To describe age and time trends in added sugar, free sugar and total sugar intake among German 3–18-year-olds.
Overall, 10,761 3-day dietary records kept between 1985 and 2016 by 1312 DONALD participants (660 boys, 652 girls) were analysed (%E) using polynomial mixed-effects regression models.
TS intake decreased with age (♂: linear, quadratic and cubic trend all p < 0.0098; ♀: linear trend p < 0.0001). While the oldest children had the lowest FS intake (linear, quadratic trend: p < 0.0001), the youngest children had the lowest AS intake (linear, quadratic trend p < 0.0001, cubic trend p = 0.0004). In terms of time trends, TS (♂: cubic trend p = 0.0052; ♀: quadratic trend p = 0.0608, cubic trend p = 0.0014) and FS (quadratic trend p = 0.0163, cubic trend p < 0.0001) intake increased between 1985 and 2005 and decreased thereafter, most notably since 2010. AS intake decreased between 1985 and 1995, increased slightly until 2005 and decreased thereafter, most notably since 2010 (linear, quadratic, cubic trend p < 0.0001). FS intake exceeded 10%E/day throughout the 30-year study period.
Our results do not support the common assumptions that sugar intake is on the rise and generally higher among adolescents than among younger children. Of note, TS, AS and FS intakes have decreased in the last decade among all age groups. Nevertheless, FS intake still exceeds the intake level recommended by the WHO.
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WHO (2015) Sugars intake for adults and children: Guideline. World Health Organization, Geneva
Moynihan PJ, Kelly SAM (2014) Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res 93(1):8–18. https://doi.org/10.1177/0022034513508954
Peres MA, Sheiham A, Liu P et al (2016) Sugar consumption and changes in dental caries from childhood to adolescence. J Dent Res 95(4):388–394. https://doi.org/10.1177/0022034515625907
Te Morenga L, Mallard S, Mann J (2012) Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 346:e7492. https://doi.org/10.1136/bmj.e7492
Welsh JA, Cunningham SA (2011) The role of added sugars in pediatric obesity. Pediatr Clin N Am 58(6):1455–1456. https://doi.org/10.1016/j.pcl.2011.09.009
Ludwig DS, Peterson KE, Gortmaker SL (2001) Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 357(9255):505–508. https://doi.org/10.1016/S0140-6736(00)04041-1
Welsh JA, Sharma A, Cunningham SA et al (2011) Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation 123(3):249–257. https://doi.org/10.1161/CIRCULATIONAHA.110.972166
Vos MB, Kaar JL, Welsh JA et al (2017) Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation 135(19):e1017–e1034. https://doi.org/10.1161/CIR.0000000000000439
Rodríguez LA, Madsen KA, Cotterman C et al (2016) Added sugar intake and metabolic syndrome in US adolescents: cross-sectional analysis of the National Health and Nutrition Examination Survey 2005–2012. Publ Health Nutr 19(13):2424–2434. https://doi.org/10.1017/S1368980016000057
Steinberger J, Daniels SR, Eckel RH et al (2009) Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 119(4):628–647. https://doi.org/10.1161/CIRCULATIONAHA.108.191394
Buyken AE, Mela DJ, Dussort P et al (2018) Dietary carbohydrates: a review of international recommendations and the methods used to derive them. Eur J Clin Nutr. https://doi.org/10.1038/s41430-017-0035-4
World Health Organization (2003) Diet, nutrition, and the prevention of chronic diseases: report of a WHO/FAO Expert Consultation. WHO technical report series, vol 916. World Health Organization, Geneva
Max Rubner-Institut & Bundesforschungsinstitut für Ernährung und Lebensmittel (2008) In Nationale Verzehrsstudie II. Ergebnisbericht, Teil 2. Die bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen (National Nutrition Survey II. Outcome Report, Part 2. The Nationwide Survey on Nutrition for Adolescents and Adults for Adolescents and Adults). https://www.bmel.de/SharedDocs/Downloads/Ernaehrung/NVS_ErgebnisberichtTeil2.pdf?__blob=publicationFile
Heuer T (2017) Estimation of “free” sugar intake in Germany based on the data of the German National Nutrition Survey II. https://www.openagrar.de/receive/openagrar_mods_00030594
Mensink GB (2007) Die aktuelle Nährstoffversorgung von Kindern und Jugendlichen in Deutschland. Ernährungsumschau 54:636–646
German Nutrition Society (2012) The Nutrition Report 2012. DGE, Bonn
