Dietary Sources of Energy, Solid Fats, and Added Sugars Among Children and Adolescents in the United States
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Dietary Sources of Energy, Solid Fats, and Added Sugars
Among Children and Adolescents in the United States
Jill Reedy, PhD, MPH, RD and
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
Susan M. Krebs-Smith, PhD, MPH, RD
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
Abstract
Objective—The objective of this research was to identify top dietary sources of energy, solid
fats, and added sugars among 2–18 year olds in the United States.
Methods—Data from the National Health and Nutrition Examination Survey (NHANES), a
cross-sectional study, were used to examine food sources (percentage contribution and mean
intake with standard errors) of total energy (2005–06) and calories from solid fats and added
sugars (2003–04). Differences were investigated by age, sex, race/ethnicity, and family income,
and the consumption of empty calories—defined as the sum of calories from solid fats and added
sugars—was compared with the corresponding discretionary calorie allowance.
Results—The top sources of energy for 2–18 year olds were grain desserts (138 kcal/day), pizza
(136 kcal), and soda (118 kcal). Sugar-sweetened beverages (soda and fruit drinks combined)
provided 173 kcal/day. Major contributors varied by age, sex, race/ethnicity, and income. Nearly
40% of total calories consumed (798 kcal/day of 2027 kcal) by 2–18 year olds were in the form of
empty calories (433 kcal from solid fat and 365 kcal from added sugars). Consumption of empty
calories far exceeded the corresponding discretionary calorie allowance for all sex-age groups
(which range from 8–20%). Half of empty calories came from six foods: soda, fruit drinks, dairy
desserts, grain desserts, pizza, and whole milk.
Conclusion—There is an overlap between the major sources of energy and empty calories: soda,
grain desserts, pizza, and whole milk. The landscape of choices available to children and
adolescents must change to provide fewer unhealthy foods and more healthy foods with fewer
calories. Identifying top sources of energy and empty calories can provide targets for changes in
the marketplace and food environment. However, product reformulation alone is not sufficient—
the flow of empty calories into the food supply must be reduced.
Introduction
In the United States (US) today, over 23 million children and adolescents are overweight or
obese (1,2). Excess body weight, poor diet, and sedentary behavior have been associated
with an increased risk of many chronic diseases, including hypertension, dyslipidemia, type
2 diabetes, as well as depression, poor self-esteem, and associated quality of life issues (3,4).
Author responsible for correspondence/reprint requests: Jill Reedy, PhD, Division of Cancer Control and Population Sciences,
National Cancer Institute, 6130 Executive Blvd. MSC 7344, Bethesda, MD 20892, 301-594-6605, 301-435-3710 (FAX),
reedyj@mail.nih.gov.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
the resulting proof before it is published in its final citable form. Please note that during the production process errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
NIH Public Access
Author Manuscript
J Am Diet Assoc. Author manuscript; available in PMC 2012 August 27.
Published in final edited form as:
J Am Diet Assoc. 2010 October ; 110(10): 1477–1484. doi:10.1016/j.jada.2010.07.010.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Among Children and Adolescents in the United States
Jill Reedy, PhD, MPH, RD and
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
Susan M. Krebs-Smith, PhD, MPH, RD
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
Abstract
Objective—The objective of this research was to identify top dietary sources of energy, solid
fats, and added sugars among 2–18 year olds in the United States.
Methods—Data from the National Health and Nutrition Examination Survey (NHANES), a
cross-sectional study, were used to examine food sources (percentage contribution and mean
intake with standard errors) of total energy (2005–06) and calories from solid fats and added
sugars (2003–04). Differences were investigated by age, sex, race/ethnicity, and family income,
and the consumption of empty calories—defined as the sum of calories from solid fats and added
sugars—was compared with the corresponding discretionary calorie allowance.
Results—The top sources of energy for 2–18 year olds were grain desserts (138 kcal/day), pizza
(136 kcal), and soda (118 kcal). Sugar-sweetened beverages (soda and fruit drinks combined)
provided 173 kcal/day. Major contributors varied by age, sex, race/ethnicity, and income. Nearly
40% of total calories consumed (798 kcal/day of 2027 kcal) by 2–18 year olds were in the form of
empty calories (433 kcal from solid fat and 365 kcal from added sugars). Consumption of empty
calories far exceeded the corresponding discretionary calorie allowance for all sex-age groups
(which range from 8–20%). Half of empty calories came from six foods: soda, fruit drinks, dairy
desserts, grain desserts, pizza, and whole milk.
