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

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

Understanding the relationship between the intake of sugars and diet quality can inform public health recommendations. This systematic review synthesized recent literature on associations between sugar intake and diet quality in generally healthy populations aged 2 years or older. We searched databases from 2010 to 2022 for studies of any design examining associations between quantified sugar intake in the daily diet and dietary indexes (DIs) or micronutrient intakes. Different sugar types and diet quality measures were analyzed separately. We converted DI results to Pearson's r correlations and grouped indexes with or without a free or added sugar component to facilitate cross-study comparisons. Meta-analysis was deemed inappropriate. From 13,869 screened records, we included 27 cross-sectional studies. NUQUEST risk of bias ratings were neutral (n = 18 studies) or poor (n = 9), and strength of evidence by the GRADE approach was very low due to study design. Most studies reported negative associations for added and free sugars with diet quality indexes (r ranging from -0.13 to -0.42) and nutrients of public health concern (fiber, vitamin D, calcium, potassium), while associations with total sugars were mixed. Due to cross-sectional study designs, the clinical relevance of these findings is unclear. Prospective studies are needed to minimize confounding and inform causal relationships.

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

The relative importance of amount and frequency of sugars intake for caries development has been a matter of debate in recent years, yet only one study has formally evaluated this question among adults. The aims of this study were to explore the shape of the relationship between amount and frequency of added sugars intake and their associations with dental caries among adults. Cross-sectional data from 10,514 adults, aged 20+ years, from the National Health and Nutrition Examination Survey (NHANES) 2011–2016 were analyzed. The amount (g/day) and frequency (items/day and episodes/day) of added sugars intake were derived from dietary recalls. Dental caries was indicated by the DMFS and DS scores. Fractional polynomials were used to characterize the relationship between amount and frequency of added sugars intake. Their associations with DMFS and DS were evaluated in negative binomial regression models adjusting for confounders. There was a logarithmic relationship between amount and frequency of added sugars intake. The amount of added sugars intake was positively associated with the DMFS (rate ratio: 1.11, 95% CI: 1.07–1.15) and DS scores (1.43, 95% CI: 1.33–1.54). However, the estimates for frequency of added sugars intake varied depending on how it was expressed. When expressed in items/day, it was not associated with the DMFS (1.02, 95% CI: 0.99–1.04) or DS score (0.91, 95% CI: 0.81–1.02). When expressed in episodes/day, it was positively associated with the DMFS (1.43, 95% CI: 1.33–1.54) but not with the DS score (0.95, 95% CI: 0.86–1.04). This study found a curvilinear relationship between the amount and frequency of added sugars intake. Furthermore, the amount of added sugars intake was more consistently and strongly associated with dental caries than the frequency of intake.