CHARACTERISTICS OF NHANES CHILDREN AND ADULTS WHO CONSUMED GREATER THAN OR EQUAL TO 50% OF THEIR CALORIES/DAY FROM SUGAR AND THOSE WHO DO NOT

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1 CHARACTERISTICS OF NHANES CHILDREN AND ADULTS WHO CONSUMED GREATER THAN OR EQUAL TO 50% OF THEIR CALORIES/DAY FROM SUGAR AND THOSE WHO DO NOT Data from the National Health and Nutrition Examination Survey (NHANES) Cycles , , , & Kelly Nemec NHANES Research Project NTR 555 Nutrition in Epidemiology December 8, 2015

2 Background and Rationale Dietary sugar intake among children and adults has been of concern over the past decade Over the past few years, US children have been consuming about 16% of their calories from sugar, while adults have been consuming about 13% of their calories from sugar 1,2 Researchers have found that those who smoke every day consume more sugar and those who have higher education consume less sugar 3,4 Previous research shows an association among sugar intake and food security status 5

3 Research Question What are the characteristics of NHANES US children and adults who consume 50% or more of their calories/day from sugar and who consume less than 50% of their calories/day from sugar?

4 Objectives Determine the characteristics of children and adults who consumed 50% of their calories from sugar and those who consumed <50% of their calories from sugar. Determine the association among adults who consumed 50% of their calories from sugar and those who consumed <50% of their calories from sugar and education level. Determine the association among adults who consumed 50% of their calories from sugar and those who consumed <50% of their calories from sugar and smoking status. Determine the association among adults and children who consumed 50% of their calories from sugar and those who consumed <50% of their calories from sugar and race/ethnicity. Determine the association among adults and children who consumed 50% of their calories from sugar and those who consumed <50% of their calories from sugar and child and adult food security category. Determine the association among adults who consumed 50% of their calories from sugar and those who consumed <50% of their calories from sugar and marital status.

5 Study Sample

6 Outcome Variables Demographics Categorical: Gender, race/ethnicity, marital status, education level of adults (+20 years old) Continuous: age Food Security Status (children and adult) Categorical Full, marginal, low, very low Sugar Intake- % of calories from sugar (sugarscore) Categorical Those who consume 50% of their calories from sugar, those who consume <50% of their calories from sugar Body Mass Index Continuous Total Energy Intake Continuous Smoking Status Categorical Every day, some days, not at all

7 Data Analysis Frequencies (n, (%)) Gender, race/ethnicity, marital status, smoking status, education level, adult/child food security status Mean±SD Body Mass Index (BMI) and total energy intake Statistics (all p values set at <0.05) Chi-square: association among % of calories from sugar (sugarscore) and education level in adults Chi-square: association among % of calories from sugar (sugarscore) and smoking status in adults Chi-square: association among % of calories from sugar (sugarscore) and ethnicity/race in adults and children Chi-square: association among % of calories from sugar (sugarscore) and food security status in adults and children Chi-square: association among % of calories from sugar (sugarscore) and marital status in adults

8 Table 1. Demographic Characters of Children and Adults by Sugar Intake (n=32890) Characteristics Children Adults Gender: n (%) Female Male Age (years): Mean ±SD All Children (n=11693) 5761 (34.7) 5932 (36.4) <50% kcal sugar (n=11522) 5678 (49.3) 5844 (50.7) 50% kcal sugar (n=171) 83 (48.5) 88 (51.5) All Adults (n=21197) (65.3) (63.6) < 50% kcal sugar (n=20867) (50.9) (49.1) 50% kcal sugar (n=501) 197 (59.7) 133 (40.3) 10.39± ± ± ± ± ± Race: n (%) Mexican American Other Hispanic Non-Hispanic White Non-Hispanic Black Other Marital Status: n (%) 3 Married Widowed Divorced Separated Never Married Living with Partner Total Kcal/Day: Mean±SD 3101 (46.7) 1096 (37.2) 3351 (25.8) 3135 (40.1) 1010 (40.2) ± (26.6) 1080 (9.4) 3283 (28.5) 3090 (26.8) 1001 (8.7) 33 (19.3) 16 (9.4) 68 (39.8) 45 (26.3) 9 (5.3) 3549 (53.4) 1848 (62.8) 9623 (74.2) 4676 (59.9) 1501 (59.8) (50.2) 1736 (8.2) 2173 (10.3) 698 (3.3) 3870 (18.3) 1631 (7.7) 3518 (16.9) 1832 (8.8) 9445 (45.3) 4581 (22.0) 1491 (7.1) (51.4) 1717 (8.4) 2120 (10.4) 684 (3.3) 3797 (18.6) 1599 (7.8) 31 (9.4) 16 (4.8) 178 (53.9) 95 (28.8) 10 (3.0) 129 (40.3) 19 (5.9) 53 (16.6) 14 (4.4) 73 (22.8) 32 (10.0) ± ± ± ± ±

