More Sugar May Mean More Diabetes

Diabetes rates increase as sugar consumption increases in countries across the world

(RxWiki News) Gaining too much weight increases the risk of diabetes. But your diabetes risk may rely as much on what you eat as it does on how much you eat.

A recent study found that increases in diabetes rates across the world occurred following increase in sugar intake.

The researchers looked at 175 countries to determine whether a link existed specifically between sugar and diabetes.

Even when they took into account lifestyle factors like obesity and physical activity, the results showed that sugar on its own was strongly linked to increases in diabetes.

The study could not show that sugar caused diabetes, but the link could not be explained by chance.

"Reduce your sugar intake."

The study, led by Sanjay Basu, MD, PhD, of the Stanford Prevention Research Center at Stanford University School of Medicine, compared diabetes rates and sugar availability in 175 countries.

The researchers used food supply data from the United Nations to analyze each country's use of sugars, fibers, fruits, meats, cereals, oils and total food.

Then, they calculated the average number of calories of each of these items the citizens of those countries ate on a daily basis.

Next, the researchers compared this analysis to the rates of diabetes among individuals aged 20 to 79 in each of those countries from 2000 through 2010.

The researchers adjusted their calculations to account for other factors that might influence the diabetes rates, including the percentage of overweight and obese individuals in each country, the aging trends in each country and changes in income or urbanization.

They also took into account lifestyle factors that may occur as the sugar availability in a country increases, such as more sedentary lifestyles, increases in other food types, eating more food in general or consuming more overall calories.

The researchers also adjusted their analysis to account for differences across countries in the gross domestic product (GDP), an economic indicator used to identify countries' levels of wealth.

The researchers found that diabetes rose alongside increases in sugar consumption – even after taking all the other factors into account.

They found that for each 150 additional calories a day a nation's people consumed on average, the rate of diabetes in that country increased by 0.1 percent. However, this link was not strong and could have been due to chance.

Yet each additional 150 calories of sugar available in a country was linked with a 1.1 percent increase in diabetes cases in that country – and those results were strong enough that chance could be ruled out. A standard soft drink has about 150 calories of sugar.

From 2000 to 2010, diabetes rates increased 27 percent on average across the world. About a quarter of this increase could be explained by an increase in sugar availability, the researchers concluded.

This trend was especially strong in countries like the Philippines, Romania, Sri Lanka, Georgia and Bangladesh. In these countries, diabetes rates have been high and increasing even while obesity rates have not increased at the same rate – but sugar availability increased 20 percent over this time.

Even when the researchers made adjustments to see if simple weight gain – without people being overweight or obese – was related to the increase, they did not find the same strong correlation as they did to sugar access.

In fact, the researchers found that diabetes rates were highest in countries where sugar had been easily available for the longest amount of time. When sugar availability dropped in countries, their diabetes rates also dropped – even when other factors like total calories, obesity rates and physical activity levels did not change or were taken into consideration.

"We're not diminishing the importance of obesity at all, but these data suggest that at a population level there are additional factors that contribute to diabetes risk besides obesity and total calorie intake, and that sugar appears to play a prominent role," said Dr. Basu in a prepared statement.

The study could not establish that eating too much sugar outright causes diabetes because this kind of study cannot show that one thing definitely causes another.

There is, however, a strong correlation between high consumption rates of sugar and high diabetes rates in populations. Further research will have to be done to see if evidence does show sugar intake by itself increases diabetes risk.

Deborah Gordon, MD, a dailyRx expert who specializes in nutrition, said she welcomes a study that the sugar industry really cannot defend.

"We can remove the low-fat blindfolds and train our analytical eyes on our own sugar consumption, which has risen in this country in parallel with our diabetes trends," Dr. Gordon said. "How can we reduce our sugar intake? How can I influence my patients to cultivate other preferences and scale back sugar consumption? What a big change that could make in our individual and collective health."

Dr. Gordon also noted, however, that the study reminded her of her concerns about a recent FDA petition to include artificial sweeteners in milk because there is also research linking certain artificial sweeteners, including aspartame, to diabetes risk.

"The take home message from all of this is to cultivate a broader palate, and for most people this will mean shedding their fear of dietary fat," Dr. Gordon said. "Full-fat milk doesn't need sweetener (and is associated with greater weight loss than non-fat milk in clinical studies). Eggs for breakfast are just fine: brain and heart healthy, and need no sugar."

The study was published February 27 in the journal PLOS ONE. The research did not receive external funding. The authors declared no conflicts of interest.

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Review Date: 
February 27, 2013