Research Original Research| Volume 110, ISSUE 10, P1477-1484, October 2010

Dietary Sources of Energy, Solid Fats, and Added Sugars among Children and Adolescents in the United States



      The objective of this research was to identify top dietary sources of energy, solid fats, and added sugars among 2- to 18-year-olds in the United States.


      Data from the National Health and Nutrition Examination Survey, a cross-sectional study, were used to examine food sources (percentage contribution and mean intake with standard errors) of total energy (data from 2005-2006) and energy from solid fats and added sugars (data from 2003-2004). Differences were investigated by age, sex, race/ethnicity, and family income, and the consumption of empty calories—defined as the sum of energy from solid fats and added sugars—was compared with the corresponding discretionary calorie allowance.


      The top sources of energy for 2- to 18-year-olds were grain desserts (138 kcal/day), pizza (136 kcal/day), and soda (118 kcal/day). 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 energy consumed (798 of 2,027 kcal/day) by 2- to 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% to 20%). Half of empty calories came from six foods: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk.


      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 less energy. 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.
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        • Ogden C.L.
        • Carroll M.D.
        • Flegal K.M.
        High body mass index for age among US children and adolescents, 2003-2006.
        JAMA. 2008; 299: 2401-2405
        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • Lamb M.M.
        • Flegal K.M.
        Prevalence of high body mass index in US children and adolescents, 2007-2008.
        JAMA. 2010; 303: 242-249
        • Dietz W.H.
        Health consequences of obesity in youth: Childhood predictors of adult disease.
        Pediatrics. 1998; 101: 518-525
        • Schwimmer J.B.
        • Burwinkle T.M.
        • Varni J.W.
        Health-related quality of life of severely obese children and adolescents.
        JAMA. 2003; 289: 1813-1819
        • Nielsen S.J.
        • Siega-Riz A.M.
        • Popkin B.M.
        Trends in energy intake in US between 1977 and 1996: Similar shifts seen across age groups.
        Obesity Res. 2002; 10: 370-378
        • Nielsen S.J.
        • Popkin B.M.
        Patterns and trends in food portion sizes, 1977-1998.
        JAMA. 2003; 289: 450-453
        • Brownell K.D.
        • Schwartz M.B.
        • Puhl R.M.
        • Henderson K.E.
        • Harris J.L.
        The need for bold action to prevent adolescent obesity.
        J Adolesc Health. 2009; 45: S8-S17
        • Krebs-Smith S.M.
        • Reedy J.
        • Bosire C.
        Healthfulness of the U.S. food supply: Little improvement despite decades of dietary guidance.
        Am J Prev Med. 2010; 38: 472-477
      1. Usual dietary intakes: Food intakes, US population, 2001-04.
        (National Cancer Institute Web site) (Accessed December 17, 2009)
      2. (MyPyramid Web site) (Accessed December 17, 2009)
      3. Dietary Guidelines for Americans, 2005.
        6th ed. US Government Printing Office, Washington DC2005
        • Guenther P.M.
        • Reedy J.
        • Krebs-Smith S.M.
        Development of the Healthy Eating Index-2005.
        J Am Diet Assoc. 2008; 108: 1896-1901
        • Basiotis P.P.
        • Guenther P.M.
        • Lino M.
        • Britten P.
        Americans consume too many calories from solid fat, alcohol, and added sugar.
        Nutrition Insight. June 2006; (Accessed December 17, 2009)
      4. Dietary interview, NHANES 2003-2006.
        (Public Data General Release File Documentation. National Center for Health Statistics Web site) (Accessed December 17, 2009)
        • Subar A.F.
        • Krebs-Smith S.M.
        • Cook A.
        • Kahle L.L.
        Dietary sources of nutrients among US children, 1989-1991.
        Pediatrics. 1998; 102: 913-923
        • Subar A.F.
        • Krebs-Smith S.M.
        • Cook A.
        • Kahle L.L.
        Dietary sources of nutrients among US adults, 1989 to 1991.
        J Am Diet Assoc. 1998; 98: 537-547
        • Cotton P.A.
        • Subar A.F.
        • Friday J.E.
        • Cook A.
        Dietary sources of nutrients among US adults, 1994 to 1996.
        J Am Diet Assoc. 2004; 104: 921-930
        • Bachman J.L.
        • Reedy J.
        • Subar A.F.
        • Krebs-Smith S.M.
        Sources of food group intakes among the US population, 2001-2002.
        J Am Diet Assoc. 2008; 108: 804-814
        • Troiano R.P.
        • Berrigan D.
        • Dodd K.W.
        • Mâsse L.C.
        • Tilert T.
        • McDowell M.
        Physical activity in the United States measured by accelerometer.
        Med Sci Sports Exerc. 2008; 40: 181-188
        • Thompson F.E.
        • Dennison B.A.
        Dietary sources of fats and cholesterol in US children aged 2 through 5 years.
        Am J Public Health. 1994; 84: 799-806
        • Troiano R.P.
        • Briefel R.R.
        • Carroll M.D.
        • Bialostosky K.
        Energy and fat intakes of children and adolescents in the United States: Data from the National Health and Nutrition Examination Surveys.
        Am J Clin Nutr. 2000; 72: 1343S-1353S
        • Guthrie J.F.
        • Morton J.F.
        Food sources of added sweeteners in the diets of Americans.
        J Am Diet Assoc. 2000; 100: 43-51
        • Nielsen S.
        • Popkin B.
        Changes in beverage intake between 1977 and 2001.
        Am J Prev Med. 2004; 27: 205-210
        • Wang Y.C.
        • Bleich S.N.
        • Gortmaker S.L.
        Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004.
        Pediatrics. 2008; 121: e1604-e1614
        • Wang Y.C.
        • Gortmaker S.L.
        • Sobol A.M.
        • Kuntz K.M.
        Estimating the energy gap among US children: A counterfactual approach.
        Pediatrics. 2006; 118: e1721-e1733
        • Swinburn B.
        • Sacks G.
        • Ravussin E.
        Increased food energy supply is more than sufficient to explain the US epidemic of obesity.
        Am J Clin Nutr. 2009; 90: 1453-1456
      5. Overview.
        (Healthy Weight Commitment Foundation Web site) (Accessed December 17, 2009)
      6. General Mills announces plans to reduce sugar content of children's cereals.
        (Robert Wood Johnson Foundation Web site) (Accessed December 17, 2009)


      J. Reedy is a nutritionist, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.


      S. M. Krebs-Smith is chief, Risk Factor Monitoring and Methods Branch in the Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.

      Linked Article

      • Labeling Solid Fats and Added Sugars As Empty Calories
        Journal of the American Dietetic AssociationVol. 111Issue 2
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          My purpose is to question the logic of grouping solids fats with added sugars and labeling the combination as empty calories. These terms are used extensively in the Journal's October 2010 research paper by Reedy and Krebs-Smith (1). The authors determined that about 54% of the empty calories consumed by children and adolescents were from solid fats and 46% were from added sugars.
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