Sugar-Sweetened Beverages in Childhood Increases Diabetes, MASLD Risk, With Melissa Wallach, MD, and Meghan Tozzi, MD

Despite widespread awareness of the cardiovascular risks of excess sugar intake, it still makes up roughly 17% of a child’s daily calorie intake – half of which is from sugar-sweetened drinks like soda and juice.1

Previous research has demonstrated that children who consume >10% of their daily caloric intake from added sugars are more likely to exhibit abnormal cholesterol levels, which is associated with a higher risk of type 2 diabetes (T2D). Metabolic dysfunction-associated liver disease (MASLD) is also a substantial risk factor associated with higher sugar intake.1

“We really need to talk to our patients about the fact that, even though the baby in front of you appears very healthy, what we do with regard to their nutrition now can affect long-term things like blood pressure, diabetes, and even fatty liver disease,” Melissa Wallach, MD, a pediatrician at K. Hovnanian Children’s Hospital, Hackensack Meridian Jersey Shore University Medical Center, told HCPLive in an exclusive interview. “While we have control over what goes in the baby’s mouth, especially at the first year of life, we recommend absolutely no juice.”

Previous scientific statements from the American Heart Association (AHA) recommend that children between 2 and 18 years should have <25 grams of added sugar daily, equating to roughly 6 teaspoons. A substantial amount of this sugar comes from sodas, fruit drinks, sports drinks, and sweet teas – even those marketed as healthy. A single 12-ounce can of soda can contain up to 10 teaspoons of sugar, exceeding the daily recommendation of added sugar and approaching the overall daily sugar limit for children.1

Another statement from the AHA functionally defined sugar-sweetened beverages as drinks composed almost exclusively of added sugars and water. The document also provided recommendations to manage children’s access to sugar-sweetened beverages, which include the following:

• Avoid soda, sweet tea or coffee, fruit drinks, and sports drinks in favor of serving water or milk
• Limit access to fruit juice, which generally has substantially more sugar per serving than whole fruit
• Read nutrition labels carefully, as many foods now list added sugar separately. Aim for <25 grams of added sugar per day for children ≥2 years
• Limit processed and pre-packaged food and drinks.2

A significant degree of exposure to added sugars takes place outside the home, with school lunches often providing juice or chocolate milk to supplement lunches that are already largely empty calories. Additionally, free breakfast and lunch programs, an attempt to provide for lower income families, often presents those children with even higher amounts of added sugar, putting them at greater risk.2

“Many of our children, especially from low-income families, do receive the majority of their nutrition at school through free breakfasts and lunches,” Meghan Tozzi, MD, a pediatric cardiologist at Joseph M. Sanzari Children’s Hospital, Hackensack Meridian, Hackensack University Medical Center, told HCPLive. “We’re providing so many empty calories to children – we’re handing them what we’re telling them not to have.”

Editors’ Note: Tozzi and Wallach report no relevant disclosures.

References

1. Hackensack Meridian Health. Unmasking the Real Sugar Threat to Our Kids During Heart Month. Newswise. February 19, 2026. Accessed March 12, 2026. https://www.newswise.com/articles/unmasking-the-real-sugar-threat-to-our-kids-during-heart-month

2. Vos MB, Kaar JL, Welsh JA, et al. Added sugars and cardiovascular disease risk in children: A scientific statement from the American Heart Association. Circulation. 2017;135(19). doi:10.1161/cir.0000000000000439