Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy

Abstract

Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.

Associations between Intake of Dietary Sugars and Diet Quality: A Systematic Review of Recent Literature

“…The average study population mean/median age was 25 years old (mean/median range: 2.08 to 52.56 years), with 15 studies on child/adolescent populations below a mean/median age of 18 years. One study did not report the mean or median age [ 14 ].…”

“…Sixteen studies from 15 articles reported on associations between dietary intakes of sugar and fiber [ 13 , 14 , 16 , 17 , 19 , 22 , 24 , 25 , 26 , 27 , 30 , 31 , 33 , 36 , 38 ], and the results are presented in Supplemental Table S4 along with factors accounted for by each study’s design or analysis. Most of these studies (62.5%) were rated as moderate for potential bias (neutral ROB) due to the study design, but other studies that only had one dietary intake measure and that did not control for important confounders were rated as high for potential bias (poor ROB; see Supplemental Table S2 ).…”

“…Most studies (75%) controlled for energy intake by including a total energy covariate in models and/or by assessing sugar as %E and fiber as %E, g/1000 kcal, or g/1000 kJ. While three other studies assessed sugar (%E), their models did not include total energy, and they analyzed fiber as a percentage of the population above the Adequate Intake (AI) level [ 14 ], as absolute intake (g) [ 30 ], or as a component score [ 33 ]. One remaining study analyzed both sugar and fiber as only absolute intakes (g) without controlling for energy [ 25 ].…”

“…One remaining study analyzed both sugar and fiber as only absolute intakes (g) without controlling for energy [ 25 ]. Eight of the studies were conducted in child or adolescent populations [ 16 , 17 , 19 , 26 , 27 , 30 , 38 ] or reported separate results for participants under age 19 [ 14 ]. All other studies were conducted in adult populations [ 13 , 22 , 24 , 31 , 33 , 36 ] or combined adolescents and adults in analyses [ 25 ].…”

Amount and Frequency of Added Sugars Intake and Their Associations with Dental Caries in United States Adults

“…Data on all foods and drinks ingested, including their corresponding USDA Food and Nutrient Database for Dietary Studies (FNDDS) code, time and place of eating, quantity (g), and calories, were obtained from the two 24 h dietary recalls in each NHANES cycle (the first carried out in person and the second over the phone 3 to 10 days later) [17]. Three indicators of added sugars intake were created from each recall day, which were then averaged across the two days [18]. One indicator reflected the amount of added sugars intake (g/day).…”