Skip to main content Accessibility help

Dietary sugars intake and micronutrient adequacy: a systematic review of the evidence

  • Sigrid A. Gibson (a1)


Guidelines for sugars intake range from a population mean of less than 10 % energy from free sugars, to a maximum for individuals of 25 % energy from added sugars. The aim of the present review was to examine the evidence for micronutrient dilution by sugars and evaluate its nutritional significance. From a web-based search of MEDLINE and hand search of linked papers, forty-eight relevant publications were identified on sugars (total sugars, non-milk extrinsic sugars, or added sugars) or sugar-containing drinks. These included five reports from expert committees, six reviews, thirty-three observational studies and four small-scale interventions. There was inconsistency between studies as to the relationship between sugars intake (however expressed) and micronutrients. The statistical patterns varied between nutrients and population groups. Curvilinear associations were found in some analyses, with lower nutrient intakes at both extremes of sugar intake; however, factors such as dieting and under-reporting may confound the associations observed. Some studies found statistically significant inverse associations but these were weak, with sugars explaining less than 5 % of the variance. Mean intakes of most micronutrients were above the RDA or reference nutrient intake except among very high consumers of sugars. The available evidence does not allow for firm conclusions on an optimal level of added sugars intake for micronutrient adequacy and the trends that exist may have little biological significance except for a few nutrients (for example, Fe). It is established that energy intake is the prime predictor of micronutrient adequacy. A better understanding of valid approaches to energy adjustment, misreporting and the assessment of micronutrient adequacy is crucial to further progress in this area.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dietary sugars intake and micronutrient adequacy: a systematic review of the evidence
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dietary sugars intake and micronutrient adequacy: a systematic review of the evidence
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dietary sugars intake and micronutrient adequacy: a systematic review of the evidence
      Available formats


