title: The Scientific Basis of Guideline Recommendations on Sugar Intake: A Systematic Review.
abstract: BACKGROUND
  The relationship between sugar and health is affected by energy balance, macronutrient substitutions, and diet and lifestyle patterns. Several authoritative organizations have issued public health guidelines addressing dietary sugars.
  
  
  OBJECTIVE
  To systematically review guidelines on sugar intake and assess consistency of recommendations, methodological quality of guidelines, and the quality of evidence supporting each recommendation.
  
  
  METHODS
  MEDLINE, EMBASE, and Web of Science (1995 to September 2016); guideline registries; and gray literature (bibliographies, Google, and experts).
  
  
  METHODS
  Guidelines addressing sugar intake that reported their methods of development and were published in English between 1995 and 2016.
  
  
  METHODS
  Three reviewers independently assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II), instrument. To assess evidence quality, articles supporting recommendations were independently reviewed and their quality was determined by using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methods.
  
  
  RESULTS
  The search identified 9 guidelines that offered 12 recommendations. Each of the reviewed guidelines indicated a suggested decrease in the consumption of foods containing nonintrinsic sugars. The guidelines scored poorly on AGREE II criteria, specifically in rigor of development, applicability, and editorial independence. Seven recommendations provided nonquantitative guidance; 5 recommended less than 25% to less than 5% of total calories from nonintrinsic sugars. The recommendations were based on various health concerns, including nutrient displacement, dental caries, and weight gain. Quality of evidence supporting recommendations was low to very low.
  
  
  CONCLUSIONS
  The authors conducted the study independent of the funding source, which is primarily supported by the food and agriculture industry.
  
  
  CONCLUSIONS
  Guidelines on dietary sugar do not meet criteria for trustworthy recommendations and are based on low-quality evidence. Public health officials (when promulgating these recommendations) and their public audience (when considering dietary behavior) should be aware of these limitations.
  
  
  BACKGROUND
  Technical Committee on Dietary Carbohydrates of the North American branch of the International Life Sciences Institute. (PROSPERO: CRD42015029182).
authors.affiliation: From University of Minnesota, St. Paul, Minnesota; McMaster University, Hamilton, Ontario, Canada; Kerman University of Medical Sciences, Kerman, Iran; and The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Erickson
authors.affiliation: From University of Minnesota, St. Paul, Minnesota; McMaster University, Hamilton, Ontario, Canada; Kerman University of Medical Sciences, Kerman, Iran; and The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Behnam
authors.initials: B
authors.lastname: Sadeghirad
authors.affiliation: From University of Minnesota, St. Paul, Minnesota; McMaster University, Hamilton, Ontario, Canada; Kerman University of Medical Sciences, Kerman, Iran; and The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lyubov
authors.initials: L
authors.lastname: Lytvyn
authors.affiliation: From University of Minnesota, St. Paul, Minnesota; McMaster University, Hamilton, Ontario, Canada; Kerman University of Medical Sciences, Kerman, Iran; and The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Slavin
authors.affiliation: From University of Minnesota, St. Paul, Minnesota; McMaster University, Hamilton, Ontario, Canada; Kerman University of Medical Sciences, Kerman, Iran; and The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Johnston
mesh_terms: D019422:Dietary Sucrose / Q000008:administration & dosage* / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D018673:Nutrition Policy; D017410:Practice Guidelines as Topic / Q000592:standards*
chemical_list: D019422:Dietary Sucrose