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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

Richard Wood

Second Advisor

Zhenhua Liu

Third Advisor

Daniel Gerber

Subject Categories

Public Health Education and Promotion


We carried out a secondary data analysis of adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. All analyses were weighted using NHANES sample weights to account for the complex survey design, survey non-response, and post-stratification. Overall, the majority of our population (60.4%) exceeded the USDA/HHS recommendation on added sugar consumption.

In the first study, soft drink availability at home was positively associated with added sugar intake (p

In the second study, added sugar intake was negatively associated with diet quality determined by Healthy Eating Index (HEI) 2015, after adjusting for covariates. With regards to energy and nutrient intakes, excess added sugar intake was significantly related to high energy intake and compromised intakes of most macro- and micro-nutrients. Interestingly, excess added sugar intake was significantly associated with reduced sodium consumption, even after adjusting for energy intake (p<0.001).

In our third study, after adjusting for covariates, individuals consuming more than 25% of calories from added sugar in the diet had nearly 4-times likelihood of having low HDL- cholesterol, compared to those consuming ≤10% of calories from added sugar (OR=3.68 among men, p=0.01; OR=3.88 among women, p

Together, the results of these studies suggest that certain consumer behaviors may be related to added sugar intake. Consuming excess amount of added sugar in the diet may play a complicated role in affecting diet quality, and in the risks of developing cardio-metabolic abnormalities. Our findings provide evidence for future intervention and policy changes in terms of reducing added sugar intake, to aid in efforts to promote healthy eating and overall health among adults.