To our knowledge, this is the first paper to provide data on sources of solid fats and added sugars (collectively, empty calories) as well as total energy, among diets of children and adolescents, examined by race/ethnicity, income, and age groups. The variables examined are based on the most recent available data on a nationally representative sample of US children and adolescents.
Several previously published analyses laid the foundation for this work (15
). Subar et al. examined data from the 1989–1991 Continuing Survey of Food Intakes by Individuals (15
) and found 2–18 year olds in the US consumed 11.7% of energy from milk and 4.3% of total energy from soda (and 6.5% from all sugar-sweetened beverages). A higher proportion of energy consumption from soda and all sugar-sweetened beverages (5.8% and 8.5%, respectively) and a lower proportion of milk (7.1%) were identified in the current study. These trends regarding an increase in total energy from soda and fruit drinks are consistent with previous research (24
). More recently, Wang et al. found that 2–19 years olds consumed 10–15% of energy intake from sugar-sweetened beverages and 100% fruit juice (25
). Although the food groupings and age groupings were slightly different, our results are consistent with their findings (2–18 year olds consumed 11.1% of energy intake from sugar-sweetened beverages and 100% fruit juice) (25
A notable overlap was found between the major sources of energy and major sources of empty calories: soda, grain desserts, pizza, and whole milk. Soda is made up solely of empty calories; grain desserts can provide some nutrients but are generally rich in both solid fats and added sugars; and pizza and whole milk supply needed nutrients but are also rich in solid fats. Whole milk has more nutrient-dense alternatives: fat-free milk and/or reduced-fat milk. Pizza and grain desserts are generally made commercially; these foods could benefit from reformulation to reduce the empty calories and make them healthier.
The landscape of choices available to children and adolescents must change to provide fewer unhealthy foods and more healthy foods with fewer calories. Several analyses have attempted to quantify the existing “energy gap,” or energy imbalance that contributes to overweight and obesity among children and adolescents (26
). Whether the energy gap is 150 (26
) or 350 kcal/day (27
), identifying sources of energy and empty calories can provide targets for changes in the marketplace and the food environment. Dietitians, nutritionists, and other health professionals can work to promote healthier food environments for children and adolescents at multiple levels—at the macro-, community-, school-, and individual-levels.
Groups such as the Healthy Weight Commitment Foundation, a partnership among major food and beverage manufacturers, trade associations, retailers, and others, have formed around the common goal of reducing childhood obesity by 2015 (28
). Given recent weight status trends, this is an ambitious goal, but one that the food industry is uniquely positioned to influence through the use of product innovation, portion control, and promotions. For example, a major cereal manufacturer has committed to reducing to single digits the grams of sugar per serving in sugar-sweetened breakfast cereals advertised to children (29
), and other companies participating in this new initiative may consider smaller-portion packages. However, such steps will not reduce obesity if they do not significantly reduce the flow of empty calories into the nation’s food supply, limit unhealthy foods, and provide consistent messaging about healthy foods. Future studies may investigate links between changes in empty calories in the food supply and changes in dietary intake.
Several caveats are worth noting, to aid in interpretation of the data. First, decisions regarding how to group or separate foods influenced the rankings. Fat-free milk, reduced-fat milk and whole milk were analyzed separately, as were soda, fruit drinks, and fruit juices, to allow for meaningful differences to be seen where they existed (for example, whole milk was a top source among younger children compared to adolescents). Although it was informative to examine these as discrete foods, it was also useful to combine them to see their additive contribution to energy intakes.
Second, the rankings for the specific foods also depended in part on how ubiquitously a given food was consumed. Foods that contained the most calories, solid fats, and/or added sugars were not necessarily the major contributors to population intake. Because some foods were commonly consumed in the population, they contributed more to total intake than foods that contained more energy (or solid fats or added sugars) per portion. Similarly, because adolescents require and consumed more energy than smaller children, the rankings for all ages considered together were heavily influenced by those of older children and teenagers.
Third, the mean contribution represents the average per capita rather than per user. For example, all persons age 2–18 consumed an average of 116 kcal/day from soda. If the analysis was restricted to only those children and adolescents who reported drinking soda on a given day, average caloric intake from soda would be higher.
Finally, these analyses make use of data from NHANES 2003–04. Although more recent NHANES data are available, MPED updates have not kept up with NHANES releases. It is not expected that substantial shifts in sources of energy, saturated fat or added sugars occurred in the relatively short span between these survey cycles. However, updated databases for MyPyramid equivalents are necessary to enable monitoring of trends. More current MPED data also are necessary for any other analysis requiring that food intake be evaluated in relation to dietary guidance.