Urinary sucrose and fructose to validate self-reported sugar intake in children and adolescents: results from the I.Family study
- 294 Downloads
Excessive consumption of free sugar increases the risk for non-communicable diseases where a proper assessment of this intake is necessary to correctly estimate its association with certain diseases. Urinary sugars have been suggested as objective biomarkers for total and free sugar intake in adults but less is known about this marker in children and adolescents. Therefore, the aim of this exploratory study is to evaluate the relative validity of self-reported intake using urinary sugars in children and adolescents.
The study was conducted in a convenience subsample of 228 participants aged 5–18 years of the I.Family study that investigates the determinants of food choices, lifestyle and health in European families. Total, free and intrinsic sugar intake (g/day) and sugar density (g/1000 kcal) were assessed using 24-h dietary recalls (24HDRs). Urinary sucrose (USUC) and urinary fructose (UFRU) were measured in morning urine samples and corrected for creatinine excretion (USUC/Cr, UFRU/Cr). Correlation coefficients, the method of triads and linear regression models were used to investigate the relationship between intake of different types of sugar and urinary sugars.
The correlation between usual sugar density calculated from multiple 24HDRs and the sum of USUC/Cr and UFRU/Cr (USUC/Cr + UFRU/Cr) was 0.38 (p < 0.001). The method of triads revealed validity coefficients for the 24HDR from 0.64 to 0.87. Linear regression models showed statistically significant positive associations between USUC/Cr + UFRU/Cr and the intake of total and free sugar.
These findings support the relative validity of total and free sugar intake assessed by self-reported 24HDRs in children and adolescents.
Keywords24-h dietary recall Dietary sugar Sugar biomarker Urine sugars Validity coefficient
This work was done as part of the I.Family Study (http://www.ifamilystudy.eu/). We gratefully acknowledge the financial support of the European Commission within the Seventh RTD Framework Programme Contract No. 266044. We thank the I.Family children and their parents for participating in this extensive examination. We are grateful for the support from school boards, headmasters and communities.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during this research. The study was approved by the local ethics committee in each center and has been conducted according to the guidelines laid down in the 1964 Declaration of Helsinki and its later amendments. Study participants did not undergo any procedures unless they (and their parents) had given consent for examinations, collection of samples, subsequent analysis and storage of personal data and collected samples. Study subjects and their parents could consent to single components of the study while abstaining from others.
- 1.World Health Organization (2015) Guideline: sugars intake for adults and children. WHO, GenevaGoogle Scholar
- 2.World Health Organization (2003) Joint WHO/FAO expert consultation. Diet, nutrition and the prevention of chronic diseases. WHO, GenevaGoogle Scholar
- 3.World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AIRC, Washington, D.C.Google Scholar
- 4.World Cancer Research Fund/American Institute for Cancer Research (2017) Our Cancer Prevention Recommendations. http://www.wcrf.org/int/research-we-fund/our-cancer-prevention-recommendations/. Accessed 29 Nov 2017
- 5.Svensson Å, Larsson C, Eiben G, Lanfer A, Pala V, Hebestreit A, Huybrechts I, Fernández-Alvira J, Russo P, Koni A, De Henauw S, Veidebaum T, Molnár D, Lissner L, on behalf of the IDEFICS consortium (2014) European children’s sugar intake on weekdays versus weekends: the IDEFICS study. Eur J Clin Nutr 68:822–828CrossRefGoogle Scholar
- 7.Börnhorst C, Huybrechts I, Hebestreit A, Vanaelst B, Molnar D, Bel-Serrat S, Mouratidou T, Moreno LA, Pala V, Eha M, Kourides YA, Siani A, Eiben G, Pigeot I (2013) Diet-obesity associations in children: approaches to counteract attenuation caused by misreporting. Public Health Nutr 16:256–266. (On behalf of the IDEFICS consortium)CrossRefGoogle Scholar
- 9.Huybrechts I, Börnhorst C, Pala V, Moreno L, Barba G, Lissner L, Fraterman A, Veidebaum T, Hebestreit A, Sieri S, Ottevaere C, Tornaritis M, Molnár D, Ahrens W, De Henauw S, on behalf of the IDEFICS consortium (2011) Evaluation of the Children’s Eating Habits Questionnaire used in the IDEFICS study by relating urinary calcium and potassium to milk consumption frequencies among European children. Int J Obesity 35:S69–S78CrossRefGoogle Scholar
