Protocol - Sugar Intake (Added)
Description
These questions from the Five-Factor Screener may be useful to assess an individual’s approximate intake of several foods. These particular questions address added sugars. No portion size questions are asked. This screener does not attempt to assess total diet.
Specific Instructions
None
Availability
Protocol
These questions are about the different kinds of foods you ate or drank during the PAST MONTH, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else.
*Read text if the respondent needs further clarification about the information requested.
1. During the past month, how often did you drink regular, carbonated SODA OR SOFT DRINKS that contain sugar? Do NOT include diet soda.
*Read if necessary: Do NOT include diet or sugar-free fruit drinks. Do NOT include juices or tea in cans. DO NOT include diet mineral water or diet flavored waters.
00 [ ] Never
01 [ ] 1-3 times last month
02 [ ] 1-2 times per week
03 [ ] 3-4 times per week
04 [ ] 5-6 times per week
05 [ ] 1 time per day
06 [ ] 2 times per day
07 [ ] 3 times per day
08 [ ] 4 times per day
09 [ ] 5 or more times per day
97 [ ] Refused
99 [ ] Don’t know
NOW we are going to ask about FRUIT-FLAVORED drinks WITH ADDED SUGAR.
2. How often did you drink FRUIT-FLAVORED DRINKS with sugar (such as Kool-Aid®, Hi-C®, lemonade, or cranberry cocktail)? Do NOT include diet drinks.
*Read if necessary: INCLUDE Gatorade® and other sports drinks with added sugar. INCLUDE Tampico®, Sunny Delight®, and Twister®. Do NOT include 100% fruit juices or soda. Do NOT include yogurt drinks or carbonated water.
00 [ ] Never
01 [ ] 1-3 times last month
02 [ ] 1-2 times per week
03 [ ] 3-4 times per week
04 [ ] 5-6 times per week
05 [ ] 1 time per day
06 [ ] 2 times per day
07 [ ] 3 times per day
08 [ ] 4 times per day
09 [ ] 5 or more times per day
97 [ ] Refused
99 [ ] Don’t know
3. During the past month, how often did you eat DOUGHNUTS, sweet rolls, Danish, muffins, or Pop-Tarts®? Do NOT include sugar-free items. *Read if necessary: INCLUDE low-fat kinds.
00 [ ] Never
01 [ ] 1-3 times last month
02 [ ] 1-2 times per week
03 [ ] 3-4 times per week
04 [ ] 5-6 times per week
05 [ ] 1 time per day
06 [ ] 2 times per day
07 [ ] 3 times per day
08 [ ] 4 times per day
09 [ ] 5 or more times per day
97 [ ] Refused
99 [ ] Don’t know
4. During the past month . . . How often did you eat COOKIES, CAKE, PIE, or BROWNIES? Do NOT include sugar-free kinds. *Read if necessary: INCLUDE low-fat kinds. Do NOT include ice cream and other frozen desserts or candy.
00 [ ] Never
01 [ ] 1-3 times last month
02 [ ] 1-2 times per week
03 [ ] 3-4 times per week
04 [ ] 5-6 times per week
05 [ ] 1 time per day
06 [ ] 2 times per day
07 [ ] 3 times per day
08 [ ] 4 times per day
09 [ ] 5 or more times per day
97 [ ] Refused
99 [ ] Don’t know
Scoring Procedures The following procedures are used to convert an individual’s responses to an estimate of that individual’s daily intake of added sugars in teaspoons: 1. The frequency reported categorically on the questionnaire is converted to the number of times consumed per day as shown below. In general, the midpoint of the frequency range was used.
| Table 1. Conversion of Frequency Response to Times per Day | |
| Frequency Response | Times per Day |
| Never | 0 |
| 1-3 times per month | 0.067 |
| 1-2 times per week | 0.214 |
| 3-4 times per week | 0.5 |
| 5-6 times per week | 0.786 |
| 1 time per day | 1 |
| 2 times per day | 2 |
| 3 times per day | 3 |
| 4 times per day | 4 |
| 5 or more times per day | 5 |
2. The age- and gender-specific portion sizes (below) for each food are multiplied by the frequency calculated in Step 1. For added sugar, a Pyramid serving is 1 teaspoon.
| Table 2. Median Portion Size in Pyramid Servings per Mention by Gender and Age for Added Sugar | |||||||
| Food Group | Age Group | ||||||
| 18-27 | 28-37 | 38-47 | 48-57 | 58-67 | 68-77 | 78-99 | |
| Men | |||||||
| Soda (P1) | 11.835000 | 9.990000 | 9.947000 | 9.683000 | 9.683000 | 9.631000 | 9.605000 |
| Fruit drinks (P2) | 9.627000 | 8.561000 | 8.985000 | 8.194000 | 6.815000 | 5.463000 | 5.307000 |
| Doughnuts, sweet rolls, muffins (P3) | 4.3080000 | 4.196000 | 3.707000 | 3.095000 | 2.897000 | 2.837000 | 2.781500 |
| Cookies, pie, cake, brownies (P4) | 5.189000 | 5.027000 | 4.845000 | 4.716000 | 4.730000 | 4.428000 | 3.968000 |
| Women | |||||||
| Soda (P1) | 9.815000 | 9.683000 | 9.683000 | 9.644000 | 8.443500 | 8.370000 | 9.683000 |
| Fruit drinks (P2) | 7.997000 | 7.876000 | 6.418000 | 6.002000 | 6.418000 | 5.116000 | 5.116000 |
| Doughnuts, sweet rolls, muffins (P3) | 2.966000 | 2.966000 | 2.797000 | 2.966000 | 2.498000 | 2.627000 | 2.627000 |
| Cookies, pie, cake, brownies (P4) | 4.133000 | 3.650000 | 3.842000 | 3.719000 | 4.027500 | 3.571000 | 3.166500 |
