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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch‐Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Siani A, Thies F, Tsabouri S, Adan R, Emmett P, Galli C, Kersting M, Moynihan P, Tappy L, Ciccolallo L, de Sesmaisons‐Lecarré A, Fabiani L, Horvath Z, Martino L, Muñoz Guajardo I, Valtueña Martínez S, Vinceti M. Tolerable upper intake level for dietary sugars. EFSA J 2022; 20:e07074. [PMID: 35251356 PMCID: PMC8884083 DOI: 10.2903/j.efsa.2022.7074] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50-75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (> 15-50% probability) and very low for hypertension (0-15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.
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BROWN ANDREWW, ASLIBEKYAN STELLA, BIER DENNIS, DA SILVA RAFAELFERREIRA, HOOVER ADAM, KLURFELD DAVIDM, LOKEN ERIC, MAYO-WILSON EVAN, MENACHEMI NIR, PAVELA GREG, QUINN PATRICKD, SCHOELLER DALE, TEKWE CARMEN, VALDEZ DANNY, VORLAND COLBYJ, WHIGHAM LEAHD, ALLISON DAVIDB. Toward more rigorous and informative nutritional epidemiology: The rational space between dismissal and defense of the status quo. Crit Rev Food Sci Nutr 2021; 63:3150-3167. [PMID: 34678079 PMCID: PMC9023609 DOI: 10.1080/10408398.2021.1985427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To date, nutritional epidemiology has relied heavily on relatively weak methods including simple observational designs and substandard measurements. Despite low internal validity and other sources of bias, claims of causality are made commonly in this literature. Nutritional epidemiology investigations can be improved through greater scientific rigor and adherence to scientific reporting commensurate with research methods used. Some commentators advocate jettisoning nutritional epidemiology entirely, perhaps believing improvements are impossible. Still others support only normative refinements. But neither abolition nor minor tweaks are appropriate. Nutritional epidemiology, in its present state, offers utility, yet also needs marked, reformational renovation. Changing the status quo will require ongoing, unflinching scrutiny of research questions, practices, and reporting-and a willingness to admit that "good enough" is no longer good enough. As such, a workshop entitled "Toward more rigorous and informative nutritional epidemiology: the rational space between dismissal and defense of the status quo" was held from July 15 to August 14, 2020. This virtual symposium focused on: (1) Stronger Designs, (2) Stronger Measurement, (3) Stronger Analyses, and (4) Stronger Execution and Reporting. Participants from several leading academic institutions explored existing, evolving, and new better practices, tools, and techniques to collaboratively advance specific recommendations for strengthening nutritional epidemiology.
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Affiliation(s)
- ANDREW W. BROWN
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | | | - DENNIS BIER
- Baylor College of Medicine, Houston, Texas, USA
| | | | - ADAM HOOVER
- Clemson University, Clemson, South Carolina, USA
| | - DAVID M. KLURFELD
- United States Department of Agriculture, Agricultural Research Service, Beltsville, Maryland, USA
| | - ERIC LOKEN
- University of Connecticut, Storrs, Connecticut, USA
| | - EVAN MAYO-WILSON
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - NIR MENACHEMI
- Indiana University Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - GREG PAVELA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - PATRICK D. QUINN
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - DALE SCHOELLER
- University of Wisconsin-Madison Biotechnology Center, Madison, Wisconsin, USA
| | - CARMEN TEKWE
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - DANNY VALDEZ
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - COLBY J. VORLAND
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - LEAH D. WHIGHAM
- University of Texas Health Science Center School of Public Health, El Paso, Texas, USA
| | - DAVID B. ALLISON
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
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Identification of psychological correlates of dietary misreporting under laboratory and free-living environments. Br J Nutr 2021; 126:264-275. [PMID: 33028428 DOI: 10.1017/s000711452000389x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Errors inherent in self-reported measures of energy intake (EI) are substantial and well documented, but correlates of misreporting remain unclear. Therefore, potential predictors of misreporting were examined. In Study One, fifty-nine individuals (BMI = 26·1 (sd 3·8) kg/m2, age = 42·7 (sd 13·6) years, females = 29) completed a 14-d stay in a residential feeding behaviour suite where eating behaviour was continuously monitored. In Study Two, 182 individuals (BMI = 25·7 (sd 3·9) kg/m2, age = 42·4 (sd 12·2) years, females = 96) completed two consecutive days in a residential feeding suite and five consecutive days at home. Misreporting was directly quantified by comparing covertly measured laboratory weighed intakes (LWI) with self-reported EI (weighed dietary record (WDR), 24-h recall, 7-d diet history, FFQ). Personal (age, sex and %body fat) and psychological traits (personality, social desirability, body image, intelligence quotient and eating behaviour) were used as predictors of misreporting. In Study One, those with lower psychoticism (P = 0·009), openness to experience (P = 0·006) and higher agreeableness (P = 0·038) reduced EI on days participants knew EI was being measured to a greater extent than on covert days. Isolated associations existed between personality traits (psychoticism and openness to experience), eating behaviour (emotional eating) and differences between the LWI and self-reported EI, but these were inconsistent between dietary assessment techniques and typically became non-significant after accounting for multiplicity of comparisons. In Study Two, sex was associated with differences between LWI and the WDR (P = 0·009), 24-h recall (P = 0·002) and diet history (P = 0·050) in the laboratory, but not home environment. Personal and psychological correlates of misreporting identified displayed no clear pattern across studies or dietary assessment techniques and had little utility in predicting misreporting.
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Chan V, Davies A, Wellard-Cole L, Lu S, Ng H, Tsoi L, Tiscia A, Signal L, Rangan A, Gemming L, Allman-Farinelli M. Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App. Nutrients 2021; 13:nu13061806. [PMID: 34073378 PMCID: PMC8228902 DOI: 10.3390/nu13061806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 01/02/2023] Open
Abstract
Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18–30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.
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Affiliation(s)
- Virginia Chan
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
- Correspondence:
| | - Alyse Davies
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Lyndal Wellard-Cole
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
- Cancer Prevention and Advocacy Division, Cancer Council NSW, Woolloomooloo, NSW 2011, Australia
| | - Silvia Lu
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Hoi Ng
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Lok Tsoi
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Anjali Tiscia
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Louise Signal
- Health Promotion & Policy Research Unit, Department of Public Health, University of Otago, 6242 Wellington, New Zealand;
| | - Anna Rangan
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Luke Gemming
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
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