Conclusion—There is an overlap between the major sources of energy and empty calories: soda,
grain desserts, pizza, and whole milk. The landscape of choices available to children and
adolescents must change to provide fewer unhealthy foods and more healthy foods with fewer
calories. Identifying top sources of energy and empty calories can provide targets for changes in
the marketplace and food environment. However, product reformulation alone is not sufficient—
the flow of empty calories into the food supply must be reduced.
Introduction
In the United States (US) today, over 23 million children and adolescents are overweight or
obese (1,2). Excess body weight, poor diet, and sedentary behavior have been associated
with an increased risk of many chronic diseases, including hypertension, dyslipidemia, type
2 diabetes, as well as depression, poor self-esteem, and associated quality of life issues (3,4).
Author responsible for correspondence/reprint requests: Jill Reedy, PhD, Division of Cancer Control and Population Sciences,
National Cancer Institute, 6130 Executive Blvd. MSC 7344, Bethesda, MD 20892, 301-594-6605, 301-435-3710 (FAX),
reedyj@mail.nih.gov.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
the resulting proof before it is published in its final citable form. Please note that during the production process errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
NIH Public Access
Author Manuscript
J Am Diet Assoc. Author manuscript; available in PMC 2012 August 27.
Published in final edited form as:
J Am Diet Assoc. 2010 October ; 110(10): 1477–1484. doi:10.1016/j.jada.2010.07.010.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Although overweight and obesity are found in all subpopulations, the burden is particularly
striking among children, adolescents, and underserved populations. Children and
adolescents are now experiencing weight-related chronic diseases once seen only among
adults. Additionally, the prevalence of overweight is higher among adolescents compared to
younger children, Mexican-American boys compared to non-Hispanic black or white boys,
and Mexican-American and Non-Hispanic black girls compared to non-Hispanic white girls
(2).
Multiple factors influence overweight and obesity rates, but ultimately, an imbalance
between energy consumed and energy expended is the determining factor. The current
environment (including food stores, restaurants, schools, and worksites) and customs
surrounding food in the US have been labeled “obesogenic” and “toxic” due to the
contributions made to this imbalance by large portion sizes, snacking, away-from-home
meals, and consumption of sugar-sweetened beverages (5–7). Ironically, in a food
environment that supplies an overabundance of energy, there are too few vegetables, whole
grains, fruits, and milk products (8). Therefore, US children and adolescents do not always
consume the types and amounts of food they need to support an active, healthy lifestyle (9).
Recommendations for fruits, vegetables, whole grains and other nutrient-bearing food
groups are available in the 2005
Dietary Guidelines for Americans and MyPyramid (10,11).
These resources also define the concept of a “discretionary calorie allowance” to provide
limits for excess calories from consumption of food groups beyond recommended amounts
and all calories from solid fats, alcoholic beverages, and added sugars (SoFAAS). These
SoFAAS represent empty calories, or sources of energy with virtually no nutritional value,
and have been examined previously in relation to discretionary calorie allowances (12).
Although the discretionary calorie allowance should be considered an upper bound on
consumption of calories from SoFAAS, such intakes far exceed the recommended
discretionary calorie allowances across all sex-age groups in the US population (13). The
purpose of this paper is to identify the top as-eaten food sources of energy, solid fats, and
added sugars among US children and adolescents. “As-eaten” food sources include
composite foods (e.g., cookies), and mixed dishes (e.g., pizza), as well as discrete foods
(e.g., milk or apples).
Methods
Data source and sample
Data from the National Health and Nutrition Examination Survey (NHANES), a cross-
sectional study, were used to examine food sources of total energy (2005–06) and calories
from solid fats and added sugars (2003–04). NHANES is a nationally representative survey
with a complex multistage, stratified probability sample. Trained interviewers conducted in-
person 24-hour dietary recalls with all eligible persons, using automated data collection
systems that included multiple passes. Survey participants ages 12 years and older
completed the dietary interview on their own, proxy-assisted interviews were conducted
with children ages 6 to 11 years, and proxy respondents reported for children younger than
age 5 years (14). The NHANES protocol was approved by the National Center for Health
Statistics Research Ethics Review Board, Hyattsville, Maryland, and all participants
provided informed consent. Further information regarding the design of the NHANES,
including sampling and weighting procedures, can be found at
http://www.cdc.gov/nchs/nhanes.htm.
