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The scientific basis of guideline recommendations on sugar intake

07 / 02 / 17

The research team evaluated 9 International Guidelines offering 12 recommendations on sugar consumption (including those from USA, WHO, UK and Australia) to assess consistency, methodological quality and quality of evidence supporting them using the AGREE II instrument and GRADE methods (endorsed by numerous health organisations worldwide).

Overall, guideline quality was moderate, with Australian guidelines doing best by meeting the 60% threshold for all 6 domains within AGREE II (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence). Using GRADE* methods, the quality of available evidence to link sugar with health outcomes was generally rated low to very low. The authors found no reliable evidence that currently recommended daily caloric thresholds for sugar are strongly associated with negative health effects. The authors conclude guidelines on sugar intake do not meet criteria for trustworthy recommendations and are based on low quality evidence.

NOTE: The study was funded by the food and agriculture industry via the North American branch of the International Life Sciences Institute (ILSI) and the review says, “the authors, having expertise in study methodology (particularly in the development of practice guidelines), wrote the protocol and conducted the study independent of the funding body. However, given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully.”

* GRADE is a systematic and explicit approach to making judgements about quality of evidence and strength of clinical recommendations. Find out more at

Erickson J, Sadeghirad B, Lytvyn L, Slavin J, Johnston BC. The Scientific Basis of Guideline Recommendations on Sugar Intake: A Systematic Review. Ann Intern Med.  doi: 10.7326/M16-2020