Cheng G, Libuda L, Karaolis-Danckert N et al (2010) Trends in dietary carbohydrate quality during puberty from 1988 to 2007: a cause for concern? Br J Nutr 104(9):1375–1383. https://doi.org/10.1017/S0007114510002278
Ventura AK, Mennella JA (2011) Innate and learned preferences for sweet taste during childhood. Curr Opin Clin Nutr Metab Care 14(4):379–384. https://doi.org/10.1097/MCO.0b013e328346df65
Drewnowski A, Mennella JA, Johnson SL et al (2012) Sweetness and food preference. J Nutr 142(6):1142S–1148S. https://doi.org/10.3945/jn.111.149575
Mikkilä V, Räsänen L, Raitakari OT et al (2005) Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study. BJN 93(6):923–931
Dietz WH (1994) Critical periods in childhood for the development of obesity. Am J Clin Nutr 59(5):955–959. https://doi.org/10.1093/ajcn/59.5.955
Mahoney LT, Burns TL, Stanford W et al (1996) Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol 27(2):277–284
The NS, Suchindran C, North KE et al (2010) Association of adolescent obesity with risk of severe obesity in adulthood. JAMA 304(18):2042–2047. https://doi.org/10.1001/jama.2010.1635
Buyken AE, Mitchell P, Ceriello A et al (2010) Optimal dietary approaches for prevention of type 2 diabetes: a life-course perspective. Diabetologia 53(3):406–418. https://doi.org/10.1007/s00125-009-1629-8
Obesity Society (2014) U.S. adult consumption of added sugars increased by more than 30% over three decades. https://www.sciencedaily.com/releases/2014/11/141104141731.htm. Accessed 26 Nov 2018
Digital Journal (2016) Rise in sugar consumption by children. http://www.digitaljournal.com/life/health/rise-in-sugar-consumption-by-children/article/474491. Accessed 26 Nov 2018
Alexy U, Sichert-Hellert W, Kersting M (2002) Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents. J Nutr 132(9):2785–2791. https://doi.org/10.1093/jn/132.9.2785
Alexy U, Sichert-Hellert W, Kersting M (2002) Fifteen-year time trends in energy and macronutrient intake in German children and adolescents: results of the DONALD study. BJN 87(06):595. https://doi.org/10.1079/BJN/2002572
Kroke A, Manz F, Kersting M et al (2004) The DONALD Study History, current status and future perspectives. Eur J Nutr 43(1):45–54. https://doi.org/10.1007/s00394-004-0445-7
Buyken AE, Alexy U, Kersting M et al (2012) Die DONALD Kohorte. Ein aktueller Überblick zu 25 Jahren Forschung im Rahmen der Dortmund Nutritional and Anthropometric Longitudinally Designed Study (The DONALD cohort. An updated overview on 25 years of research based on the Dortmund Nutritional and Anthropometric Longitudinally Designed study). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55(6–7):875–884. https://doi.org/10.1007/s00103-012-1503-6
Sichert-Hellert W, Kersting M, Chahda C et al (2007) German food composition database for dietary evaluations in children and adolescents. J Food Compos Anal 20(1):63–70. https://doi.org/10.1016/j.jfca.2006.05.004
Scientific Advisory Committee on Nutrition (2016) Minutes of the 48th Meeting. https://app.box.com/s/ivrivaemf7fgeo9a17xdmv167c4uvteu/file/106585193169. Accessed March 2019
Swan GE, Powell NA, Knowles BL et al (2018) A definition of free sugars for the UK. Public Health Nutr 21(9):1636–1638. https://doi.org/10.1017/S136898001800085X
Cole TJ, Bellizzi MC, Flegal KM et al (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–1243
Cole TJ, Flegal KM, Nicholls D et al (2007) Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335(7612):194. https://doi.org/10.1136/bmj.39238.399444.55
Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39(Suppl 1):5–41
Sichert-Hellert W, Kersting M, Schöch G (1998) Underreporting of energy intake in 1 to 18 year old German children and adolescents. Z Ernahrungswiss 37(3):242–251
Libuda L, Alexy U, Kersting M (2014) Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: not quantity, but quality is the issue. Br J Nutr 111(1):141–150. https://doi.org/10.1017/S0007114513002031
Diethelm K, Bolzenius K, Cheng G et al (2011) Longitudinal associations between reported sleep duration in early childhood and the development of body mass index, fat mass index and fat free mass index until age 7. Int J Pediatr Obes 6(2–2):e114–e123. https://doi.org/10.3109/17477166.2011.566338
de Graaf C, Zandstra EH (1999) Sweetness intensity and pleasantness in children, adolescents, and adults. Physiol Behav 67(4):513–520. https://doi.org/10.1016/S0031-9384(99)00090-6