3. Regression coefficients (see below) are applied according to the equation below.
| Table 3. Estimated Regression Coefficients for Sum of Foods Predicting Teaspoons of Added Sugar, by Gender | ||
| Parameter | Men | Women |
| Intercept (b0) | 1.672746 | 1.591494 |
| b1 | 0.534485 | 0.491231 |
To estimate Pyramid teaspoons of added sugars, the model is:
E (Dietary Factor1/3) = b0 + b1 (NFG1P1 + NFG2P2 + ... + NFG4P4)1/3
Teaspoons of added sugars was cube-root-transformed to approximate normality; NFGk is the usual number of times per day an individual consumed food group k; Pk is the median portion size of group k; and k indexes the 4 added sugar food groups.
For men:
Cube root of Daily Pyramid Servings (i.e., teaspoons) of Added Sugars = 1.672746 + 0.534485 (cube root of (Daily Frequency * Gender/Age Specific Portion Size per Mention for Soda + Daily Frequency * Gender/Age Specific Portion Size per Mention for Fruit Drinks + Daily Frequency * Gender/Age Specific Portion Size per Mention for Doughnuts, sweet rolls, muffins + Daily Frequency * Gender/Age Specific Portion Size per Mention for Cookies, pie, cake, brownies))
For women:
Cube root of Daily Pyramid Servings of Added Sugars = 1.591494 + 0.491231 (cube root of (Daily Frequency * Gender/Age Specific Portion Size per Mention for Soda + Daily Frequency * Gender/Age Specific Portion Size per Mention for Fruit Drinks + Daily Frequency * Gender/Age Specific Portion Size per Mention for Doughnuts, sweet rolls, muffins + Daily Frequency * Gender/Age Specific Portion Size per Mention for Cookies, pie, cake, brownies))
Pop-Tarts® is a registered trademark, Kellogg NA Co.; Kool-Aid ® is a registered trademark, Kraft Foods Inc.; Hi-C® is a registered trademark, The Coca-Cola Company; Gatorade® is a registered trademark, PepsiCo Inc.; Tampico® is a registered trademark, Tampico Beverages, Inc.; Sunny Delight® is a registered trademark, Sunny Delight Beverages Co.; Twister® is a registered trademark, Tropicana Products, Inc.
Personnel and Training Required
The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided. There are multiple modes to administer this question (e.g., paper-and-pencil and computer-assisted interviews).
Equipment Needs
While the source instrument was developed to be administered by computer, the PhenX Working Group acknowledges these questions can be administered in a non-computerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Interviewer-administered questionnaire
Lifestage
Adult, Senior
Participants
Ages 18 years and older
Selection Rationale
Vetted against several other sugar intake questions, these questions from the National Cancer Institute (NCI) Five-Factor Screener were selected because they are low burden and have been validated against the 24-hour dietary recall.
Language
Chinese, English, Spanish
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Logical Observation Identifiers Names and Codes (LOINC) | PhenX - sugar protocol | 62286-0 | LOINC |
| Human Phenotype Ontology | Abnormal glucose homeostasis | HP:0011014 | HPO |
| caDSR Form | PhenX PX051001 - Sugar Intake Added | 5850262 | caDSR Form |
Derived Variables
None
Process and Review
The Expert Review Panel #1 reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.
Guidance from the ERP includes:
• No significant changes to measure
Back-compatible: no changes to Data Dictionary
Previous version in Toolkit archive (link)
Protocol Name from Source
National Cancer Institute (NCI) Five-Factor Screener, 2005
Source
Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey (NHIS) 2005. Diet and Nutrition Questionnaire, questions NAC.030_00.00 (question 1), NAC.060_00.00 (question 2), NAC.136_00.00 (question 3), and NAC.137_00.00 (question 4).
National Cancer Institute, Five-Factor Screener 2005. National Health Interview Survey (NHIS) Diet and Nutrition, NAC.010-NAC.138.
General References
National Cancer Institute. (2005). Five-factor screener: National Health Interview Survey (NHIS) validation results. Retrieved from https://www.phenxtoolkit.org/domains/view/50000#tab4content
Protocol ID
51001
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX051001_Cookie_Cake_Pie_Frequency | ||||
| PX051001040000 | During the past month... How often did you more | N/A | ||
| PX051001_Doughnut_Frequency | ||||
| PX051001030000 | During the past month, how often did you eat more | N/A | ||
| PX051001_Fruit_Flavored_Drink_Frequency | ||||
| PX051001020000 | How often did you drink FRUIT-FLAVORED more | N/A | ||
| PX051001_Soda_Frequency | ||||
| PX051001010000 | During the past month, how often did you more | N/A | ||
Measure Name
Sugar Intake (added)
Release Date
October 30, 2009
Definition
A measure to approximate an individual’s intake of added sugars quantified as teaspoon equivalents.
Purpose
High consumption of added sugar increases risk for metabolic disturbances and weight gain.
Keywords
Nutrition and Dietary Supplements, metabolic disease, obesity, dietary guidelines, NHIS
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 51001 | Sugar Intake (Added) |
Publications
Ross, J. M., et al. (2022) The effects of cannabis use on physical health: A co-twin control study. Drug and Alcohol Dependence. 2022 January; 230: 109200. doi: 10.1016/j.drugalcdep.2021.109200