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Protocol - Sugar Intake (Added)

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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.

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.

Protocol Name from Source:

2005 National Cancer Institute (NCI) Five-Factor Screener 2005

Availability:

Publicly available

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 CategoryRequired
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

Life Stage:

Adult, Senior

Participants:

Ages 18 years and older

Specific Instructions:

None

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

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Past Month Added Sugar Intake Number 2946975 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) PhenX - sugar protocol 62286-0 LOINC
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)

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://phenxtoolkit.org/domains/view/50000#tab4content

Protocol ID:

51001

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX051001_Cookie_Cake_Pie_Frequency PX051001040000 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. 4 N/A
PX051001_Doughnut_Frequency PX051001030000 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 4 N/A
PX051001_Fruit_Flavored_Drink_Frequency PX051001020000 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. 4 N/A
PX051001_Soda_Frequency PX051001010000 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. 4 N/A
Research Domain Information
Measure Name:

Sugar Intake (added)

Release Date:

October 1, 2015

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