# Assessment and Evaluation of the Intake of Sugars in European Countries
## 4 Discussion
[52], Dutch adults consumed 7.5 g/d less sugar (about thirty calories) because of the so-called prevention agreement to reduce the amount of (added) sugars in food products. The range in the years of data collection of the included surveys is 2003-2018. The most recent data on children is from Ireland (2018) and, on adults, from Austria (2017). The minority of the surveys completed the data collection in 2016 or later. So, many data are (somewhat) old and will not be representative of the actual situation. Most data presented on total, free and/or added sugars are probably outdated. The data on the trends show that the current intake is probably lower than the figures presented in this paper. According to the systematic review of [PERSON] et al. [53], consumption among US children and adolescents increased substantially in the decades preceding 2000, followed by a faster and continued decline of the intake of sugar-sweetened beverages and dietary sugars. Other international intake trends did not reveal drastic increases and decreases in sugars (from sugar-sweetened beverages). In this review eight out of fifteen studies were from Europe. All dietary intake methodologies are, to some extent, imperfect due to limitations. For instance, there may be incomplete reporting by subjects that do not remember the consumption of specific foods or beverages, foods consumed that are not recorded when keeping records, biased sampling, and inaccurately measuring or estimations of (standard) portion sizes. There are many uncertainties in the results of food consumption surveys. The most relevant uncertainties for this review are discussed hereafter. For an overview of the critical uncertainties in food consumption surveys, see [PERSON] et al. [54]. The uncertainties can be large, especially for (high and low) percentile values. That is the reason that only mean values are presented, since these are less prone to bias. In contrast to total sugars (that can be analyzed), the content of free and added sugars is not readily available in most food composition databases. To estimate the content of added sugars, a ten-step approach is available [55], and according to the authors the last four last steps are subjective. The surveys are nationwide, but this no guarantee for the representativeness of the samples. A small sample size and small number of recording days contribute to a sampling error and thereby sampling uncertainty [56]. In this paper 152 different population groups are presented with data on the intake of total, free, and/or added sugars and 81 have a sample size below 250 respondents. A smaller sample size introduces more uncertainty about the estimates. Another type of sampling uncertainty is selection bias. This can be unintentionally due to response bias, especially when the response rate is low, and intentionally by excluding population groups such as sick people and non-native-language speaking subjects. The range in the response rate is 23-75%. The lower the response rate, the more likely that a response bias exists. The survey with the lowest response (23%) was from Portugal. Food composition tables are needed to estimate the intake of sugars. There is a broad range of foods containing sugars with varying quantities in different food products, both solid and liquid. Food consumption surveys cannot incorporate all the food products that are available in the marketplace whereby the data of the surveys are incomplete regarding the food products and thereby the intake of sugars. Due to the limited number of food products included in the food composition tables, the estimates of the intake of sugars are crude figures. For instance, the over 28,000 codes in a Dutch food consumption survey that is included in this paper were linked to 1599 codes of the Dutch food composition table. This means that the assessment of the intake of sugars is based on broad categories rather than single foods, and information (on the variability) is lost in the exposure assessment.