Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Added Sugars & Risk of CVD in Children

Circulation; ePub 2016 Aug 22; Vos, Kaar, et al

The American Heart Association (AHA) has issued a scientific statement on the association of added sugars and increased cardiovascular disease (CVD) among US children after determining that few children safely consume low amounts of sugar as part of a healthy diet. The statement examined 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity. The writing committee determined that it is reasonable to recommend that children consume ≤25 g (100 cal or ~6 teaspoons) of added sugars per day and avoid added sugars for children <2 years of age. Further details of the recommendations include:

• In randomized, controlled trials in which children and adolescents switch from sugar-sweetened beverages (SSBs) to noncaloric beverages, reductions in weight were found, strengthening the likelihood that it is added sugars intake (at least in beverage form) that drives the causality of the findings. Therefore, it is recommended that children and adolescents limit their intake of SSBs to 1 or fewer 8-oz beverages per week (Class I; Level of Evidence A).

• On the basis of the studies showing an association between decreased CVD risk factors and a low consumption of added sugars and the high potential benefit-to-risk ratio, it is reasonable to recommend that children and adolescents consume ≤25 g (100 cal or ≈6 teaspoons) of added sugars per day (Class IIa; Level of Evidence C).

• Because there is minimal room for nutrient-free calories in the habitual diets of very young children, added sugars should be avoided in the diet of children <2 years of age (Class III; Level of Evidence C).


Vos MB, Kaar JL, Welsh JA, et al. Added sugars and cardiovascular disease risk in children. [Published online ahead of print August 22, 2016]. Circulation. doi:10.1161/CIR.0000000000000439.


The major contributors to morbidity and mortality in the US are heavily influenced by lifestyle choices. Our understanding of the link between these lifestyle choices and the outcomes of obesity, diabetes, and cardiovascular disease has increased dramatically in the last 10 years. Currently US children average 80 grams of added sugars daily, meaning primarily sucrose and high-fructose corn syrup. These added sugars account for approximately 16% of all calories consumed. About half of these added sugars are consumed in the form of sugar-sweetened beverages (soda and juices), with the other half in foods including cakes, cookies, and muffins. The recommendation to decrease added sugar in the diet is an important step in combating the epidemics of obesity and diabetes. Decreasing added sugar intake from 80 grams daily to 25 grams daily will be a challenge. The clearest first step will be decreasing or eliminating sugar-sweetened beverages and obvious high-calorie sources of sugar including candies and cookies. It will only be by addressing important lifestyle issues of correct nutrition, exercise, and decreasing sedentary behavior that we will be likely to stem the tide of the most threatening diseases of our time.1,2,3Neil Skolnik, MD

  1. Spring B, Ockene JK, Gidding SS, et al. AHA – Science Advisory: Better population health through behavior change in adults: A call to action. Circulation. 2013;128(19):2169-76. doi:10.1161/01.cir.0000435173.25936.e1.
  2. Young DR, Hivert MF, Alhassan S, et al. Sedentary behavior and cardiovascular morbidity and mortality: A science advisory from the American Heart Association. [Published online ahead of print August 15, 2016]. Circulation. doi:10.1161/CIR.0000000000000440.
  3. LeFevre ML, Siu AL, Peters JJ, et al. Behavioral counseling to promote healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;161(8):587-593. doi:10.7326/M14-1796.