Lytle LA, Seifert S, Greenstein J et al (2000) How do children’s eating patterns and food choices change over time? Results from a cohort study. Am J Health Promot 14(4):222–228. https://doi.org/10.4278/0890-1171-14.4.222
Story M, Neumark-Sztainer D, French S (2002) Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 102(3 Suppl):S40–S51
Rabenberg M, Mensink G (2013) Fizzy drinks, juices etc.- The consumption of beverages containing sugars in Germany. Robert Koch-Institut
Linseisen J, Gedrich K, Karg G et al (1998) Sucrose intake in Germany. Z Ernahrungswiss 37(4):303–314
Wittekind A, Walton J (2014) Worldwide trends in dietary sugars intake. Nutr Res Rev 27(2):330–345. https://doi.org/10.1017/S0954422414000237
Fagt S, Biltoft-Jensen A, Matthiessen J, Velsing Groth M, Christensen T, Trolle E (2010) Dietary habits of Denmark 1995–2006 Status and development with focus on fruits, vegetables and added sugar, 1. udgave. National Food Institute, Technical University Denmark
Thompson FE, McNeel TS, Dowling EC et al (2009) Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: national Health Interview Survey, 2005. J Am Diet Assoc 109(8):1376–1383. https://doi.org/10.1016/j.jada.2009.05.002
Pawellek I, Grote V, Theurich M et al (2017) Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age. Eur J Clin Nutr 71(1):25–32. https://doi.org/10.1038/ejcn.2016.206
Libuda L, Alexy U, Sichert-Hellert W et al (2008) Pattern of beverage consumption and long-term association with body-weight status in German adolescents–results from the DONALD study. Br J Nutr 99(6):1370–1379. https://doi.org/10.1017/S0007114507862362
Gose M, Krems C, Heuer T et al (2016) Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT). Br J Nutr 115(8):1498–1507. https://doi.org/10.1017/S0007114516000544
Jebb SA (2015) Carbohydrates and obesity: from evidence to policy in the UK. Proc Nutr Soc 74(3):215–220. https://doi.org/10.1017/S0029665114001645
Kranz S, Siega-Riz AM (2002) Sociodemographic determinants of added sugar intake in preschoolers 2 to 5 years old. J Pediatr 140(6):667–672. https://doi.org/10.1067/mpd.2002.124307
Tasevska N (2015) Urinary sugars—a biomarker of total sugars intake. Nutrients 7(7):5816–5833. https://doi.org/10.3390/nu7075255
Davy B, Jahren H (2016) New markers of dietary added sugar intake. Curr Opin Clin Nutr Metab Care 19(4):282–288. https://doi.org/10.1097/MCO.0000000000000287
Regulation (EU) No 1169/2011 of the European Parliament and of the Council of 25 October 2011 on the provision of food information to consumers, amending Regulations (EC) No 1924/2006 and (EC) No 1925/2006 of the European Parliament and of the Council, and repealing Commission Directive 87/250/EEC, Council Directive 90/496/EEC, Commission Directive 1999/10/EC, Directive 2000/13/EC of the European Parliament and of the Council, Commission Directives 2002/67/EC and 2008/5/EC and Commission Regulation (EC). https://eur-lex.europa.eu/eli/reg/2011/1169/oj
U.S. Department of Agriculture/U.S. Department of Health and Human Services (2000) Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin No. 232. Washington, DC: U.S. Government Printing Office
The DONALD Study is financially supported by the Ministry of Science and Research of North Rhine-Westphalia, Germany. The results presented in this article are part of a project funded by the German Federal Ministry of Food and Agriculture (BMEL) through the Federal Office for Agriculture and Food (BLE), grant 2816HS024. The participation of all children and their families in the DONALD Study is gratefully acknowledged. We also thank the DONALD staff for carrying out the anthropometric measurements, for administering the questionnaires, and for collecting and coding the dietary records.
Conflict of interest
AEB is a member of the International Carbohydrate Quality Consortium (ICQC). IP, SS, KWDC and UA declare that they have no conflict of interest.
The DONALD Study was approved by the Ethics Committee of the University of Bonn, Germany.
All assessments in the DONALD Study were performed with parental and later on participants’ written informed consent.
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Perrar, I., Schmitting, S., Della Corte, K.W. et al. Age and time trends in sugar intake among children and adolescents: results from the DONALD study. Eur J Nutr 59, 1043–1054 (2020). https://doi.org/10.1007/s00394-019-01965-y
- Sugar intake
- Added sugar
- Free sugar