- 10.Börnhorst C, Bel-Serrat S, Pigeot I, Huybrechts I, Ottavaere C, Sioen I, De Henauw S, Mouratidou T, Mesana MI, Westerterp K, Bammann K, Lissner L, Eiben G, Pala V, Rayson M, Krogh V, Moreno LA (2014) Validity of 24-h recalls in (pre-)school aged children: comparison of proxy-reported energy intakes with measured energy expenditure. Clin Nutr 33:79–84. (On behalf of the IDEFICS consortium)CrossRefGoogle Scholar
- 16.Tasevska N, Midthune D, Potischman N, Subar AF, Cross AJ, Bingham SA, Schatzkin A, Kipnis V (2011) Use of the predictive sugars biomarker to evaluate self-reported total sugars intake in the observing protein and energy nutrition (OPEN) study. Cancer Epidemiol Biomark Prev 20:490–500CrossRefGoogle Scholar
- 17.Luceri C, Caderni G, Lodovici M, Spagnesi MT, Monserrat C, Lancioni L, Dolara P (1996) Urinary excretion of sucrose and fructose as a predictor of sucrose intake in dietary intervention studies. Cancer Epidemiol Biomark Prev 5:167–171Google Scholar
- 18.Bingham S, Luben R, Welch A, Tasevska N, Wareham N, Khaw KT (2007) Epidemiologic assessment of sugars consumption using biomarkers: comparisons of obese and nonobese individuals in the European prospective investigation of cancer Norfolk. Cancer Epidemiol Biomark Prev 16:1651–1654CrossRefGoogle Scholar
- 19.Ahrens W, Bammann K, Siani A, Buchecker K, De Henauw S, Iacoviello L, Hebestreit A, Krogh V, Lissner L, Mårild S, Molnar D, Pitsiladis Y, Reisch L, Tornaritis M, Veidebaum T, Pigeot I, on behalf of the IDEFICS consortium (2011) The IDEFICS cohort: design, characteristics and participation in the baseline survey. Int J Obesity 35(Suppl 1):S3–S15CrossRefGoogle Scholar
- 20.Ahrens W, Siani A, Adan R, De Henauw S, Eiben G, Gwozdz W, Hebestreit A, Hunsberger M, Kaprio J, Krogh V, Lissner L, Molnar D, Moreno LA, Page A, Pico C, Reisch L, Smith RM, Tornaritis M, Veidebaum T, Williams G, Pohlabeln H, Pigeot I, On behalf of the I.Family consortium (2017) Cohort profile: the transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort. Int J Epidemiol 46:1394–1395jGoogle Scholar
- 21.Stomfai S, Ahrens W, Bammann K, Kovacs E, Mårild S, Michels N, Moreno L, Pohlabeln H, Siani A, Tornaritis M, on behalf of the IDEFICS consortium (2011) Intra-and inter-observer reliability in anthropometric measurements in children. Int J Obesity 35(Suppl 1):S45-S51Google Scholar
- 22.Suling M, Hebestreit A, Peplies J, Bammann K, Nappo A, Eiben G, Alvira JF, Verbestel V, Kovács E, Pitsiladis Y, Veidebaum T, Hadjigeorgiou C, Knof K, Ahrens W, on behalf of the IDEFICS consortium (2011) Design and results of the pretest of the IDEFICS study. Int J Obesity 35(Suppl 1):S30-S44Google Scholar
- 25.Börnhorst C, Huybrechts I, Hebestreit A, Krogh V, De Decker A, Barba G, Moreno L, Lissner L, Tornaritis M, Loit H, Molnár D, Pigeot I, on behalf of the IDEFICS consortium (2014) Usual energy and macronutrient intakes in 2–9-year-old European children. Int J Obesity 38(Suppl 1):S115–S123CrossRefGoogle Scholar
- 26.Lanfer A, Knof K, Barba G, Veidebaum T, Papoutsou S, de Henauw S, Soos T, Moreno LA, Ahrens W, Lissner L, on behalf of the IDEFICS consortium (2012) Taste preferences in association with dietary habits and weight status in European children: results from the IDEFICS study. Int J Obesity 36:27–34CrossRefGoogle Scholar
- 27.Lissner L, Lanfer A, Gwozdz W, Olafsdottir S, Eiben G, Moreno LA, Santaliestra-Pasías AM, Kovács É, Barba G, Loit H-M, Kourides Y, Pala V, Pohlabeln H, De Henauw S, Buchecker K, Ahrens W, Reisch L (2012) Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study. Eur J Epidemiol 27:705–715CrossRefGoogle Scholar
- 30.Kipnis V, Midthune D, Buckman DW, Dodd KW, Guenther PM, Krebs-Smith SM, Subar AF, Tooze JA, Carroll RJ, Freedman LS (2009) Modeling data with excess zeros and measurement error: application to evaluating relationships between episodically consumed foods and health outcomes. Biometrics 65:1003–1010CrossRefGoogle Scholar
- 31.Börnhorst C, Huybrechts I, Ahrens W, Eiben G, Michels N, Pala V, Molnar D, Russo P, Barba G, Bel-Serrat S, Moreno LA, Papoutsou S, Veidebaum T, Loit HM, Lissner L, Pigeot I, on behalf of the IDEFICS consortium (2013) Prevalence and determinants of misreporting among European children in proxy-reported 24 h dietary recalls. Br J Nutr 109:1257–1265CrossRefGoogle Scholar
- 32.Bergmeyer HU (1974) Methods of enzymatic analysis, 2nd edn. Academic Press, New YorkGoogle Scholar
- 34.R Core Team (2014) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 36.Tasevska N, Midthune D, Tinker LF, Potischman N, Lampe JW, Neuhouser ML, Beasley JM, Van Horn L, Prentice RL, Kipnis V (2014) Use of a urinary sugars biomarker to assess measurement error in self-reported sugars intake in the nutrition and physical activity assessment study (NPAAS). Cancer Epidemiol Biomark Prev 23:2874–2883CrossRefGoogle Scholar