Associations Between Added Sugars Intake from Various Food and Beverage Sources and Diet Quality Among the US Population

Background: A diet high in added sugars has been linked to poor diet quality; however, little is known about specific sources of added sugars and their association with diet quality. Objective: This study examined associations between added sugars intake from specific food and beverage sources and diet quality, as indicated by the Healthy Eating Index (HEI) 2020 score, among the U.S. population. Methods: Data from eight consecutive 2-year cycles of the National Health and Nutrition Examination Survey (2003-2004 through 2017-2018) were pooled, and regression analysis was conducted to examine associations between total HEI-2020 score or HEI-2020 component scores and added sugars intake (% kcal) from key contributors: soft drinks, fruit drinks and coffee and tea; ready-to-eat cereals; flavored milk; sweet bakery products; and snack/meal bars. Results: A higher added sugars intake from soft drinks, fruit drinks and coffee and tea was associated with lower diet quality (lower total HEI score and lower scores on most of the HEI components) among both children and adults (p < 0.0001). In contrast, higher added sugars intakes from flavored milk (p < 0.0001) and snack/meals bars (p < 0.001) among children, and from sweet bakery products (p < 0.0001) among adults, were associated with higher diet quality. For all these associations, changes in the total HEI score across quintiles of added sugars intake were very small, ranging from 50.2 to 52.8 for children and 55.4 to 57.5 for adults, depending on the added sugars source. Conclusions: The nature of the relationship between added sugars intake and diet quality depends on the source of added sugars. While the small differences in diet quality may be of limited practical significance, our results suggest that the consideration of the different roles of various added sugars sources in the diet is warranted when developing dietary guidance.