A recently published study used the GRADE approach to investigate significant differences in dietary sugar intake recommendations published by authoritative health organizations.
Over the course of many years, evidence supporting an association between various health outcomes and sugar consumption has been used to create diet recommendations for the public. These recommendations are usually created by large health authorities or organizations, and tend to distinguish between types of sugars, particularly nonintrinsic sugars i.e. free sugars and added sugars. Added sugars generally include monosaccharides and disaccharides that have been added to food products during their production, they don’t include sugars naturally found in milk and fruits and fruit juice. Free sugars consist of sugars that have been added to food products as well as sugars that are naturally present in honey, fruit, milk, and syrup.
Recently published guidelines on dietary sugar intake have been supported by quantitative and qualitative evidence, most of which advocate for the limitation of one’s sugar intake, especially products containing nonintrinsic sugars. Some authoritative health organizations have issued dietary sugar recommendations that varied significantly with a variety of reasons justifying the lowering of sugar intake. The primary aim of a new systematic review was to assess the quality of evidence used for the formation of each organization’s sugar intake public health guidelines. A variety of parameters including the clarity of presentation, editorial independence, applicability, and overall assessment were considered when analyzing the consistency and quality of guidelines. The GRADE (grading of recommendations, assessment, and evaluation) method was also used to assess the quality of studies that comprised the basis of public health guidelines.
5315 total records were screened by independent reviewers, and only 9 public health guidelines (these 9 PHGs gave 12 recommendations on sugar consumption) met the inclusion and exclusion criteria. Regarding clarity of presentation, the median score was 59.3% of for the 12 guidelines; 4 guidelines met the 60% threshold. The guidelines also yielded a low median score (34.7%) for the applicability measure. Applicability refers to whether the guidelines detailed specific resource implications and strategies for applying recommendations, as well as outlining facilitators and barriers to doing so.
Researchers used the GRADE method to assess the quality of studies supporting the recommendations of the 9 PHGs and deemed their evidence to be low or very low. Moving forward, PGHs should be specific, and outcomes should be transparent and highly relevant to the target population.
Written By: Melissa Booker