Sugar has been complicated issue in science with researchers for years saying that sugar does not really put you at risk for diabetes.
In a large epidemiological study researchers from the Stanford University School of Medicine, the University of California-Berkeley and the University of California-San Francisco, led by Dr. Sanjay Basu, MSc, MD, PhD, associate professor of medicine at Stanford Prevention Center and Stanford Health Policy Associate, new findings have suggested that the populations food supply containing increased amounts of sugar was linked to higher diabetes rates.
While experimental and observational studies suggest that sugar intake is associated with the development of type 2 diabetes, independent of its role in obesity, it is unclear whether alterations in sugar intake can account for differences in diabetes prevalence among overall populations, according to the study’s abstract.
For the study researchers examined data from the United Nations Food and Agricultural Organization food supply data to capture market availability of different food items (sugars, fibers, fruits, meats, cereals, oils, and total food) in kilocalories per person per day in each country for each year of the analysis. The dependent variables in the analysis were International Diabetes Federation estimates of diabetes prevalence among persons aged 20 to 79 years old from 2000 through 2010. The sugar availability and diabetes rates were from 175 countries over the last ten years.
According to Dr. Basu this is the first large-scale population-based evidence for the theory that not all calories are equal from a diabetes-risk standpoint.
Other alternative explanations for the link for sugar and diabetes had included sedentary behavior; rates of economic development; household income; urbanization of the population; tobacco and alcohol use; and percentage of the population age 65 or older, since age is also associated with diabetes risk.
The findings revealed more sugar was linked with more diabetes. For every additional 50 calories of sugar available per person per day, the prevalence of diabetes in the population rose 1 percent, even after controlling for obesity, physical activity, other types of calories and a number of economic and social variables. A 12-ounce can of soda contains about 150 calories of sugar. In contrast, an additional 150 calories of any type caused only a 0.1 percent increase in the population's diabetes rate.
Not only was sugar availability correlated to diabetes risk, but the longer a population was exposed to excess sugar, the higher its diabetes rate after controlling for obesity and other factors. In addition, diabetes rates dropped over time when sugar availability dropped, independent of changes to consumption of other calories and physical activity or obesity rates.
The researchers write “Our results show that sugar availability is a significant statistical determinant of diabetes prevalence rates worldwide.” “We found that obesity appeared to exacerbate, but not confound, the impact of sugar availability on diabetes prevalence, strengthening the argument for targeted public health approaches to excessive sugar consumption. We also noted that longer exposure to high sugar was associated with accentuated diabetes prevalence, while reduced sugar exposure was associated with decline in diabetes prevalence.”
Dr. Basu notes that these findings does not prove sugar causes diabetes but emphasizes but the findings do provide real-world support for the body of previous laboratory and experimental trials that suggest sugar affects the liver and pancreas in ways that other types of foods or obesity do not.
Dr. Robert H Lustig, MD, Professor of Pediatrics in the Division of Endocrinology at University of California, San Francisco, and Director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF and senior author of this study commented "Epidemiology cannot directly prove causation.” "But in medicine, we rely on the postulates of Sir Austin Bradford Hill to examine associations to infer causation, as we did with smoking. You expose the subject to an agent, you get a disease; you take the agent away, the disease gets better; you re-expose and the disease gets worse again. This study satisfies those criteria, and places sugar front and center."
Dr. Marion Nestle, PhD, Paulette Goddard Professor in the Department of Nutrition, Food Studies, and Public Health at New York University, Professor of Sociology at NYU and Visiting Professor of Nutritional Sciences at Cornell, author of three prize winning books including Food Politics: How the Food Industry Influences Nutrition and Health; and not part of this study had commented "As far as I know, this is the first paper that has had data on the relationship of sugar consumption to diabetes.” "This has been a source of controversy forever. It's been very, very difficult to separate sugar from the calories it provides. This work is carefully done, it's interesting and it deserves attention."
Dr. Nestle points out that these findings add to many other studies that suggest people should cut back on their sugar intake. "At this point we have enough circumstantial evidence to advise people to keep their sugar a lot lower than it normally is”, says Dr. Nestle.
This study is published in POLS ONE.