Reedy and Krebs-Smith Page 2
J Am Diet Assoc. Author manuscript; available in PMC 2012 August 27.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
striking among children, adolescents, and underserved populations. Children and
adolescents are now experiencing weight-related chronic diseases once seen only among
adults. Additionally, the prevalence of overweight is higher among adolescents compared to
younger children, Mexican-American boys compared to non-Hispanic black or white boys,
and Mexican-American and Non-Hispanic black girls compared to non-Hispanic white girls
(2).
Multiple factors influence overweight and obesity rates, but ultimately, an imbalance
between energy consumed and energy expended is the determining factor. The current
environment (including food stores, restaurants, schools, and worksites) and customs
surrounding food in the US have been labeled “obesogenic” and “toxic” due to the
contributions made to this imbalance by large portion sizes, snacking, away-from-home
meals, and consumption of sugar-sweetened beverages (5–7). Ironically, in a food
environment that supplies an overabundance of energy, there are too few vegetables, whole
grains, fruits, and milk products (8). Therefore, US children and adolescents do not always
consume the types and amounts of food they need to support an active, healthy lifestyle (9).
Recommendations for fruits, vegetables, whole grains and other nutrient-bearing food
groups are available in the 2005
Dietary Guidelines for Americans and MyPyramid (10,11).
These resources also define the concept of a “discretionary calorie allowance” to provide
limits for excess calories from consumption of food groups beyond recommended amounts
and all calories from solid fats, alcoholic beverages, and added sugars (SoFAAS). These
SoFAAS represent empty calories, or sources of energy with virtually no nutritional value,
and have been examined previously in relation to discretionary calorie allowances (12).
Although the discretionary calorie allowance should be considered an upper bound on
consumption of calories from SoFAAS, such intakes far exceed the recommended
discretionary calorie allowances across all sex-age groups in the US population (13). The
purpose of this paper is to identify the top as-eaten food sources of energy, solid fats, and
added sugars among US children and adolescents. “As-eaten” food sources include
composite foods (e.g., cookies), and mixed dishes (e.g., pizza), as well as discrete foods
(e.g., milk or apples).
Methods
Data source and sample
Data from the National Health and Nutrition Examination Survey (NHANES), a cross-
sectional study, were used to examine food sources of total energy (2005–06) and calories
from solid fats and added sugars (2003–04). NHANES is a nationally representative survey
with a complex multistage, stratified probability sample. Trained interviewers conducted in-
person 24-hour dietary recalls with all eligible persons, using automated data collection
systems that included multiple passes. Survey participants ages 12 years and older
completed the dietary interview on their own, proxy-assisted interviews were conducted
with children ages 6 to 11 years, and proxy respondents reported for children younger than
age 5 years (14). The NHANES protocol was approved by the National Center for Health
Statistics Research Ethics Review Board, Hyattsville, Maryland, and all participants
provided informed consent. Further information regarding the design of the NHANES,
including sampling and weighting procedures, can be found at
http://www.cdc.gov/nchs/nhanes.htm.
Reedy and Krebs-Smith Page 2
J Am Diet Assoc. Author manuscript; available in PMC 2012 August 27.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Defining a list of specific foods
NHANES dietary intake data are catalogued according to discrete codes representing foods
as eaten. For this analysis, food codes representing similar foods were combined to provide
an indication of the contribution of distinct foods as-eaten to the consumption of energy,
solid fats, and added sugars. That is, the food codes reported by 2–18 year olds during any
of the years examined were sorted into 96 mutually exclusive food categories, which are
hereafter referred to as
specific foods. The list of specific foods (Figure 1) was adapted from
earlier analyses (15–17) and has been used in a previous project (18).
Defining energy from solid fats and added sugars
USDA’s MyPyramid Equivalents Database (MPED) Version 2.0 (19) was used to estimate
energy from solid fats and added sugar (MPED values for grams of solid fat and teaspoons
of added sugars were converted based on 9 kcal/gram and 16 kcal/teaspoon, respectively).
