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The Scientific Basis of Guideline Recommendations on Sugar Intake

TO THE EDITOR: Erickson and colleagues' systematic review (1) challenges recommendations by public health officials that persons should decrease sugar consumption and declares that a clear link between consumption of added sugars and health effects is lacking. The authors state that the 20152020 Dietary Guidelines for Americans (2) did not cite any previously published studies as evidence for its recommendations. However, the U.S. Department of Health and Human Services has released an extensive appendix (3) that shows previously published studies as evidence. The U.S. Department of Agriculture also released a 500-page report (4) that provides evidence from previously published studies that negates this statement. Although the methods of Erickson and colleagues' review are sound, the authors do not point out that high-quality evidence on diet and its effect on health has been difficult to find. Randomized controlled trials, the gold standard of evidence-based medicine, are impractical to carry out on large population groups for long periods. Public health officials have to work with the available evidence. Considering the validity of the process for developing guidelines as separate from the validity of the science linking increased sugar intake with health outcomes is important. Decisions for public health sometimes need to be based on the available evidence. The argument that various guidelines were based on evidence judged to be of low- to very-low quality may be entirely valid. However, it should not be taken as an implication that a body of high-quality evidence contradicts the guidelines.