Establishing 24-Hour Urinary Sucrose Plus Fructose as a Predictive Biomarker for Total Sugars Intake

Background: Twenty-four-hour urinary sucrose and fructose (24uSF) has been studied as a biomarker of total sugars intake in two feeding studies conducted in the United Kingdom (UK) and Arizona (AZ). We compare the biomarker performance in these populations, testing whether it meets the criteria for a predictive biomarker. Methods: The UK and AZ feeding studies included 13 and 98 participants, respectively, aged 18 to 70 years, consuming their usual diet under controlled conditions. Linear mixed models relating 24uSF to total sugars and personal characteristics were developed in each study and compared. The AZ calibrated biomarker equation was applied to generate biomarker-estimated total sugars intake in UK participants. Stability of the model across AZ study subpopulations was also examined. Results: Model coefficients were similar between the two studies [e.g., log(total sugars): UK 0.99, AZ 1.03, P = 0.67], as was the ratio of calibrated biomarker person-specific bias to between-person variance (UK 0.32, AZ 0.25, P = 0.68). The AZ equation estimated UK log(total sugar intakes) with mean squared prediction error of 0.27, similar to the AZ study estimate (0.28). Within the AZ study, the regression coefficients of log(total sugars) were similar across age, gender, and body mass index subpopulations. Conclusions: Similar model coefficients in the two studies and good prediction of UK sugar intakes by the AZ equation suggest that 24uSF meets the criteria for a predictive biomarker. Testing the biomarker performance in other populations is advisable. Impact: Applications of the 24uSF biomarker will enable improved assessment of the role of sugars intake in risk of chronic disease, including cancer.