To capture how well diets conform to current guidance, the MPED incorporates data from a
“recipe” file, which disaggregates all foods reported in the survey to individual ingredients,
and assigns those ingredients to MyPyramid groupings. For example, yogurt with fruit is
separated into yogurt, fat, fruit, and caloric sweetener in the recipe file and assigned
corresponding cup-equivalents of milk and fruit, grams of solid fat, and teaspoons of added
sugar. Because MPED is currently available only through NHANES 03–04, energy from
solid fats and added sugars were calculated for those years.
Statistical analysis
Dietary recalls (Day 1 only) for all 2–18 years olds with data deemed reliable by the study
developers were included in this analysis. Appropriate weighting factors were applied to
adjust for differential probabilities of selection and various sources of non-response. Mean
intakes of total energy, energy from solid fats, and energy from added sugars were
calculated. The percentage contribution and mean intake (with standard errors) of
specific
foods to total energy, energy from solid fats, and energy from added sugars were also
estimated. Differences were examined by age (using age groups featured in current guidance
(10,11): 2–3, 4–8, 9–13, and 14–18 years old), sex, race/ethnicity (Non-Hispanic Whites,
Non-Hispanic Blacks, Mexican Americans), and family income based on the federal poverty
income ratio (PIR) (using three PIR categories: less than 130% of PIR, 131% to 185%, and
greater than 185%). The PIR is the ratio of income to the designated poverty threshold for
the family’s composition as defined by the US Census Bureau; family income less than
185% of PIR is considered low-income and qualifies for the Special Supplemental Program
for Women, Infants, and Children and reduced-price school meals, and income less than
130% qualifies for the Supplemental Nutrition Assistance Program (formerly the Food
Stamp Program) and free school meals.
Finally, the contribution of “empty calories”—defined as the sum of energy from solid fats
and added sugars—was calculated and put side by side with the corresponding discretionary
calorie allowance for each sex-age group (11). Low activity levels were assumed, because
most children and adolescents do not achieve the 60 minutes per day of cardiorespiratory
activity recommended in national physical activity guidelines (20). Data analyses were
conducted using SAS (version 9.1, SAS Institute Inc, Cary, NC) and SUDAAN (version
9.0,Research Triangle Institute, Research Triangle Park, NC).
Results
Mean intakes of energy, solid fats, and added sugars, along with the contributions
(percentage and absolute intake) of specific foods contributing at least 2%, are available
online at www.riskfactor.cancer.gov/foodsources/energy. Data are provided for persons 2–
Reedy and Krebs-Smith Page 3
J Am Diet Assoc. Author manuscript; available in PMC 2012 August 27.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
NHANES dietary intake data are catalogued according to discrete codes representing foods
as eaten. For this analysis, food codes representing similar foods were combined to provide
an indication of the contribution of distinct foods as-eaten to the consumption of energy,
solid fats, and added sugars. That is, the food codes reported by 2–18 year olds during any
of the years examined were sorted into 96 mutually exclusive food categories, which are
hereafter referred to as
specific foods. The list of specific foods (Figure 1) was adapted from
earlier analyses (15–17) and has been used in a previous project (18).
Defining energy from solid fats and added sugars
USDA’s MyPyramid Equivalents Database (MPED) Version 2.0 (19) was used to estimate
energy from solid fats and added sugar (MPED values for grams of solid fat and teaspoons
of added sugars were converted based on 9 kcal/gram and 16 kcal/teaspoon, respectively).
To capture how well diets conform to current guidance, the MPED incorporates data from a
“recipe” file, which disaggregates all foods reported in the survey to individual ingredients,
and assigns those ingredients to MyPyramid groupings. For example, yogurt with fruit is
separated into yogurt, fat, fruit, and caloric sweetener in the recipe file and assigned
corresponding cup-equivalents of milk and fruit, grams of solid fat, and teaspoons of added
sugar. Because MPED is currently available only through NHANES 03–04, energy from
solid fats and added sugars were calculated for those years.
