Age and time trends in sugar intake among children and adolescents: results from the DONALD study
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.
KeywordsSugar intake Added sugar Free sugar Trends Children Adolescents
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.
Compliance with ethical standards
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.
- 1.WHO (2015) Sugars intake for adults and children: Guideline. World Health Organization, GenevaGoogle Scholar
- 9.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 CrossRefGoogle Scholar
- 10.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 CrossRefGoogle Scholar
- 12.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, GenevaGoogle Scholar
- 13.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
- 14.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
- 15.Mensink GB (2007) Die aktuelle Nährstoffversorgung von Kindern und Jugendlichen in Deutschland. Ernährungsumschau 54:636–646Google Scholar
- 16.German Nutrition Society (2012) The Nutrition Report 2012. DGE, BonnGoogle Scholar
- 25.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
- 26.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
- 30.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 CrossRefGoogle Scholar
- 32.Scientific Advisory Committee on Nutrition (2016) Minutes of the 48th Meeting. https://app.box.com/s/ivrivaemf7fgeo9a17xdmv167c4uvteu/file/106585193169. Accessed March 2019
- 36.Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39(Suppl 1):5–41Google Scholar
- 39.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 CrossRefGoogle Scholar
- 43.Rabenberg M, Mensink G (2013) Fizzy drinks, juices etc.- The consumption of beverages containing sugars in Germany. Robert Koch-InstitutGoogle Scholar
- 46.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 DenmarkGoogle Scholar
- 47.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 CrossRefGoogle Scholar
- 55.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
- 56.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 OfficeGoogle Scholar