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Proportion of the US population whose intakes of added sugars exceed the suggested maximum in the dietary reference intakes

Canadian Sugar Institute
10 Bay Street, Suite 620
Toronto, Ontario M5J 2R8
Canada
E-mail: rkaplan{at}sugar.ca

Dear Sir:

In a recent issue of the Journal, Murphy and Johnson (1) estimated the proportions of US subpopulations with intakes of added sugars exceeding 25% of energy intake, which is the "suggested" maximum according to the dietary reference intake (DRI) macronutrient report (2). This maximum was based on the decreased intake of some micronutrients in US subpopulations whose intakes of added sugars exceed this maximum (2). Unfortunately, the data of Murphy and Johnson (1) represent overestimates of the true proportion because of the use of incorrect methodology.

To assess the proportion of the population whose intakes exceed the maximum, the distribution of usual (long-term average) intakes of added sugars as a percentage of energy must be known (2). It is noted in the DRI report that average intakes of added sugars are estimated to be 15.7% of energy intake (2); however, distributions of usual intakes were not provided.

On the basis of unadjusted, 1-d, 24-h dietary recalls provided in the DRI report (2), Murphy and Johnson (1) estimated the proportion of subjects in each of 9 subgroups (categorized by age and sex) who reported intakes of >25% of energy from added sugars. They divided the number of subjects in each subgroup with intakes of >25% of energy from added sugars by the total number of participants in each subgroup and reported this as the proportion who consume >25% of energy from added sugars. They concluded that the proportion ranges from 8.7% (females aged 51 y) to 30.1% (females aged 14–18 y).

The problem with these data is that they are based on unadjusted, 1-d, 24-h dietary recalls (1), which are inappropriate for determining the proportion of the population with intakes above a specified value. As noted in the DRI report on applications in dietary assessment (3), 1-d, 24-h dietary recalls can provide a good estimate of mean usual intakes in a population but overestimate variability because of large within-person variation. Thus, using 1-d, 24-h dietary recalls to estimate the proportion of a population with intakes above or below a recommended intake leads to overestimates of the true proportion (3).

The potential magnitude of the problem has been addressed (4). With the use of national survey data, the proportion of men with intakes of <30% of energy from fat was estimated by using 1-d, 24-h dietary recalls; 3-d, 24-h dietary recalls; or "usual" intakes as estimated with the use of the Iowa State University method, which controls for within-person variability. All 3 methods resulted in similar estimates of mean intake but very different estimates of the proportion with intakes below the recommended value. On the basis of 1-d intakes, 28% of men consumed <30% of energy from fat; however, when usual intake distributions were applied, only 14% of men consumed <30% of energy from fat. Thus, the estimate obtained with 1-d dietary recalls overestimated the true proportion by 100%.

It is imperative that accurate estimates of the proportion of the population whose intakes of added sugars exceed the DRI suggested maximum be determined to assess whether any public health problem exists at current intakes. The values provided by Murphy and Johnson (1) represent overestimates and should not be cited as a true representation of the proportion of the population whose intakes exceed the maximum. Until data are available on variability in usual intakes of added sugars as a percentage of energy, it is not possible to estimate the true proportion. Until then, only mean intakes, which are currently estimated to be 15.7% of energy intake in the United States (5), should be reported.

REFERENCES

1. Murphy SP, Johnson RK. The scientific basis of recent US guidance on sugars intake. Am J Clin Nutr 2003;78(suppl):827S–33S.
2. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academy Press, 2002.
3. Institute of Medicine. Dietary reference intakes: applications in dietary assessment. Washington, DC: National Academy Press, 2000.
4. Guenther PM, Kott PS, Carriquiry AL. Development of an approach for estimating usual nutrient intake distributions at the population level. J Nutr 1997;127:1106–12.[Abstract/Free Full Text]
5. US Department of Agriculture, Agriculture Research Service. Pyramid servings intakes by US children and adults: 1994-96, 1998. October 2000. Internet: http://www.barc.usda.gov/bhnrc/cnrg/ (accessed 10 December 2003).

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kaplan, R. J Search for Related Content PubMed PubMed Citation Articles by Kaplan, R. J Agricola Articles by Kaplan, R. J