focus on reducing added sugar intake are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Chen LY, Qiao QH, Zhang SC, Chen YH, Chao GQ, Fang LZ (2012) Metabolic syndrome and gallstone disease. World J Gastroenterol 18:4215–4220. doi:10.3748/wjg.v18.i31.4215

    Article  CAS  Google Scholar 

  2. Lovre D, Mauvais-Jarvis F (2015) Trends in prevalence of the metabolic syndrome. Jama 314:950. doi:10.1001/jama.2015.8625

    Article  Google Scholar 

  3. Ford ES, Giles WH, Dietz WH (2002) Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. Jama 287:356–359

    Article  Google Scholar 

  4. van Vliet-Ostaptchouk JV, Nuotio ML, Slagter SN, Doiron D, Fischer K, Foco L, Gaye A, Gogele M, Heier M, Hiekkalinna T, Joensuu A, Newby C, Pang C, Partinen E, Reischl E, Schwienbacher C, Tammesoo ML, Swertz MA, Burton P, Ferretti V, Fortier I, Giepmans L, Harris JR, Hillege HL, Holmen J, Jula A, Kootstra-Ros JE, Kvaloy K, Holmen TL, Mannisto S, Metspalu A, Midthjell K, Murtagh MJ, Peters A, Pramstaller PP, Saaristo T, Salomaa V, Stolk RP, Uusitupa M, van der Harst P, van der Klauw MM, Waldenberger M, Perola M, Wolffenbuttel BH (2014) The prevalence of metabolic syndrome and metabolically healthy obesity in Europe a collaborative analysis of ten large cohort studies. BMC Endocr Disord 14:9. doi:10.1186/1472-6823-14-9

    Article  Google Scholar 

  5. O’Neil CE, Fulgoni VL 3rd, Nicklas TA (2011) Candy consumption was not associated with body weight measures, risk factors for cardiovascular disease, or metabolic syndrome in US adults: NHANES 1999–2004. Nutr Res 31:122–130. doi:10.1016/j.nutres.2011.01.007

    Article  Google Scholar 

  6. Tsai CJ, Leitzmann MF, Willett WC, GiovannucCIEL (2005) Glycemic load, glycemic index, and carbohydrate intake in relation to risk of cholecystectomy in women. Gastroenterology 129:105–112. doi:10.1053/j.gastro.2005.05.016

    Article  Google Scholar 

  7. Drewnowski A, Rehm CD (2014) Consumption of added sugars among US children and adults by food purchase location and food source. Am J Clin Nutr 100:901–907. doi:10.3945/ajcn.114.089458

    Article  CAS  Google Scholar 

  8. Medicine Io (2002) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients) (2005) National Academy Press: Washington, USA. Available at: http://www.nap.edu/read/10490/chapter/10491

  9. de Ruyter JC, Olthof MR, Seidell JC, Katan MB (2012) A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 367:1397–1406. doi:10.1056/NEJMoa1203034

    Article  Google Scholar 

  10. Agriculture USDoHaHSaUSDo (2015) 2015–2020 Dietary Guidelines for Americans. 8th edn. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/

  11. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB (2014) Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 174:516–524. doi:10.1001/jamainternmed.2013.13563.

    Article  CAS  Google Scholar 

  12. Feldeisen SE, Tucker KL (2007) Nutritional strategies in the prevention and treatment of metabolic syndrome. Appl Physiol Nutr Metabol Physiol Appl Nutr Metab 32:46–60. doi:10.1139/h06-101

    Article  CAS  Google Scholar 

  13. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LM, Wylie-Rosett J, American Heart Association Nutrition Committee of the Council on Nutrition PA, Metabolism, the Council on E, Prevention (2009) Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 120:1011–1020. doi:10.1161/CIRCULATIONAHA.109.192627.

    Article  CAS  Google Scholar 

  14. Ma Y, Olendzki BC, Wang J, Persuitte GM, Li W, Fang H, Merriam PA, Wedick NM, Ockene IS, Culver AL, Schneider KL, Olendzki GF, Carmody J, Ge T, Zhang Z, Pagoto SL (2015) Single-component versus multicomponent dietary goals for the metabolic syndrome: a randomized trial. Ann Intern Med 162:248–257. doi:10.7326/M14-0611

    Article  Google Scholar 

  15. Wang J, Olendzki BC, Wedick NM, Persuitte GM, Culver AL, Li W, Merriam PA, Carmody J, Fang H, Zhang Z, Olendzki GF, Zheng L, Ma Y (2013) Challenges in sodium intake reduction and meal consumption patterns among participants with metabolic syndrome in a dietary trial. Nutr J 12:163. doi:10.1186/1475-2891-12-163

    Article  Google Scholar 

  16. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F, American Heart A, National Heart L, Blood I (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752. doi:10.1161/CIRCULATIONAHA.105.169404.

