Sugar coated: AHA throws support behind reducing added sugars

Sept. 19, 2016
Maria Perno Goldie, RDH, reviews the scientific evidence abut added sugars that led to the Amerian Heart Association's statement supporting decreased sugar in the diets of children and adolescents.  

By Maria Perno Goldie, RDH, MS

The American Heart Association (AHA) recently released a scientific statement titled, “Added Sugars and Cardiovascular Disease Risk in Children.”(1) The authors conducted a literature review of original research and systematic studies on the connection between added sugar and risk factors for cardiovascular disease (CVD) in children and adolescents. Based on their review, the AHA supports decreased amounts of added sugar in the diets of children and adolescents. This article will review the theoretical basis for the statement.

The AHA statement follows a World Health Organization (WHO) fact sheet from 2015 that recommends that sugar intake should be less than 10% of the daily caloric intake of adults and children and that intakes less than 5% would reduce the incidence of noncommunicable diseases, specifically mentioning the reduction of dental caries as a health benefit of these guidelines.(2)

The AHA scientific review examined the effect of sugar added to both food and beverages on CVD risk factors. They focused on the effect of sugar-sweetened beverages because these drinks contribute a significant number of calories to the American diet.(3,4) The AHA conservatively estimates that children between the ages of two and 19 consume 80 grams of sugar per day.(1) The review found that added sugars increase risk factors for CVD such as obesity, blood pressure, and cholesterol for all children and insulin-resistance in overweight children.

The AHA recommends that children and adolescents consume no more than 8 ounces of sugar-sweetened beverages and no more than 25 grams of added sugar per day.(1) They also suggest that parents and those taking care of infants and young children not add sugar to the diets of children under two-years-old. These precautions are necessary to reduce the risk for CVDs.

In 2010, the Robert Wood Johnson Foundation convened an expert panel to consider approaches to the ethics problems related to interventions for childhood obesity. We know that obesity is a risk factor for CVD and other diseases.(5) They proposed frameworks for policy approaches and ethical aspects of interventions and evaluation. They referenced a study among middle-school children that reported that the risk of obesity increased by 60% for every additional sugar-sweetened beverage consumed per day, regardless of levels of exercise.(6) The experts provided examples of policy interventions for childhood obesity to illustrate the application of these frameworks considering the ethical issues. They suggested soft drink taxes, menu calorie labeling, and a variety of interventions in schools.(5)

The Institute of Medicine published Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation in 2011.(7) In addition to the general harmful health effects of sugar, the report mentions dental decay and erosion.

And lastly, there is evidence of wrongdoing on the part of sugar companies. Internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, were published recently in the Journal of the American Medical Association (JAMA) Internal Medicine.(8) The allegations are that the sugar industry paid scientists in the 1960s to minimize the link between sugar and heart disease and promote saturated fat as the chief risk for many diseases. This is based on information in the documents that point to the Sugar Research Foundation, now called the Sugar Association, compensating three Harvard scientists about $50,000 to publish a 1967 review of research on sugar, fat, and heart disease. The study did not support the link between sugar and heart health, but did implicate saturated fat as the culprit.

The bottom line is that we need to maintain and healthy diet and limit the intake of sugar and saturated fat. For more information on maintaining a healthy diet, view the 2015–2020 Dietary Guidelines for Americans and MyPlate.(9,10)

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Maria Perno Goldie, RDH, MS, is the owner of Seminars for Women’s Health and Sex-based Medicine. She is the former editorial director of PennWell’s RDH eVillage Focus, and past president of the International Federation of Dental Hygienists and American Dental Hygienists’ Association. Maria is organizing the third International Dental Hygiene Educator’s Forum to be held March 2017 in Long Beach, CA, in conjunction with the American Dental Education Association (ADEA).


  5. Kersh R, Stroup DF, Taylor WC. Childhood obesity: a framework for policy approaches and ethical considerations. Prev Chronic Dis 2011:8(5): A93. Accessed September 13, 2016.
  6. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001;357(9255):505-8.
  7. IOM (Institute of Medicine). 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press.
  8. Kearns CE, Schmidt LA, and Glantz SA. Sugar Industry and Coronary Heart Disease Research. A Historical Analysis of Internal Industry Documents. JAMA Intern Med. Published online September 12, 2016. doi:10.1001/jamainternmed.2016.5394.
  9. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at