Statistical analysis
Dietary recalls (Day 1 only) for all 2–18 years olds with data deemed reliable by the study
developers were included in this analysis. Appropriate weighting factors were applied to
adjust for differential probabilities of selection and various sources of non-response. Mean
intakes of total energy, energy from solid fats, and energy from added sugars were
calculated. The percentage contribution and mean intake (with standard errors) of
specific
foods to total energy, energy from solid fats, and energy from added sugars were also
estimated. Differences were examined by age (using age groups featured in current guidance
(10,11): 2–3, 4–8, 9–13, and 14–18 years old), sex, race/ethnicity (Non-Hispanic Whites,
Non-Hispanic Blacks, Mexican Americans), and family income based on the federal poverty
income ratio (PIR) (using three PIR categories: less than 130% of PIR, 131% to 185%, and
greater than 185%). The PIR is the ratio of income to the designated poverty threshold for
the family’s composition as defined by the US Census Bureau; family income less than
185% of PIR is considered low-income and qualifies for the Special Supplemental Program
for Women, Infants, and Children and reduced-price school meals, and income less than
130% qualifies for the Supplemental Nutrition Assistance Program (formerly the Food
Stamp Program) and free school meals.
Finally, the contribution of “empty calories”—defined as the sum of energy from solid fats
and added sugars—was calculated and put side by side with the corresponding discretionary
calorie allowance for each sex-age group (11). Low activity levels were assumed, because
most children and adolescents do not achieve the 60 minutes per day of cardiorespiratory
activity recommended in national physical activity guidelines (20). Data analyses were
conducted using SAS (version 9.1, SAS Institute Inc, Cary, NC) and SUDAAN (version
9.0,Research Triangle Institute, Research Triangle Park, NC).
Results
Mean intakes of energy, solid fats, and added sugars, along with the contributions
(percentage and absolute intake) of specific foods contributing at least 2%, are available
online at www.riskfactor.cancer.gov/foodsources/energy. Data are provided for persons 2–
Reedy and Krebs-Smith Page 3
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
18 years and by age, sex, race/ethnicity, and income level. For ease of presentation in this
paper, mean intakes of energy, solid fats, and added sugars, and results from the top five
sources are summarized in Tables 1 and 2 and Figure 2.
Energy
The top five sources of energy for 2–18 years olds were grain desserts (cakes, cookies,
donuts, pies, crisps, cobblers, and granola bars) (138 kcal/day), pizza (136 kcal), soda (118
kcal), yeast breads (114 kcal), and chicken and chicken mixed dishes (113 kcal) (Table 1).
These foods each contributed more than 5% to energy intake, or more than 100 kcal per
child per day. Combining related specific foods within the beverage category, children and
adolescents consumed 173 kcal from sugar-sweetened beverages (combining soda and fruit
drinks) and 146 kcal from milk (combining whole and reduced-fat versions) (data for fruit
drinks and reduced fat milk do not always appear in the top five sources, so these data are
available online).
These major contributors varied by age group. For example, the top five sources of energy
for 2–3 years olds included whole milk (104 kcal/day), fruit juice (93 kcal), reduced-fat milk
(91 kcal), and pasta and pasta dishes (86 kcal). Pasta and reduced-fat milk were also among
the top five sources of energy for 4–8 years olds (97 and 95 kcal, respectively).
The top contributors of energy also varied by race/ethnicity (Table 2). For example, major
contributors for 2–18 year old Non-Hispanic Blacks included fruit drinks (100 kcal/day) and
pasta and pasta dishes (90 kcal), while Mexican-Americans’ top sources included Mexican
mixed dishes (136 kcal) and whole milk (99 kcal). Non-Hispanic Blacks and Whites
consumed more energy from sugar-sweetened beverages (combining soda and fruit drinks)
than from milk (combining all milks), whereas Mexican-Americans consumed more energy
from milk than from sugar-sweetened beverages (Table 2 and online tables). The top five
sources of energy by income were consistent across income levels, but varied in ranking
order.
Solid Fats
The average daily intake of energy from solid fats among 2–18 year olds is 433 kcal (Table
1). The major sources of solid fat were pizza (50 kcal/day from solid fat), grain desserts (43
kcal), whole milk (35 kcal), regular cheese (34 kcal), and fatty meats (29 kcal). This list
varied by age group, with younger children obtaining a greater share of their solid fat from
both whole and reduced-fat milk and 14–18 year olds getting more from fried potatoes.
Major contributors also included fried potatoes among non-Hispanic Blacks and persons
with PIR between 131% and 185%, Mexican dishes among Mexican-Americans, reduced-
fat milk among non-Hispanic Whites and persons with PIR greater than 185%, and pasta
among persons with PIR greater than 185% (Table 2).
