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Session: Sugar, Beverage, and Disease Risk (Oral 37)

(OR37-07-24) Associations Between Dietary Sugar Intake and Diet Quality Indexes: A Systematic Review of Recent Literature

Tuesday, July 2, 2024
11:12 AM – 11:24 AM CT
Location:  W375B

    Presenting Author(s)

  • Kelly C. Cara, PhD (she/her/hers)

    Post-Doctoral Fellow
    American Cancer Society
    Atlanta, Georgia, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Zhongqi Fan, MS

    Graduate Student
    The Gerald J. And Dorothy R. Friedman School Of Nutrition Science And Policy at Tufts University
    Malden, Massachusetts, United States

  • YC

    Yu-Hsiang Chiu

    Friedman School of Nutrition Science and Policy at Tufts University

  • XJ

    Xu Jiang

    Friedman School of Nutrition Science and Policy at Tufts University

  • HA

    Haya Alhmly

    Friedman School of Nutrition Science and Policy at Tufts University

  • MC

    Mei Chung, PhD, MPH

    Associate Professor
    Friedman School of Nutrition Science and Policy at Tufts University
    Boston, Massachusetts, United States

Objectives: Dietary guidelines promote nutrient-dense foods and limited intake of added and free sugars. Understanding the relationship between sugar intake and diet quality can inform public health recommendations for healthy food choices and reduced chronic disease risk. This systematic review aimed to synthesize recent literature on associations between sugar intake and diet quality in generally healthy populations.

Methods: We searched 4 databases from Jan 2010 to Oct 2022 for studies of any design that examined associations for quantified sugar intake in daily diet and diet quality indexes (DIs) in generally healthy populations aged ≥2. We separately analyzed sugar types and different DIs. Modified Nutrition Quality Evaluation Strengthening Tools assessed risk of bias. 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.

Results: From 13,869 screened records, we included 11 papers on cross-sectional studies measuring diet quality with indexes. No studies of other designs met eligibility criteria. Risk of bias was neutral (n = 7) or poor (n = 4) due to study design and lack of account for important confounding factors. For DIs with a free or added sugar component, results across sugar types were mixed. Correlations with added sugar were negative (n = 4; rrange = -0.42 to -0.13; P < 0.05) except for one null result (r = 0.00; 95% CI -0.14, 0.14). Correlations were mixed for total sugar intake (n = 2; rrange = -0.20 to 0.09) and positive for free sugar intake (n = 1; r = 0.17; 95% CI 0.10, 0.24). Dose-response relationships within individual studies were present for negative and positive associations. DIs with no sugar component also had mixed results. Correlations were mixed for added sugar intake (n = 5; rrange = -0.21 to 0.39) and free sugar intake (n = 2; rrange = -0.22 to 0.06) but null for total sugar intake (n = 1; r = 0.00; 95% CI -0.09, 0.09).

Conclusions: Studies using diet quality indexes with or without a free or added sugar component showed mixed but mostly negative associations with added sugar and mixed results for total and free sugars. Only cross-sectional studies were identified by this review. Prospective studies are needed to minimize confounding and inform causal relationships.

Funding Sources: World Sugar Research Organisation