Added sugars and micronutrient dilution
There is increasing concern that high intakes of added sugars promote micronutrient dilution. However, the overall conclusion to emerge from the existing evidence base is that associations between reported intakes of added sugars and intakes of micronutrients are inconsistent and often non-linear, both across and within age groups, and between the genders. If a nutrient displacement effect does exist, a high consumption of added sugar does not necessarily compromise overall micronutrient intakes and similarly, consuming less added sugar is no guarantee that micronutrient intakes will be optimized. Clarification of this issue has been beset by methodological and conceptual difficulties. The observed associations between added sugars and micronutrient intake have been heavily contingent on both the definition of sugars chosen and the analytical approach used for adjusting for differences in reported energy intake. These issues have been further compounded by mis-reporting of food intake of unknown direction and magnitude and the cut-offs used to determine ‘inadequate’ micronutrient intakes which vary over time and between studies and countries. In the absence compelling evidence that micronutrient intakes are compromised by a high consumption of added sugars, it may now be appropriate to question the legitimacy of the nutrient dilution hypothesis as it is highly likely that it is oversimplifying more subtle and complex dietary issues. Recommendations for further research are made to help bring resolution to these issues.