    Article  Google Scholar 

  17. American Heart Association Nutrition C, Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114:82–96. doi:10.1161/CIRCULATIONAHA.106.176158

    Article  Google Scholar 

  18. US Department of Agriculture ARS, Nutrient Data Laboratory (2015) USDA National Nutrient Database for Standard Reference, Release 28. Version Current: September 2015. Available at: http://www.ars.usda.gov/nea/bhnrc/ ndl

  19. McCullough ML, Willett WC (2006) Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. Public Health Nutr 9:152–157

    Article  Google Scholar 

  20. Alhassan S, Kim S, Bersamin A, King AC, Gardner CD (2008) Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study. Int J Obes 32:985–991. doi:10.1038/ijo.2008.8

    Article  CAS  Google Scholar 

  21. Schoeller DA, Thomas D, Archer E, Heymsfield SB, Blair SN, Goran MI, Hill JO, Atkinson RL, Corkey BE, Foreyt J, Dhurandhar NV, Kral JG, Hall KD, Hansen BC, Heitmann BL, Ravussin E, Allison DB (2013) Self-report-based estimates of energy intake offer an inadequate basis for scientific conclusions. Am J Clin Nutr 97:1413–1415. doi:10.3945/ajcn.113.062125

    Article  CAS  Google Scholar 

  22. Dhurandhar NV, Schoeller D, Brown AW, Heymsfield SB, Thomas D, Sorensen TI, Speakman JR, Jeansonne M, Allison DB, Energy Balance Measurement Working G (2015) Energy balance measurement: when something is not better than nothing. Int J Obes 39:1109–1113. doi:10.1038/ijo.2014.199 (Lond)

    Article  CAS  Google Scholar 

  23. Ervin RB, Ogden CL (2013) Consumption of added sugars among US adults, 2005–2010. NCHS Data Brief 8

  24. Wakimoto P, Block G (2001) Dietary intake, dietary patterns, and changes with age: an epidemiological perspective. The J Gerontol Series A,Biol Sci Med Sci 56(Spec No 2):65–80

    Article  Google Scholar 

  25. Bhargava A, Amialchuk A (2007) Added sugars displaced the use of vital nutrients in the National Food Stamp Program Survey. J Nutr 137:453–460

    Article  CAS  Google Scholar 

  26. MacIntyre UE, Venter CS, Kruger A, Serfontein M (2012) Measuring micronutrient intakes at different levels of sugar consumption in a population in transition: the Transition and Health during Urbanisation in South Africa (THUSA) study. S Afr J Clin Nutr 25:8

    Google Scholar 

  27. Louie JC, Tapsell LC (2015) Association between intake of total vs added sugar on diet quality: a systematic review. Nutr Rev 73:837–857. doi:10.1093/nutrit/nuv044

    Article  Google Scholar 

  28. An R (2016) Beverage consumption in relation to discretionary food intake and diet quality among US adults, 2003 to 2012. J Acad Nutr Diet 116:28–37. doi:10.1016/j.jand.2015.08.009

    Article  Google Scholar 

  29. Wansink B (2004) Environmental factors that increase the food intake and consumption volume of unknowing consumers. Annu Rev Nutr 24:455–479. doi:10.1146/annurev.nutr.24.012003.132140

    Article  CAS  Google Scholar 

  30. Americans TDGF (2015) scientific-report-of-the-2015-dietary-guidelines-advisory-committee.Available at: http://health.gov/dietaryguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf

  31. Grundy SM (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement: Executive Summary. Circulation 112:e285–e290. doi:10.1161/circulationaha.105.169405

    Article  Google Scholar 

  32. Hebert JR, Ebbeling CB, Matthews CE, Hurley TG, Ma Y, Druker S, Clemow L (2002) Systematic errors in middle-aged women’s estimates of energy intake: comparing three self-report measures to total energy expenditure from doubly labeled water. Ann Epidemiol 12:577–586

    Article  Google Scholar 

Download references

Acknowledgements

We thank all participants for their dedication to the study.

Funding

The work was supported by grant 5R01HL094575-04 to Dr. Yunsheng Ma from the National Heart, Lung and Blood Institute (NHLBI), and in part by China Scholarship Council (No. 201506265015) to Dr. Lijuan Zhang as a visiting scholar.

Author information

Authors and Affiliations

  1. Department of Cardiology, Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China

    Lijuan Zhang

  2. Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Lijuan Zhang, Sherry Pagoto, Christine May, Barbara Olendzki & Yunsheng Ma

  3. Department of Biomedical and Nutritional Sciences, University of Massachusetts at Lowell, Lowell, MA, 01854, USA

    Katherine L.Tucker

  4. Department of Computer Science, Worcester Polytechnic Institute, Worcester, MA, 01609, USA

    Carolina Ruiz

  5. Department of Computer Science, University of Massachusetts at Lowell, Lowell, MA, 01854, USA

    Yu Cao

Authors
  1. Lijuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sherry Pagoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine May
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Olendzki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katherine L.Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carolina Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yu Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yunsheng Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yunsheng Ma.

Ethics declarations

Conflict of interest

None of the authors reported a conflict of interest related to the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, L., Pagoto, S., May, C. et al. Effect of AHA dietary counselling on added sugar intake among participants with metabolic syndrome. Eur J Nutr 57, 1073–1082 (2018). https://doi.org/10.1007/s00394-017-1390-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-017-1390-6

Keywords

Search

Navigation