9 Table 1. Demographic Characters of Children and Adults by Sugar Intake Continued (n=32890) Characteristics Children Adults Education Level of Adults 20 Years Old: n (%) 4 Less than 9 th grade 9-11 th grade (includes 12 th grade with no diploma) High school graduate/ged or equivalent Some college of AA degree College graduate or above Smoking Status: n (%) Smokes cigarettes every day Smokes cigarettes some days Does not smoke cigarettes at all Adult Food Security Category: n (%) Full Food Security Marginal Food Security Low Food Security Very Low Food Security Child Food Security Category (for children 17): n (%) Full Food Security Marginal Food Security Low Food Security Very Low Food Security All Children (n=11693) 2528 (76.5) 256 (7.8) 453 (13.7) 65 (2.0) <50% kcal sugar (n=11522) 2492 (76.6) 253 (7.8) 446 (13.7) 62 (1.9) 50% kcal sugar (n=171) 36 (73.5) 3 (6.1) 7 (14.3) 3 (6.1) All Adults (n=21197) 2393 (11.3) 3242 (15.3) 4757 (22.4) 5774 (27.2) 4312 (20.3) 829 (39.3) 159 (6.6) 1154 (54.7) 3633 (76.9) 471 (10.0) 433 (9.2) 188 (4.0) < 50% kcal sugar (n=20867) 2355 (11.7) 3180 (15.8) 4660 (23.1) 5678 (28.1) 4289 (21.2) 809 (3.8) 156 (7.5) 1143 (54.2) 3591 (77.0) 464 (10.0) 422 (9.1) 184 (3.9) 50% kcal sugar (n=501) 38 (12.0) 62 (19.6) 97 (30.7) 96 (30.4) 23 (7.3) 20 (58.8) 3 (8.8) 11 (32.4) 42 (65.6) 7 (10.9) 11 (17.2) 4 (6.3) 1 3 and 18 years of age 2 >18.1 years of age 3 11 subjects were missing/not reported 4 22 subjects were missing/not reported

10 Figure'1.'Chi'square'analysis'indicates'that'there'is'a'significant'association'among' adults'who'consumed'greater'than'or'equal'to'50%'of'their'calories'from'sugar'and' those'who'consumed'less'than'50%'of'their'calories'from'sugar'and'education'level' (p<0.001).'

11 Figure'2.'Chi'square'analysis'indicates'that'there'is'a'significant'association'among' adults'who'consumed'greater'than'or'equal'to'50%'of'their'calories'from'sugar'and' those'who'consumed'less'than'50%'of'their'calories'from'sugar'and'smoking'status' (p=0.036).'

12 Figure'3.'Chi'square'analysis'indicates'that'there'is'a'significant'association'among' children'who'consumed'greater'than'or'equal'to'50%'of'their'calories'from'sugar' and'those'who'consumed'less'than'50%'of'their'calories'from'sugar'and' race/ethnicity'(p=0.010).

13 Figure'4.'Chi'square'analysis'indicates'that'there'is'a'significant'association'among' adults'who'consumed'greater'than'or'equal'to'50%'of'their'calories'from'sugar'and' those'who'consumed'less'than'50%'of'their'calories'from'sugar'and'race/ethnicity' (p<0.001).'

14 Figure'5.'Chi'square'analysis'indicates'that'there'is'no'significant'association'among' children'who'consumed'greater'than'or'equal'to'50%'of'their'calories'from'sugar' and'those'who'consumed'less'than'50%'of'their'calories'from'sugar'and'child'food' security'status'(p=0.203).'

15 Figure!6.!Chi!square!analysis!indicates!that!there!is!no!significant!association!among! adult!who!consumed!greater!than!or!equal!to!50%!of!their!calories!from!sugar!and! those!who!consumed!less!than!50%!of!their!calories!from!sugar!and!adult!food! security!status!(p=0.088).

16 Figure'7.'Chi'square'analysis'indicates'that'there'is'a'significant'association'among' adults'who'consumed'greater'than'or'equal'to'50%'of'their'calories'from'sugar'and' those'who'consumed'less'than'50%'of'their'calories'from'sugar'and'marital'status' (p<0.001).

17 Discussion 1.46% of children consumed 50% of their calories from sugar, while 98.54% of children consumed <50% of their calories from sugar 2.36% of adults consumed 50% of their calories from sugar, while 98.44% of adults consumed <50% of their calories from sugar There were statistically significant associations among sugar intake and marital status, smoking status, race/ ethnicity, and education level However, not clinically significant given low effect size Associations among sugar intake and smoking status, race/ethnicity, and education level is consistent with most of past research 1-4 There was no association among sugar intake and food security in both children and adults Research suggests that low food security is associated with increased sugar intake 5

18 Conclusion Non-Hispanic white children and adults and current every day smokers consumed a larger percent of their calories from sugar Those with higher education consumed less calories from sugar Further research needed to examine a broader range of individuals with more variety of demographic variables

19 References 1. Ervin RB, Kit BK, Carroll MD, Ogden CL. Consumption of added sugar among U.S. children and adolescents, National Center for Health Statistics. 2012;NCHS data brief no Ervin RB OC. Consumption of added sugars among U.S. adults, National Center for Health Statistics. 2013;NCHS data brief no Zizza CA, Sebastian RS, Wilkinson Enns C, Isik Z, Goldman JD, Moshfegh AJ. The contribution of beverages to intakes of energy and MyPlate components by current, former, and never smokers in the united states. J Acad Nutr Diet. 2015;115(12): Thompson FE, McNeel TS, Dowling EC, Midthune D, Morrissette M, Zeruto CA. Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the united states: National health interview survey, J Am Diet Assoc. 2009;109(8): Sharkey JR, Nalty C, Johnson CM, Dean WR. Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among mexican-origin children (6-11 y) in texas border colonias. BMC Pediatr. 2012;12: United States Department of Agriculture. Databases and SAS data sets. Updated Centers for Disease Control and Prevention, National Center for Health Statistics. National health and examination survey data. Published Updated Centers for Disease Control and Prevention, National Center for Health Statistics. National health and examination survey data. Updated Centers for Disease Control and Prevention, National Center for Health Statistics. National health and examination survey data. Updated Centers for Disease Control and Prevention, National Center for Health Statistics. National health and examination survey data. Updated