摘要：Objectives. We described 27-year secular trends in added-sugar intake and body mass index (BMI) among Americans aged 25 to 74 years. Methods. The Minnesota Heart Survey (1980–1982 to 2007–2009) is a surveillance study of cardiovascular risk factors among residents of the Minneapolis–St Paul area. We used generalized linear mixed regressions to describe trends in added-sugar intake and BMI by gender and age groups and intake trends by weight status. Results. BMI increased concurrently with added-sugar intake in both genders and all age and weight groups. Percentage of energy intake from added sugar increased by 54% in women between 1980 to 1982 and 2000 to 2002, but declined somewhat in 2007 to 2009; men followed the same pattern (all P < .001). Added-sugar intake was lower among women than men and higher among younger than older adults. BMI in women paralleled added-sugar intake, but men's BMI increased through 2009. Percentage of energy intake from added sugar was similar among weight groups. Conclusions. Limiting added-sugar intake should be part of energy balance strategies in response to the obesity epidemic. The increasing prevalence of overweight and obesity over several decades has contributed significantly to the burden of cardiovascular disease (CVD). 1,2 According to 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) data, 33.4% of men and 36.5% of women in the United States were obese, representing a 55.3% increase among men and an 83.4% increase among women since NHANES I (1971–1975). 3 Energy imbalance—excessive energy intake and a sedentary lifestyle—is considered to be the primary cause of the obesity epidemic. Although dietary fat consumption (as a percentage of energy) decreased between 1971 to 1975 and 2005 to 2006, total energy intake among the US population increased substantially and is mostly attributed to dietary carbohydrates. 3 As reported in a cross-sectional analysis of NHANES 1999 to 2006 data, approximately 16% of calories consumed came from added sugar in the general US adult population, 4 an increase of approximately 49% from intake reported in 1977 to 1978. 5 By contrast to natural occurring sugars from fruits and vegetables, added sugars, defined as caloric sweeteners, used by the food industry and consumers during food processing or preparation or added at the table, have potential adverse health effects. 6 Sugar-sweetened beverages, such as soda and fruit drinks, are the primary source of added sugars in the US diet. 7 Strong evidence exists that greater intake of sugar-sweetened beverages is associated with higher adiposity in children; moderate evidence has been presented for the same effect in adults. 7 Potential explanations for these associations include the effect of lower satiety for liquid calories 8 and the addictive effect of added sugars on total calorie consumption and macronutrient metabolism. 9 Significant associations were also found among US adults between dietary added sugars and other CVD risk factors, such as dyslipidemia 4 and high blood pressure. 10 According to US Department of Agriculture’s (USDA) food availability data, sugars and sweeteners available for consumption increased by 19% from 1970 to 2005, 6,11 despite a slight decline after 2000. 12,13 However, limited temporal trend data of added-sugar intake are available, especially in relation to body mass index (BMI). Most studies focus primarily on sugar-sweetened beverages rather than other sources of added sugars. 12 Although almost half of the added sugar in American diets comes from sugar-sweetened beverages, desserts (e.g., grain-based desserts) and candy contribute about 24.3%. 7 One analysis of national data from 1965 through 2004 described temporal trends of added sugar and high-fructose corn syrup (an important and commonly used caloric sweetener) intake. 12 We examined the secular trends of added sugar intake and BMI over 27 years (1980–1982 through 2007–2009) in data collected in the Minnesota Heart Survey (MHS), an ongoing surveillance study of trends in CVD risk factors among a large population living in the Minneapolis–St Paul metropolitan area.