Added Sugars
The average daily intake of energy from added sugars among all 2–18 year olds was 365
kcal (Table 1). The major sources of added sugars were soda (116 kcal/day from added
sugars), fruit drinks (55 kcal), grain desserts (40 kcal), dairy desserts (29 kcal), and candy
(25 kcal). The list does not vary markedly by age and demographic groups, but cold cereals
were among the top sources for 2–8 year old children, Non-Hispanic Whites, and low-
income groups (Table 2).
Sugar-sweetened beverages (soda and fruit drinks) represented the top two sources of
calories from added sugars among nearly all age and demographic groups (Tables 1 and 2).
The consumption of added sugar from sugar-sweetened beverages was 60 kcal/day for 2–3
Reedy and Krebs-Smith Page 4
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paper, mean intakes of energy, solid fats, and added sugars, and results from the top five
sources are summarized in Tables 1 and 2 and Figure 2.
Energy
The top five sources of energy for 2–18 years olds were grain desserts (cakes, cookies,
donuts, pies, crisps, cobblers, and granola bars) (138 kcal/day), pizza (136 kcal), soda (118
kcal), yeast breads (114 kcal), and chicken and chicken mixed dishes (113 kcal) (Table 1).
These foods each contributed more than 5% to energy intake, or more than 100 kcal per
child per day. Combining related specific foods within the beverage category, children and
adolescents consumed 173 kcal from sugar-sweetened beverages (combining soda and fruit
drinks) and 146 kcal from milk (combining whole and reduced-fat versions) (data for fruit
drinks and reduced fat milk do not always appear in the top five sources, so these data are
available online).
These major contributors varied by age group. For example, the top five sources of energy
for 2–3 years olds included whole milk (104 kcal/day), fruit juice (93 kcal), reduced-fat milk
(91 kcal), and pasta and pasta dishes (86 kcal). Pasta and reduced-fat milk were also among
the top five sources of energy for 4–8 years olds (97 and 95 kcal, respectively).
The top contributors of energy also varied by race/ethnicity (Table 2). For example, major
contributors for 2–18 year old Non-Hispanic Blacks included fruit drinks (100 kcal/day) and
pasta and pasta dishes (90 kcal), while Mexican-Americans’ top sources included Mexican
mixed dishes (136 kcal) and whole milk (99 kcal). Non-Hispanic Blacks and Whites
consumed more energy from sugar-sweetened beverages (combining soda and fruit drinks)
than from milk (combining all milks), whereas Mexican-Americans consumed more energy
from milk than from sugar-sweetened beverages (Table 2 and online tables). The top five
sources of energy by income were consistent across income levels, but varied in ranking
order.
Solid Fats
The average daily intake of energy from solid fats among 2–18 year olds is 433 kcal (Table
1). The major sources of solid fat were pizza (50 kcal/day from solid fat), grain desserts (43
kcal), whole milk (35 kcal), regular cheese (34 kcal), and fatty meats (29 kcal). This list
varied by age group, with younger children obtaining a greater share of their solid fat from
both whole and reduced-fat milk and 14–18 year olds getting more from fried potatoes.
Major contributors also included fried potatoes among non-Hispanic Blacks and persons
with PIR between 131% and 185%, Mexican dishes among Mexican-Americans, reduced-
fat milk among non-Hispanic Whites and persons with PIR greater than 185%, and pasta
among persons with PIR greater than 185% (Table 2).
Added Sugars
The average daily intake of energy from added sugars among all 2–18 year olds was 365
kcal (Table 1). The major sources of added sugars were soda (116 kcal/day from added
sugars), fruit drinks (55 kcal), grain desserts (40 kcal), dairy desserts (29 kcal), and candy
(25 kcal). The list does not vary markedly by age and demographic groups, but cold cereals
were among the top sources for 2–8 year old children, Non-Hispanic Whites, and low-
income groups (Table 2).
Sugar-sweetened beverages (soda and fruit drinks) represented the top two sources of
calories from added sugars among nearly all age and demographic groups (Tables 1 and 2).
The consumption of added sugar from sugar-sweetened beverages was 60 kcal/day for 2–3
Reedy and Krebs-Smith Page 4
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