In this large prospective study, total fructose intake was weakly positively associated with all-cause mortality in both women and men, whereas added sugar, sucrose, and added sucrose intakes were inversely associated with other-cause mortality in men. In our analyses, intake of added sugars was not associated with an increased risk of mortality. The NIH-AARP Diet and Health Study was registered at clinicaltrials.gov as NCT00340015.

Measurement error in self-reported sugars intake may explain the lack of consistency in the epidemiologic evidence on the association between sugars and disease risk. This review describes the development and applications of a biomarker of sugars intake, informs its future use and recommends directions for future research. Recently, 24 h urinary sucrose and fructose were suggested as a predictive biomarker for total sugars intake, based on findings from three highly controlled feeding studies conducted in the United Kingdom. From this work, a calibration equation for the biomarker that provides an unbiased measure of sugars intake was generated that has since been used in two US-based studies with free-living individuals to assess measurement error in dietary self-reports and to develop regression calibration equations that could be used in future diet-disease analyses. Further applications of the biomarker include its use as a surrogate measure of intake in diet-disease association studies. Although this biomarker has great potential and exhibits favorable characteristics, available data come from a few controlled studies with limited sample sizes conducted in the UK. Larger feeding studies conducted in different populations are needed to further explore biomarker characteristics and stability of its biases, compare its performance, and generate a unique, or population-specific biomarker calibration equations to be applied in future studies. A validated sugars biomarker is critical for informed interpretation of sugars-disease association studies.

ObjectiveThe objective of the present study was to investigate associations between sugar intake and overweight using dietary biomarkers in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).DesignProspective cohort study.SettingEPIC-Norfolk in the UK, recruitment between 1993 and 1997.SubjectsMen and women (n 1734) aged 39–77 years. Sucrose intake was assessed using 7 d diet diaries. Baseline spot urine samples were analysed for sucrose by GC-MS. Sucrose concentration adjusted by specific gravity was used as a biomarker for intake. Regression analyses were used to investigate associations between sucrose intake and risk of BMI>25·0 kg/m2 after three years of follow-up.ResultsAfter three years of follow-up, mean BMI was 26·8 kg/m2. Self-reported sucrose intake was significantly positively associated with the biomarker. Associations between the biomarker and BMI were positive (β=0·25; 95 % CI 0·08, 0·43), while they were inverse when using self-reported dietary data (β=−1·40; 95 % CI −1·81, −0·99). The age- and sex-adjusted OR for BMI>25·0 kg/m2 in participants in the fifth v. first quintile was 1·54 (95 % CI 1·12, 2·12; P trend=0·003) when using biomarker and 0·56 (95 % CI 0·40, 0·77; P trend<0·001) with self-reported dietary data.ConclusionsOur results suggest that sucrose measured by objective biomarker but not self-reported sucrose intake is positively associated with BMI. Future studies should consider the use of objective biomarkers of sucrose intake.

Background Understanding determinants of high consumption of sugar-sweetened beverages (SSB), a highly prevalent obesogenic behavior, will help build effective customized public health interventions. Objective To identify child and parent lifestyle and household demographic factors predictive of high SSB consumption frequency in children from low-income, ethnically diverse communities that may help inform public health interventions. Design Cross-sectional telephone household survey. Participants/Setting 717 boys and 686 girls 3–18 years old from the New Jersey Childhood Obesity Study living in five low-income cities (Camden, New Brunswick, Newark, Trenton, and Vineland). The adult most knowledgeable about household food shopping completed a questionnaire over the telephone inquiring about their and their child’s dietary and physical activity habits, and household-, parent-, and child-level demographics. Main outcome measures Child’s SSB consumption frequency. Statistical analysis performed Multivariate ordered logit models were designed to investigate a variety of variables hypothesized to affect the frequency of SSB consumption. Exploratory stratified analyses by race, gender, and age were also conducted. Results Eight percent of our study participants never consumed SSBs, 45% consumed SSBs at least once per day, and 23% consumed twice or more per day. SSB consumption was higher among children 12–18 vs. 3–5 years (p<0.0001), of non-Hispanic black vs. non-Hispanic white race/ethnicity (p=0.010), who were moderate fast food consumers vs. never consumers (p=0.003), and those whose parents were high vs. low SSB consumers (p<0.0001). Living in a non-English speaking household (p=0.030), having a parent with a college or higher education vs. less than high school (p=0.003), and having breakfast 6–7 days/week vs. never to ≤ twice/week were associated with lower SSB consumption (p=0.001). Conclusions We identified a number of household-, parental-, and child-level predictors of SSB consumption, which varied by race, gender and age, useful for building customized interventions targeting certain behaviors in ethnically diverse, low-income children.

Background Measurement error (ME) in self-reported sugars intake may be obscuring the association between sugars and cancer risk in nutritional epidemiologic studies. Methods We used 24-hour urinary sucrose and fructose as a predictive biomarker for total sugars, to assess ME in self-reported sugars intake. The Nutrition and Physical Activity Assessment Study (NPAAS) is a biomarker study within the Women’s Health Initiative (WHI) Observational Study, that includes 450 post-menopausal women aged 60–91. Food Frequency Questionnaires (FFQ), 4-day food records (4DFR) and three 24-h dietary recalls (24HRs) were collected along with sugars and energy dietary biomarkers. Results Using the biomarker, we found self-reported sugars to be substantially and roughly equally misreported across the FFQ, 4DFR and 24HR. All instruments were associated with considerable intake- and person-specific bias. Three 24HRs would provide the least attenuated risk estimate for sugars (attenuation factor, AF=0.57), followed by FFQ (AF=0.48), and 4DFR (AF=0.32), in studies of energy-adjusted sugars and disease risk. In calibration models, self-reports explained little variation in true intake (5–6% for absolute sugars; 7–18% for sugars density). Adding participants’ characteristics somewhat improved the percentage variation explained (16–18% for absolute sugars; 29–40% for sugars density). Conclusions None of the self-report instruments provided a good estimate of sugars intake, although overall 24HRs seemed to perform the best. Impact Assuming the calibrated sugars biomarker is unbiased, this analysis suggests that, measuring the biomarker in a subsample of the study population for calibration purposes may be necessary for obtaining unbiased risk estimates in cancer association studies.