We estimated the adjusted HRs by comparing the middle values of each
quintile (Q) with the lowest
quintile as reference (Q5, Q4, Q3, and Q2 vs Q1).35, 38 To examine the association between added sugar intake and CVD mortality by different
cut points, ie, less than 10 % by the World Health Organization (in line with the American Heart Association's recommendation) 4,5 and less than 25 % by the Institute of Medicine, 3 we estimated the adjusted HRs by comparing participants who consumed 25 % or more, more than 10 %, and less than 25 % of their calories from added sugar with those who consumed less than 10 % of their calories from added sugar.