Disparities in Sources of Added Sugars and High Glycemic Index Foods in Diets of US Children, 2011–2016

Rienna G. Russo, MHS; Brandilyn A. Peters, PhD; Vanessa Salcedo, MD, MPH; Vivian HC Wang, RD, MS, MPA; Simona C. Kwon, DrPH, MPH; Bei Wu, PhD; Stella Yi, PhD, MPH


Prev Chronic Dis. 2020;17(11):e139 

In This Article

Abstract and Introduction


Introduction: Added sugars and high glycemic index (GI) foods might play a role in cardiometabolic pathogenesis. Our study aimed to describe the top sources of added sugars and types of high GI foods in diets of children by race/ethnicity.

Methods: We examined data for 3,112 children, aged 6 to 11 years from the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. Mean intake was estimated and linear regression models tested for differences by race/ethnicity. Population proportions for food sources were created and ranked, accounting for survey weighting when appropriate.

Results: Asian American and Mexican American children had the lowest reported added sugar intake. Cereals were observed to contribute highly to added sugar intake. Soft drinks did not contribute as much added sugar intake for Asian American children as it did for children of other races/ethnicities. Asian American children consumed significantly more high GI foods than other groups. Types of high GI foods differed meaningfully across racial/ethnic groups (ie, Mexican American: burritos/tacos; other Hispanic, White, and Black: pizza; Asian American: rice). Rice accounted for 37% of total high GI foods consumed by Asian American children.

Conclusions: Sources of added sugars and types of high GI foods in children's diets vary across racial/ethnic groups. Targeting foods identified as top sources of added sugars for all race/ethnicities and focusing on substitution of whole grains may reduce obesity, diabetes, and related cardiometabolic risk more equitably.


Childhood obesity remains a challenge, despite numerous policies and programs focused on improving nutrition and increasing physical activity among children.[1] Disparities in obesity, diet, and physical activity are clear for Hispanic and Asian American children, but data are limited.[2–4] According to national and local estimates, the burden of obesity is highest for Hispanic children in the United States. Although obesity prevalence is lowest among Asian American children,[3] anthropomorphic differences (eg, high percentage body fat, low muscle mass) among Asian populations have led to the broad consensus that current definitions of overweight and obesity likely underestimate the true burden of the metabolic effects of obesity among Asian American children.[5] Evidence is mounting about the long-term vulnerability of these children; Hispanic and Asian American children are at the highest risk for nonalcoholic fatty liver disease;[6] therefore, they are at greater risk than children of other races/ethnicities for cardiometabolic problems throughout the life course. Yet, few studies have focused on these population subgroups.

Studies have also recognized that the top dietary sources of sodium and preferred types of beverages for Hispanic and Asian Americans are different from those for non-Hispanic White and Black Americans,[4,7] despite that most nutrition policies and programs target non-Hispanic White and Black Americans. This implies a mismatch of initiatives to improve nutrition for Hispanic and Asian American children. Incompatible cultural policies and programs, lack of attention to equitable implementation, and prolonged disparate funding will lead to greater disparities in obesity and nutrition over time for Hispanic and Asian American children.[8,9]

Added sugars have been implicated as a leading predictor of dietary cardiometabolic concerns amongst children, including obesity, diabetes, and nonalcoholic fatty liver disease.[10–12] Added sugars do not include naturally occurring sugars, such as lactose in milk and fructose in 100% fruit juice.[13] Refined grains and other foods with a high glycemic index (GI) might also contribute to cardiometabolic conditions, because insulin resistance is involved in future diabetes and development of nonalcoholic fatty liver disease. High glycemic load results in increased risk of insulin dysregulation as well. Excess weight gain, elevated blood pressure, and type 2 diabetes all share links to added sugar and consumption of high GI food.[11,14–16]

The leading source of added sugars in children's diets is often sugar-sweetened beverages; however, no research has investigated other sources of added sugars that are most often consumed by racial/ethnic groups. Additionally, refined grains and other high GI foods might play a significant role in diabetes and the development of nonalcoholic fatty liver disease, especially among Asian American and other Hispanic (non-Mexican) populations for whom rice is traditionally a staple food.[17] Because these are potential food sources of cardiometabolic risk among children, our study aimed to 1) examine racial/ethnic differences in amounts of calories and added sugars consumed, 2) examine high GI food intake, 3) identify the top 10 sources of added sugars and types of high GI foods, and 4) stratify findings by race/ethnicity.