Corresponding author

*Corresponding author: Sigrid Gibson, tel/fax +44 1483 838018, email


Hide All
1Thomson ResearchSoft (2004) EndNote.
2Mackerras, D (1996) Energy adjustment: the concepts underlying the debate. J Clin Epidemiol 49, 957962.
3Forshee, RA & Storey, ML (2004) Controversy and statistical issues in the use of nutrient densities in assessing diet quality. J Nutr 134, 27332737.
4Heaton, KW, Emmett, PM, Henry, CL, Thornton, JR, Manhire, A & Hartog, M (1983) Not just fibre – the nutritional consequences of refined carbohydrate foods. Hum Nutr Clin Nutr 37, 3135.
5Cline, AD, Tharion, WJ, Tulley, RT, Hotson, N & Lieberman, HR (2000) Influence of a carbohydrate drink on nutritional status, body composition and mood during desert training. Aviat Space Environ Med 71, 3744.
6West, JA & de Looy, AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets. Int J Obes Relat Metab Disord 25, 11221128.
7Vasilaras, TH, Astrup, A & Raben, A (2004) Micronutrient intake in overweight subjects is not deficient on an ad libitum fat-reduced, high-simple carbohydrate diet. Eur J Clin Nutr 58, 326336.
8Charlton, KE, Wolmarans, P & Lombard, CJ (1998) Evidence of nutrient dilution with a high sugar intake in older South Africans. J Hum Nutr Diet 11, 331343.
9Baghurst, K, Baghurst, P & Record, S (1992) Demographic and nutritional profiles of people consuming varying levels of sugars. Nutr Res 12, 14551465.
10Bowman, S (1999) Diets of individuals based on energy intakes from added sugars. Fam Econ Nutr Rev 12, 3138.
11Britten, P, Basiotis, PP, Davis, CA & Anand, R (2000) Is intake of added sugars associated with diet quality? In Insight 21 [USDA Center for Nutrition Policy and Promotion, editor]. Washington, DC: USDA.
12Forshee, RA & Storey, ML (2001) The role of added sugars in the diet quality of children and adolescents. J Am Coll Nutr 20, 3243.
13Charlton, KE, Kolbe-Alexander, TL & Nel, JH (2005) Micronutrient dilution associated with added sugar intake in elderly black South African women. Eur J Clin Nutr 59, 10301042.
14Kranz, S, Smiciklas-Wright, H, Siega-Riz, AM & Mitchell, D (2005) Adverse effect of high added sugar consumption on dietary intake in American preschoolers. J Pediatr 146, 105111.
15Lewis, CJ, Park, YK, Dexter, PB & Yetley, EA (1992) Nutrient intakes and body weights of individuals consuming high and moderate levels of added sugars. J Am Diet Assoc 92, 708713.
16Rugg-Gunn, AJ, Hackett, AF, Jenkins, GN & Appleton, DR (1991) Empty calories? Nutrient intake in relation to sugar intake in English adolescents. J Hum Nutr Diet 4, 101111.
17Alexy, U, Sichert-Hellert, W & Kersting, M (2002) Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents. J Nutr 132, 27852791.
18Alexy, U, Kersting, M & Schultze-Pawlitschko, V (2003) Two approaches to derive a proposal for added sugars intake for German children and adolescents. Public Health Nutr 6, 697702.
19Alexy, U, Sichert-Hellert, W & Kersting, M (2003) Associations between intake of added sugars and intakes of nutrients and food groups in the diets of German children and adolescents. Br J Nutr 90, 441447.
20Øverby, NC, Lillegaard, IT, Johansson, L & Andersen, LF (2004) High intake of added sugar among Norwegian children and adolescents. Public Health Nutr 7, 285293.
21Flynn, MA, Suqrue, DD, Codd, MB & Gibney, MJ (1996) Women's dietary fat and sugar intakes: implications for food based guidelines. Eur J Clin Nutr 50, 713719.
22Gibson, SA (1997) Do diets high in sugars compromise micronutrient intakes? Micronutrient intakes in the Dietary and Nutritional Survey of British Adults according to dietary concentration of ‘added’, ‘non-milk extrinsic’ or ‘total’ sugars. J Hum Nutr Diet 10, 125133.
23Vanhapelto, AT & Seppänen, OR (1983) Nutrient intakes of persons with low or high consumption of sugar. Näringsforskning 3, 8285.
24Linseisen, J, Gedrich, K, Karg, G & Wolfram, G (1998) Sucrose intake in Germany. Z Ernahrungswiss 37, 303314.
25Bolton-Smith, C & Woodward, M (1995) Antioxidant vitamin adequacy in relation to consumption of sugars. Eur J Clin Nutr 49, 124133.
26Gibson, SA (1997) Non-milk extrinsic sugars in the diets of pre-school children: association with intakes of micronutrients, energy, fat and NSP. Br J Nutr 78, 367378.
27Gibson, S (2001) Dietary sugars and micronutrient dilution in normal adults aged 65 years and over. Public Health Nutr 4, 12351244.
28Farris, RP, Nicklas, TA, Myers, L & Berenson, GS (1998) Nutrient intake and food group consumption of 10-year-olds by sugar intake level: the Bogalusa Heart Study. J Am Coll Nutr 17, 579585.
29Naismith, D, Nelson, M, Burley, V & Gatenby, S (1995) Does a high-sugar diet promote overweight in children and lead to nutrient deficiencies? J Hum Nutr Diet 8, 249254.
30Gibson, S (1993) Consumption and sources of sugars in the diets of British schoolchildren: are high-sugar diets nutritionally inferior? J Hum Nutr Diet 6, 355371.
