Rachel K. Johnson,
PhD, MPH, RD
Professor of Nutrition
and Associate Provost
The University of
Vermont
Member AHA
Nutrition Committee
10 committee members
10 liaison members
Expertise in nutrition, pediatrics, epidemiology, high
blood pressure, behavior, obesity, diabetes
AHA liaisons and external liaisons including ADA, FDA,
ACS, NHLBI, CDC, ADA
New scientific evidence
Nutrition and diet as it relates to health, CVD and stroke
Advisory and resource for Food Certification program
Develop scientific conferences, session proposals
Synthesize knowledge for policy and position papers
Rigorous peer-review process/AHA SACC review
DGAC 2000 – no quantifiable recommendation
“Choose beverages and foods to moderate your intake of sugars.”
DGAC 2005 – no quantifiable recommendation
“Choose and prepare foods and beverages with little added sugars or
caloric sweeteners such as amounts in USDA Food Guide or DASH.”
Improving diet has tremendous potential to prevent disease
and improve CV health
Need a number!
What do “moderate” and “little” mean?
Added sugar was not a significant component of the
human diet until the advent of modern foodprocessing methods. Since then, the intake of sugar
has risen steadily.
Between 1970 and 2000, per person daily consumption
of caloric soft drinks increased 70 percent, from 7.8
ounces to 13.2 ounces.
(Briefel RR, et al. Annu Rev Nutr. 2004;24:401-431.
2006 AHA Diet and Lifestyle Recommendations
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“The American Heart
Association is taking aim at the
nation's sweet tooth, urging
consumers to significantly cut
back on the amount of sugar
they get from such foods as soft
drinks, cookies and ice cream.”
“In a scientific statement the
organization says most women
should limit their sugar intake
to 100 calories, or about six
teaspoons, a day; for men, the
recommendation is 150
calories, or nine teaspoons.”
28,607,865 media
impressions with a potential
to reach and possibly exceed
60,780,382 media
impressions.
The American Heart
Association receives an
average of about 20 million
media impressions per
association statement.
NY Times
NBC Nightly News with Brian
Williams
U.S. News & World Report
The Associated Press
Fox News Radio
CNN.com
ABC News Network
NBC’s The Today Show
ABC’s Good Morning America
Washington Post
Reuters
475 calories per person
per day
Equal to
30 teaspoons of
sugar/day
2 ½, 12 ounce soft
drinks/day
▪ National Cancer Institute
Food Categories
Contribution to Added Sugars Intake
(% of total added sugars consumed)
Regular soft drinks
33.0
Sugars and candy
16.1
Cakes, cookies, pies
12.9
Fruit drinks (fruitades and fruit
punch)
9.7
Dairy desserts and milk products
(ice cream, sweetened yogurt,
and sweetened milk)
8.6
Other grains (cinnamon toast and
honey-nut waffles)
5.8
Source: Guthrie and Morton, Journal of the American
Dietetic Association, 2000 (14).
Blood pressure, lipids, inflammation
Obesity
Liquid versus solid
Nutrient adequacy
Discretionary calories
In the Framingham Heart Study, consumption of
>1 soft drink/day significantly increased the odds
of developing high blood pressure.
Dhingra R. Circulation. 2007; 116: 480–488.
73 million Americans (1 in 3) adults has HTN, an
additional 59 million have pre-hypertension.
IOM. 2010. A Population-Based Policy and Systems Change
Approach to Prevent and Control Hypertension.
Consumption of sugar-sweetened beverages (SSBs)
ingested with meals has doubled.
Nelson SJ and Popkin BM. Am J Prev Med 2004;27:205-210.
Children who consume more calories due to larger portion
sizes do not eat less at other times. SSBs contribute up to
10-15% of total energy intake among children.
Wang YC, et al. Pediatrics. 2008;121(6):e1604-1614.
Adults consumed the same amount of solid food at lunch
regardless of the type of beverage served (cola, diet cola,
water).
Flood et al. JADA 2006;106:1984-90.
Meta-analysis of 88 cross-sectional and
prospective studies
Higher intake of soft drinks associated with
greater energy intake and higher body
weight
Vartanian LR et al. Am J Pub Health 2007;97:667-675.
Weak satiety signals from energy-containing beverages.
Total energy intake may be greater with fluid calorie intake
than solid foods.
Increase in calorie consumption from energy-containing
beverages associated w/ greater energy intake.
More research is needed.
Reduced intakes of calcium, vitamin A, iron, and zinc
were observed with ↑ intake of added sugars,
particularly at intake levels that exceeded 25% of
energy (IOM).
Intake of sugars is inversely associated with fiber
intake .
New concept 2005 Dietary Guidelines for Americans
Calories for nutrient requirements minus estimated energy
requirement needed to maintain weight.
The remaining calories = discretionary calorie allowance
Eat additional foods from a food group above your daily
recommendation
Select a higher-calorie form of a food that’s higher in fat or
contains added sugars (whole milk vs. skim milk or sweetened vs.
unsweetened cereal)
Add fats or sweeteners to the leanest versions of foods (for
example, sauce, dressing, butter/margarine, sugar in coffee)
Food and beverages that are mostly fat, sugar or alcohol such as
candy, cake, beer, wine or regular soda
Get a personalized plan to
determine how many calories
you need per day.
Age:
Sex:
Weight:
Height:
Physical Activity: Amount of
moderate or vigorous activity
(such as brisk walking, jogging,
biking, aerobics, or yard work)
you do in addition to your
normal daily routine, most days.
A moderately active 51–55 year-old woman who eats 1800 calories per
day and maintains her weight would have about 195 discretionary calories
per day and only about 100 calories or half that amount should come from
added sugars.
In comparison, if that same woman was more physically active and
burned 2,200 calories a day, she could consume 2,200 calorie a day, and
would have a larger discretionary “budget” of about 290 calories. About
half of that amount or 145 calories could come from added sugars.
Male
Male
Female
Female
Age
21-25
46-50
51-55
71-75
Physical
activity level
Active
Sedentary
Moderately
active
Sedentary
Energy needs
calories
3000
2200
1800
1600
Discretionary
calories
512
290
195
132
Added sugars,
tsp
18
9
5
3
Added sugars,
calories
288
144
80
48
Food
Amount
Calories from
added sugars
Teaspoons
added sugars
Coca-cola
12 ounce can
140
9
Snapple
iced tea
16 ounce bottle 184
11.5
Snickers bar
1 regular sized
bar
120
7.5
Oreo cookie
4 cookies
56
3.5
Honey nut
cheerios
3/4 cup
36
2.25
Chocolate milk
8 ounces
64
4
Strawberry
yogurt
6 ounces
52
3.25
U.S. food labels contain information on
total sugars per serving, but do not
distinguish between sugars
naturally present in foods and
added sugars. Thus, it is difficult for
consumers to determine the
amount of added sugars in foods
and beverages.
• AHA recommends upper limit of half your discretionary calories from
added sugars.
• Focus on all added sugars (we do not single out any particular sugars)
• Most American women no more than 100 calories of added sugars per
day; most men, no more than 150 calories.
• Added sugars and solid fats in food, as well as alcoholic beverages,
are categorized as “discretionary calories” and should be eaten
sparingly.
• Soft drinks and other sugar-sweetened beverages are the number one
source of added sugars in the American diet.