Objective To assess recent trends in nonalcoholic fatty liver disease (NAFLD) prevalence among US adolescents. Study design Cross-sectional data from 12 714 12–19 year olds (exclusions: chronic hepatitis, hepatotoxic medications) in the National Health and Examination Survey between 1988–1994 and 2007–2010 were used to estimate trends in suspected NAFLD, defined as overweight (body mass index ≥85th percentile) plus elevated alanine aminotransferase levels (boys >25.8 U/L; girls >22.1 U/L). Linear trends in prevalence and the independent effect of demographic indicators and adiposity on NAFLD risk were tested using regression models. Complex sampling methods and P values of <.05 were used to assess statistical significance. Results Suspected NAFLD prevalence (SE) rose from 3.9% (0.5) in 1988–1994 to 10.7% (0.9) in 2007–2010 (P < .0001), with increases among all race/ethnic subgroups, males and females, and those obese (P trend ≤.0006 for all). Among those obese, the multivariate adjusted odds of suspected NAFLD were higher with increased age, body mass index, Mexican American race, and male sex; the adjusted odds in 2007–2010 were 2.0 times those in 1988–1994. In 2007–2010, 48.1% (3.7) of all obese males and 56.0% (3.5) of obese Mexican American males had suspected NAFLD. Conclusion Prevalence of suspected NAFLD has more than doubled over the past 20 years and currently affects nearly 11% of adolescents and one-half of obese males. The rapid increase among those obese, independent of body mass index, suggests that other modifiable risk factors have influenced this trend.

BACKGROUND Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contribute to a diet that is energy dense but nutrient poor and increase risk of developing obesity, cardiovascular disease, hypertension, obesity-related cancers, and dental caries. METHODS AND RESULTS For this American Heart Association scientific statement, the writing group reviewed and graded the current scientific evidence for studies examining the cardiovascular health effects of added sugars on children. The available literature was subdivided into 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity. CONCLUSIONS Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adiposity, and dyslipidemia. The committee found that it is reasonable to recommend that children consume ≤25 g (100 cal or ≈6 teaspoons) of added sugars per day and to avoid added sugars for children <2 years of age. Although added sugars most likely can be safely consumed in low amounts as part of a healthy diet, few children achieve such levels, making this an important public health target.

Although the consumption of added sugars in the United States decreased between 1999-2000 and 2007-2008, primarily because of a reduction in soda consumption, mean intakes continue to exceed recommended limits.

ABSTRACT. Objective. To examine the association between sweet drink consumption and overweight among preschool children.Methods. A retrospective cohort design was used to examine the association between sweet drink consumption and overweight at follow-up among 10 904 children who were aged 2 and 3 years and had height, weight, and Harvard Service Food Frequency Questionnaire data collected between January 1999 and December 2001 and height and weight data collected 1 year later. Sweet drinks included vitamin C-containing juices, other juices, fruit drinks, and sodas as listed on the Harvard Service Food Frequency Questionnaire. Logistic regression was used to adjust for age; gender; race/ethnicity; birth weight; and intake of high-fat foods, sweet foods, and total calories. Results were stratified by baseline BMI.Results. Among children who were normal or underweight at baseline (BMI <85th percentile), the association between sweet drink consumption and development of overweight was positive but not statistically significant. Children who were at risk for overweight at baseline (BMI 85th-<95th percentile) and consumed 1 to <2 drinks/day, 2 to <3 drinks/day, and >3 drinks/day were, respectively, 2.0 (95% confidence interval [CI]: 1.3-3.2), 2.0 (95% CI: 1.2-3.2), and 1.8 (95% CI: 1.1-2.8) times as likely to become overweight as the referent (<1 drink/ day). Children who were overweight at baseline (BMI >95th percentile) and consumed 1 to <2 drinks/day, 2 to <3 drinks/day, and >3 drinks/day were, respectively, 2.1, 2.2, and 1.8 times as likely to remain overweight as the referent.Conclusions. Reducing sweet drink consumption might be 1 strategy to manage the weight of preschool children. Additional studies are needed to understand the mechanism by which such consumption contributes to overweight. Pediatrics 2005;115:e223-e229. URL: www. pediatrics.org/cgi