As Seen On CNN - Sugar Not Only Makes You Fat, It May Make You Sick

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Anyone have thoughts about this article and the study it quotes?

Sugar not only makes you fat, it may make you sick - CNN.com

The study:

http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1819573

I am interested in knowing your thoughts on the methodology of the study. It appears the data was estimated from 1 or 2 nutritional recall interviews and extrapolated as to average added sugar consumption. Then taking these peoples mortality from CVD and correlating the two factors.

Let's discuss...
 

CoolTweetPete

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I feel like the people bashing sugar love citing studies like this one and ignoring basic physiology.

I didn't take a look at it but based on your post this was probably one of those studies that just asked people questions rather than actually observing their physiology. This is often not useful because there is zero control over other factors (people could be using tobacco or abusing drugs or alcohol) which could influence CVD and mortality. Hopefully someone can confirm. I am a novice in the art of debunking studies but this seems fishy.
 
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ellingerfarmer
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It seems there was an interview or two with study participants. The dietary aspect was a recall from the previous 24 hours. It seems the folks who consumed a sugar sweetened beverage could have likely consumed that with a high starch, high PUFA meal, which throws the image from causative to correlative.

Here are the Methods as reported in the JAMA study info:

Methods
23,24NHANES III and NHANES 1999-2010 underwent institutional review board approval and included written informed consent.

25,26 The International Statistical Classification of Diseases, 10th Revision was used to identify participants for whom CVD (codes I00-I78) was listed as the underlying cause of death.

27 Availability of second dietary recall varied by time period. In NHANES III, approximately 8% of the adult participants provided a second dietary recall; from 1999 to 2002, second recalls were not available. In 2003-2004 and 2005-2010, 93% and 88% of participants participated in second dietary surveys through the telephone interviews 3 to 10 days after mobile examination center interviews.

28 However, FNDDSs do not include information on added sugar for many foods. To estimate the intake of added sugar, we merged individual food files from NHANES with the MyPyramid Equivalents Database (MPED).29 The MPED has 2 versions; we merged the NHANES III and NHANES 1999-2002 individual foods files with MPED 1.0 and NHANES 2003-2004 and 2005-2010 food files with MPED 2.0 to calculate intake of added sugars.29,30 Of 5440 unique US Department of Agriculture food codes (8-digit codes) in NHANES 2005-2010, 5030 of these foods were available from MPED 2.0. We matched the remaining 410 foods to the nearest food codes (most of the matched food codes differed by the last 2 digits) to estimate added sugar content. For example, the food code 52302020 (muffin, fruit and/or nut, low fat) was matched to 52302010 (muffin, fruit and/or nut). A detailed description of the MPED and estimates of added sugar from foods are published elsewhere.29

31,32 which tends to attenuate the association.33 To correct for measurement errors, we used a method developed by the National Cancer Institute (NCI) that can be used to estimate the distribution of the usual percentage of calories from added sugar in the population.34This method also can be used to examine the nutrient-disease association corrected for measurement error, also known as the regression calibration.35 The NCI method requires that at least some respondents have multiple days of nutrient values to estimate the within- and between-individual variations.34,36 For the trend analysis, the models included the following covariates: day of the week when 24-hour recall was collected (weekday vs weekends), age, sex, and race/ethnicity.36 For the association analysis, we also included educational attainment, smoking status, alcohol consumption, antihypertensive medication use, physical activity, family history of CVD, and 1995 Healthy Eating Index (HEI) scores.36,37

37

4 or 25% or more3 of calories from added sugar. We conducted the pairwise 2-tailed t tests to identify the difference in means and prevalence across surveys.

35 To present the results, we calculated the 10th, 30th, 50th, 70th, and 90th percentiles’ distribution of the estimated added sugar intake as the middle value of each quintile. We estimated the adjusted HRs by comparing the middle values of each quintile (Q) with the lowest quintile as reference (Q5, Q4, Q3, and Q2 vs Q1).35,38 To examine the association between added sugar intake and CVD mortality by different cut points, ie, less than 10% by the World Health Organization (in line with the American Heart Association’s recommendation)4,5 and less than 25% by the Institute of Medicine,3we estimated the adjusted HRs by comparing participants who consumed 25% or more, more than 10%, and less than 25% of their calories from added sugar with those who consumed less than 10% of their calories from added sugar. We estimated age-, sex-, and race/ethnicity–adjusted HRs as well as the multivariable-adjusted HRs including age, sex, race/ethnicity, educational attainment, smoking status, alcohol consumption, antihypertensive medication use, physical activity level, family history of CVD, HEI score, BMI, systolic blood pressure, total serum cholesterol, and total calories. We also determined the results of stratified analysis by age group (<60 years vs ≥60 years), sex, race/ethnicity, educational attainment (<12 vs ≥12 years), physical activity (≥5 times/wk of moderate-intensity vs vigorous activities vs others), HEI score (top 50% [score ≥63.5] vs other), and BMI (normal vs overweight/obese). We calculated the covariates-adjusted number needed to harm associated with each quintile of added sugar intake at 15-years of follow-up (15 years represents the median follow-up),39 and the 95% CI of the number needed to harm was based on 2.5th and 97.5th percentile values of 500 rescaled bootstrap weights.40,41

