title: Effect of AHA dietary counselling on added sugar intake among participants with metabolic syndrome.
abstract: BACKGROUND
  High added sugar consumption has been associated with the development of metabolic syndrome (MetS). The American Heart Association (AHA) diet is designed to prevent and treat MetS; however, it remains unclear whether the AHA diet is effective on decreasing added sugar consumption. The aim of our study was to evaluate the effect of the AHA dietary counselling on added sugar consumption among participants with MetS.
  
  
  METHODS
  The AHA dietary counselling was conducted among 119 participants with MetS from June 2009 to January 2014 (ClinicalTrials.gov: NCT00911885). Unannounced 24-hour recalls were collected at baseline, 3, 6 and 12 months. Added sugar consumption patterns over time were examined using linear mixed models.
  
  
  RESULTS
  After 1-year dietary counselling, intake of added sugars decreased by 23.8 g/day (95% CI 15.1, 32.4 g/day); intake of nonalcoholic beverages dropped from the leading contributor of added sugar intake to number 7 (from 11.9 to 4.4%); the Alternative Healthy Eating Index (AHEI) score increased by 5.4 (95% CI 2.9, 8.0); however, added sugar intake for 48% participants still exceeded the recommendation. Added sugar intake per meal among different meal type was similar (24.2-25.8%) at baseline. After the 1-year dietary counselling, breakfast became the major resource of added sugar intake (33.3%); the proportion of added sugar intake from snacks decreased from 25.8% (CI 23.1, 28.5%) to 20.9% (CI 19.6, 22.3%).
  
  
  CONCLUSIONS
  Although the consumption of added sugars in participants with MetS decreased after the 1-year AHA dietary counselling, added sugar intake from majority of participants still exceeds recommended limits. Actions of successful public health strategies that focus on reducing added sugar intake are needed.
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, 200120, China.|Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Sherry
authors.initials: S
authors.lastname: Pagoto
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: May
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Olendzki
authors.affiliation: Department of Biomedical and Nutritional Sciences, University of Massachusetts at Lowell, Lowell, MA, 01854, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: L Tucker
authors.affiliation: Department of Computer Science, Worcester Polytechnic Institute, Worcester, MA, 01609, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ruiz
authors.affiliation: Department of Computer Science, University of Massachusetts at Lowell, Lowell, MA, 01854, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA. Yunsheng.Ma@umassmed.edu.
authors.forename: Yunsheng
authors.identifier: http://orcid.org/0000-0003-2317-3716
authors.initials: Y
authors.lastname: Ma
mesh_terms: D000572:American Heart Association; D015992:Body Mass Index; D050528:Diet, Carbohydrate-Restricted; D000072001:Diet, Healthy; D000073417:Dietary Sugars / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006126:Group Processes; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008404:Massachusetts; D024821:Metabolic Syndrome / Q000178:diet therapy*; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D057566:Self Report; D012727:Sex Characteristics; D014481:United States
chemical_list: D000073417:Dietary Sugars
keywords: AHA dietary counselling; Added sugar; Metabolic syndrome