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Associations of sugar intake with anthropometrics in children from ages 2 until 8 years in the EU Childhood Obesity Project



We determined the association of total sugar intake with body weight and fat mass in children on an energy-equivalent basis and potential changes in the association from 2 to 8 years of age.


Data were available from the Childhood Obesity Project Trial initiated in 2002. Sugar intake was measured by 3-day weighed food protocols at 2, 3, 4, 5, 6, and 8 years of age. Body mass index (BMI) and fat mass index (FMI) were available at the same time points. To investigate the association of sugar intake with anthropometrics over time, linear mixed models were applied. Odds ratios for having a high BMI or FMI (above one standard deviation) were estimated by logistic random-effects models. To control for total energy intake, the residual method was chosen and models were additionally adjusted for total energy intake.


Data were available for 809 children with in total 2846 observations. In an isocaloric model, an increase of 100 kcal from sugar per day was significantly associated with lower zBMI (− 0.033; 95% CI −0.061, − 0.005) and zFMI (− 0.050; 95% CI − 0.089, − 0.011). In addition, a 100 kcal higher sugar intake was related to lower odds of having a high zBMI (OR 0.743; 95% CI 0.611, 0.903).


This study provides no indication that increased total sugar intake positively affects BMI on an energy-equivalent basis. Whether the negative association of sugar is due to physiological effects or points more to macronutrient preferences or a reporting bias (lower sugar intake) in children with higher BMI can be debated.

Clinical trial registry Identifier: NCT00338689; Registered: June 19, 2006. URL:

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Body mass index


Childhood Obesity Project


Energy intake


Fat mass index


Odds ratio


World Health Organization


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We thank the participating families and all project partners for their enthusiastic support of the project. Furthermore, thanks to the European Childhood Obesity Trial Study Group, who designed and conducted the study, entered the data, and participated in the data analysis.


The studies reported herein have been carried out with partial financial support from the Commission of the European Community, specifically the RTD Program “Quality of Life and Management of Living Resources” within the Fifth Framework Program (Research Grants No. QLRT-2001-00389 and QLK1-CT-200230582) and the Sixth Framework Program (Contract No. 007036), the European Union (EU) Seventh Framework Program (FP7/2007-2013), project EarlyNutrition (Grant Agreement No. 289346), the EU H2020 project PHC-2014-DynaHealth (Grant No. 633595), and the European Research Council Advanced Grant ERC-2012-AdG (No. 322605) META-GROWTH. This manuscript does not necessarily reflect the views of the Commission and in no way anticipates the future policy in this area. No funding bodies had any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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NA analyzed the data, drafted and finalized the manuscript. DG, KG, JE, NF, DR, JH, EV, AR, BK, and VG conducted the study and entered data at study sites and critically reviewed the manuscript. BK designed the research and critically reviewed the manuscript. VG designed the research, participated in the data analysis, and critically reviewed the manuscript. All authors read and approved the final manuscript.

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Correspondence to Berthold Koletzko.

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Aumueller, N., Gruszfeld, D., Gradowska, K. et al. Associations of sugar intake with anthropometrics in children from ages 2 until 8 years in the EU Childhood Obesity Project. Eur J Nutr 59, 2593–2601 (2020).

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  • Sugar intake
  • Children
  • Overweight
  • BMI
  • Nutritional epidemiology