Rachel K. Johnson, PhD, MPH, RD Professor of Nutrition and Associate Provost The University of Vermont Member AHA Nutrition Committee

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 littleadded 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 Minimize intake of foods and beverages with added sugars

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) Dairy desserts and milk products (ice cream, sweetened yogurt, and sweetened milk) Other grains (cinnamon toast and honey-nut waffles) 9.7 8.6 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 Health2007;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 Energy needs calories Discretionary calories Added sugars, tsp Added sugars, calories Active Sedentary Moderately active 3000 2200 1800 1600 512 290 195 132 18 9 5 3 288 144 80 48 Sedentary

Food Amount Calories from added sugars Coca-cola 12 ounce can 140 9 Snapple iced tea Snickers bar 16 ounce bottle 184 11.5 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 Teaspoons added sugars

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.