Urinary sugars as biomarker for dietary sugar intake; a prospective population study

Though it is commonly believed that a high dietary intake of sugar is bad for health, there is surprisingly little scientific evidence to support this. This may relate to our difficulty in measuring dietary sugar intake given its widespread presence and variable amounts in foods. Our work suggests that sugar excretion (sucrose and fructose) in the urine (as opposed to glucose, which is may indicate diabetes) is a good reflection of dietary sugar intake. We propose to examine whether dietary sugar intake, as assessed using urine sugar excretion is related to long term risk of chronic diseases associated with ageing such as heart disease, stroke and diabetes in 25,000 men and women aged 40-79 who have been followed up between 1993 to the present for health. This may help us understand better how to prevent chronic diseases associated with ageing.

We propose to assess urinary sugars (sucrose and fructose) as a biomarker of dietary sugars intake and the risk of chronic disease in a prospective population study. Despite widely held beliefs that a high dietary sugar intake has adverse consequences for health, in particular for obesity, diabetes and cardiovascular disease risk, there has been a surprising dearth of good evidence relating sugar intake to health from epidemiologic studies. This may relate to the difficulty in assessing dietary sugar intake. Our previous work has demonstrated that urinary sugars sucrose and fructose can be used as a biomarker of sugar intake, that high through put methods such as mass spectrometry can be used for measurement of urinary sugars, and that a casual urine sample can be used to assess sugars intake in large population studies. We propose therefore in a large prospective population study EPIC-Norfolk) of 25,000 men and women aged 40-79 years in 1993-1997 who had a urine sample collected at baseline in 1993-1997 and stored frozen, who have been followed up to the present to examine the relationship between urinary sugars as a biomarker of dietary sugar intake and subsequent health endpoints, including cardiovascular disease incidence (estimated 3000 incident cases), diabetes incidence (estimated 1000 incident cases) as well as prospective measured weight change over 4 years.