(P02-009-23) Dietary Sugar Intake and Diet Quality: A Scoping Review

Objectives: Conduct a scoping review on the effect of sugar intake on diet quality in healthy populations.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement scoping review extension. Four bibliographic databases were searched for studies of humans ≥2 years old published from 1/1/2010 to 10/27/2022 in English. Intervention, cohort, or cross-sectional studies were considered if effects or associations of quantified sugar intake on diet quality index scores or intakes of micronutrients and fiber were reported in generally healthy participants. Different sugar types and diet quality outcomes were analyzed separately.

Results: Of 13,869 screened records, 25 papers were included (1 cohort; 24 cross-sectional). No intervention study met the review's eligibility criteria. Preliminary results: Dietary intakes were often captured by 24-hour recalls (60%), with food frequency questionnaires or diet diaries each used by 24% of papers. Added sugar was assessed in 52% of the papers, followed by total sugar (28%), free sugar (20%), and other sugars (12%). Sugar intake was mostly reported as % of total energy (56% of papers) or grams (40%). Most papers used intakes of minerals (60%), vitamins (56%), and fiber (48%), or all three (40%), as diet quality measures. For 14 papers examining both mineral and vitamin intakes, associations were examined with added sugar (50%), total sugar (29%), and free sugar (21%). Diet quality was measured by index scores (e.g., Healthy Eating Index) in 10 papers with most (70%) examining associations with added sugar.

Conclusions: This study included an extensive search for literature on dietary sugar and diet quality associations. Nearly all eligible studies were cross-sectional, and none were interventions. Despite its impact on human health, diet quality is often not considered a viable clinical or surrogate outcome for controlled trials, and disease outcomes are often prioritized for funding. The ethics of randomizing participants to sugar interventions may be questioned due to perceived harms. However, studies assigning reduced sugar intake from habitual patterns could provide valuable insights into causal associations between dietary sugar and diet quality measured by validated indexes or micronutrient intake adequacy.

Funding Sources: Supported by World Sugar Research Organisation