42,43

Supplement [eAppendix and eTables 1-7]). All analyses were conducted with SAS, version 9.3 (SAS Institute, Inc) or SUDAAN, version 11, to take into account the complex sampling design.43 All tests were 2-sided, and P < .05 was considered statistically significant.
 

Sheik

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I like to live as though CNN doesn't exist.

I'm drinking A&W right now and it's sooo good. It's like liquid root beer barrels.
 

tara

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I've not read the study, just the comments above.

Are they saying that people who ate more than 25% of their calories from added refined sugars correlated with more of the measured disease? 25% pure sucrose could displace a lot of food that would otherwise supply other valuable nutrients. Was there any serious attempt to control for other essential nutrients? Or for PUFA intake?

I would like it if the mainstream media would be more consistent about distinguishing what they mean by 'sugar'. Where I am, I keep hearing and seeing references to studies showing correlations between high refined-added-sugar with some particular health markers, followed by leaps to conclusions about fruit juice being terrible because it has just as much sugar as lolly-water. Even though none of the studies measured sugars from real foods, just nutrient-stripped sucrose (or other refined sweeteners). We need those minerals (eg potassium, magnesium etc) to use sugars well. I would expect the correlations to be markedly different for high-sugar diets where most of the sugars came from fruit and juice.

I also would like the mainstream media science reporting to not leap from single studies to broad conclusions. There real scientists don't do that - they are more likely to know that you need to look at the range of related studies, to be aware of the limitations of a a study's methods, and therefore more cautious with the conclusions one draws.

The title of the article, as usual, exxagerates what was found by the actual study. More accurate, perhaps, but less clickable, might be:
Mineral-depleted refined sugar in very large amounts correlated with mortality in a particular study.

I don't have a reference, but IIRC, there are also studies that measured (or maybe estimated) not so much total added refined sugars, but all sugars as a proportion of diet, in which the high-sugar eaters were typically leaner than lower-sugar eaters.

Quite apart from those issues, I've not seen Peat recommend such a high refined sugar diet as sustainably health supportive. He generally favours more mineral rich actual foods.
 
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Luann

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Without looking at the actual study: Sugar is like a flame and might contribute to oxidation; the unstable fats Americans eat are the gasoline mess at the heart of the problem.
 

Luann

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True true, and a weird memory from following the "sugar-free" thing 18 months ago: sugar is in bacon. PUFA = sugar if you're not paying attention.
 
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sugars unmask inflammation

so if it makes anyone sick ,, that means its alot of inflammations
for example sugar used to cause me legs pain as i ran 5 miles

unsaturated fat and poly unsaturated fat mask the inflammation
which is bad

because inflammation must be treated

thanks :D
 

dbh25

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"Added sugars, according to most experts, are far more harmful to our bodies than naturally occurring sugars. We're talking about the sugars used in processed or prepared foods like sugar-sweetened beverages, grain-based desserts, fruit drinks, dairy desserts, candy, ready-to-eat cereal and yeast breads. Your fruits and (natural) fruit juices are safe."
Get most of your sugar from fruit, fruit juice, honey and avoid most processed foods, I wouldn't call this earth shattering.
 

schultz

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I wouldn't call this earth shattering.

:eek:

Excellent points!

Are they saying that people who ate more than 25% of their calories from added refined sugars correlated with more of the measured disease? 25% pure sucrose could displace a lot of food that would otherwise supply other valuable nutrients. Was there any serious attempt to control for other essential nutrients? Or for PUFA intake?

As always, the voice of reason.

If you eat 25% of your calories as pure sugar you best be making sure you are getting extra nutrients from somewhere else. Sadly most people are probably not. 25% of the diet from pure sugar and fill in the rest with various processed foods that also have very poor nutrition. I went on a rant about this in one of those fruitarian threads lol (the not getting enough micronutrients thing, not the sugar thing.)
 

superhuman

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i dont get it. Why post this if you dont bother reading the study? the CNN just want to cause something that draws attention. When you read the study its just horseshit. They are just drawing conclusions from surveys and other statistics from earlier years in terms of sugar consumption. Its just as valid as showing to graphs of water consumption and diabetes development. Both has gone up in the western world the last 20 years, does not mean their is a correlation.
 

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