Added Sugar Sources and Their Impact on Diet Quality and Nutrient Intakes: An Analysis Across Added Sugar Intake Levels in United States Children and Adults.

Background: Added sugars (AS) are considered free sugars that are added to foods, and the Dietary Guidelines for Americans 2020‒2025 recommend limiting their intake to <10% calories. Objectives: To evaluate diet quality and nutrient adequacy at increasing AS intake levels. Methods: Two-day 24-h dietary recall data from the National Health and Nutrition Examination Survey 2011-2018 were used for intake assessment, and AS intake categories were defined as <10%, 10-15% and >15% of calories from AS. Results: About one-third of the children were in each AS intake category, although nearly half of the adult population was in the <10% calories from AS category, and the mean AS intake was 13.4% calories in children and 12.2% calories in adults. With increasing AS calories, diet quality (Healthy Eating Index 2020 scores), and intakes and adequacies for nutrients of public health concern (calcium, vitamin D, fiber, and potassium), and numerous other nutrients decreased among both children and adults. "Soft drinks," "fruit drinks," "tea," "cookies and brownies," "cakes and pies," "ice creams and frozen dairy desserts," and "candies" were consistently among the top 10 sources of AS for both children and adults. The top 10 sources of AS contributed ∼70% of AS in the diets of children and adults, but only 8‒11% and 2‒7% of daily intakes of nutrients of public health concern, respectively. Ready-to-eat cereals were the fourth and the ninth sources of AS and provided 6.1% and 3.1% AS, and 2.7‒9.9% and 1.5‒6.4% nutrients of public health concern in the diet. With increasing AS calories, the contribution of "soft drinks," "fruit drinks," and "tea" to AS increased, whereas the contribution of ready-to-eat cereals to AS decreased in both children and adults, respectively. Conclusions: Higher AS intakes were associated with lower diet quality, lower nutrient intakes, and lower nutrient adequacy in both children and adults; however, recommendations to reduce AS should focus on reducing AS from non-nutrient-dense sources, while recognizing the nutrient contributions of nutrient-dense foods and beverages containing AS. These findings can provide useful insights for policy and regulatory development related to nutrition and public health.