Is Sugar Intake Specifically Driving the Diabetes Epidemic?

In a country-by-country analysis, sugar availability is related to prevalence of diabetes. Multiple factors, including overweight and obesity, are associated strongly with diabetes. Yet, in individuals and in population-based studies, the correlation is far from perfect: We see both thin diabetic patients and people with marked obesity but normal blood glucose levels. In addition, some countries have high rates of obesity but low prevalence of diabetes, and some have the reverse. In a new study, researchers in California examined cross-sectional data from 175 countries. After controlling for the availability of food types, weight, age, income, and urbanization, the investigators found that the availability of sugar (and no other food) correlated strongly with prevalence of diabetes. The availability of calories from all types of foods had a weak positive correlation with prevalence of diabetes, but the availability of calories specifically from sugar had a strong positive correlation: For every 150 kcal/person/day increase in sugar availability, national prevalence of diabetes increased by 1.1%. The duration and degree of sugar availability correlated with diabetes in a dose-dependent manner. Comment: This study provides evidence that intake of sugar, more than isocaloric intake of other foods, might be an important factor driving the diabetes epidemic. However, an ecological study such as this cannot prove that the association is causal. Also, an important potential confounder levels of exercise was not tested robustly. Anthony L. Komaroff, MD Published in Journal Watch General Medicine March 12, 2013

Citation(s):
Basu S et al. The relationship of sugar to population-level diabetes prevalence: An econometric analysis of repeated cross-sectional data. PLoS ONE 2013 Feb 27; 8:e57873. (http://dx.doi.org/10.1371/journal.pone.0057873)

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