31Guenther, PM (1986) Beverages in the diets of American teenagers. J Am Diet Assoc 86, 493499.
32Harnack, L, Stang, J & Story, M (1999) Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc 99, 436441.
33Ballew, C, Kuester, S & Gillespie, C (2000) Beverage choices affect adequacy of children's nutrient intakes. Arch Pediatr Adolesc Med 154, 11481152.
34Mrdjenovic, G & Levitsky, D (2003) Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children. J Pediatr 142, 604610.
35Storey, ML, Forshee, RA & Anderson, PA (2004) Associations of adequate intake of calcium with diet, beverage consumption, and demographic characteristics among children and adolescents. J Am Coll Nutr 23, 1833.
36Marshall, TA, Eichenberger Gilmore, JM, Broffitt, MS, Stumbo, PJ & Levy, SM (2005) Diet quality in young children is influenced by beverage consumption. J Am Coll Nutr 24, 6575.
37Frary, CD, Johnson, RK & Wang, MQ (2004) Children and adolescents' choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. J Adolesc Health 34, 5663.
38Rodríguez-Artalejo, F, García, EL, Gorgojo, L, Garcés, C, Royo, MA, Martín Moreno, JM, Benavente, M, Macías, A & De Oya, M; Investigators of the Four Provinces Study (2003) Consumption of bakery products, sweetened soft drinks and yogurt among children aged 6–7 years: association with nutrient intake and overall diet quality. Br J Nutr 89, 419429.
39Johnson, RK, Frary, C & Wang, MQ (2002) The nutritional consequences of flavored-milk consumption by school-aged children and adolescents in the United States. J Am Diet Assoc 102, 853856.
40Department of Health Committee on Medical Aspects of Food Policy (1989) Dietary sugars and human disease. In Report of the Panel on Dietary Sugars. London: H.M. Stationery Office.
41World Health Organization and Food and Agriculture Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. WHO Techical Report Series no. 916. Geneva: WHO.
42Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London: H.M. Stationery Office.
43Dietary Guidelines Advisory Committee (2000) Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans. Washington, DC: Departments of Health and Human Services and Agriculture.
44Institute of Medicine (2002). Dietary Reference Intakes for Energy, Carbohydrate, Fat, Fibre, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: Food and Nutrition Board.
45Gibney, M, Sigman-Grant, M, Stanton, JL Jr & Keast, DR (1995) Consumption of sugars. Am J Clin Nutr 62, Suppl. 1, 178S194S.
46Bolton-Smith, C (1996) Intake of sugars in relation to fatness and micronutrient adequacy. Int J Obes Relat Metab Disord 20, Suppl. 2, S31S33.
47Ruxton, CH, Garceau, FJ & Cottrell, RC (1999) Guidelines for sugar consumption in Europe: is a quantitative approach justified? Eur J Clin Nutr 53, 503513.
48Ruxton, CH (2003) Dietary guidelines for sugar: the need for evidence. Br J Nutr 90, 245247.
49Murphy, SP & Johnson, RK (2003) The scientific basis of recent US guidance on sugars intake. Am J Clin Nutr 78, 827S833S.
50Rennie, KL & Livingstone, MB (2007) Associations between dietary added sugar intake and micronutrient intake: a systematic review. Br J Nutr 97, 832841.
51Saris, WHM, Astrup, A, Prentice, AM, et al. . (2000) Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. Int J Obes Relat Metab Disord 24, 13101318.
52Institute of Medicine Food and Nutrition Board (2000) Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: National Academies Press.
53Kaplan, RJ (2004) Proportion of the US population whose intakes of added sugars exceed the suggested maximum in the dietary reference intakes. Am J Clin Nutr 80, 524525.
54Barr, SI & Johnson, RK (2005) Effect of added sugars on dietary quality. J Nutr 135, 13361337.
55Forshee, RA & Storey, ML (2005) Reply to Barr and Johnson. J Nutr 135, 1337.
56Emmett, P, Rogers, I & Symes, C (2000) Food and nutrient intakes of a population sample of 3-year-old children in the South West of England in 1996. Public Health Nutr 5, 55–64.
57Kant, AK & Schatzkin, A (1994) Consumption of energy-dense, nutrient-poor foods by the US population: effect on nutrient profiles. J Am Coll Nutr 13, 285291.
58Sutherland, LA (2004) Soft drinks and obesity. J Pediatr 144, 554.
59Allport, JH (2004) Soft drinks and obesity. J Pediatr 144, 554557.
60Institute of Medicine Food and Nutrition Board (2003) Dietary Reference Intakes: Applications in Dietary Planning. Washington, DC: National Academies Press.
61Mackerras, D & Rutishauser, I (2005) 24 Hour national dietary survey data: how do we interpret them most effectively? Public Health Nutr 8, 657665.
62Hannon, EM, Kiely, M, Harrington, KE, Robson, PJ, Strain, JJ & Flynn, A (2001) The North/South Ireland Food Consumption Survey: mineral intakes in 18-64-year-old adults. Public Health Nutr 4, 10811088.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed