Diabetes is a global epidemic. The number of adults with diabetes worldwide has more than doubled in the past thirty years, and the International Diabetes Federation (IDF) estimates that at least 1 in 10 people will be living with the disease by 2030.
In the new study, researchers from the Stanford University School of Medicine, the University of California-Berkeley, and the University of California-San Francisco looked at changes in the amount of sugar in countries' food supply between the years 2000 and 2010. Their analysis showed that an increase of 150 calories of sugar per person per day resulted in a 1.1 percent jump in the country's diabetes rate after adjusting for socioeconomic and demographic factors, obesity, and other variables. A 150-calorie dose of sugar is equivalent to the amount in one 12-ounce can of regular soda.
“In countries where sugar availability was going up, we saw increasing rates of diabetes, and in countries where sugar availability was going down we saw decreasing rates of diabetes,” says Robert Lustig, MD, the study’s senior author and a professor of pediatrics at the University of California-San Francisco. Examining trends in sugar supply and diabetes prevalence for an extended period, as opposed to a single moment in time, strengthens the findings, he says.
Importantly, the association between sugar and diabetes endured even after taking into account total calories in the food supply and countries’ obesity rates. A diet high in sugar may also be high in calories, and excess calories can cause weight gain and ultimately increase risk for type 2 diabetes. This connection complicates scientists’ attempts to isolate the effect of sugar on diabetes risk. In the new analysis, there was an independent relationship between sugar availability and diabetes rates in countries that could not be explained by a simultaneous increase in obesity or total calories.
The study used annual estimates of diabetes prevalence from the IDF for the 175 countries analyzed and data on sugar availability from the United Nations Food and Agricultural Organization.
According to Dr. Lustig, the report “overturns the idea that a calorie is a calorie.” The authors say the study supports the theory that calories from sugar have a greater impact on diabetes risk compared to calories from other sources.
Because the study examined data from whole populations rather than individuals, it cannot prove that a diet high in sugar causes diabetes.
“No epidemiological study will ever be able to prove causation. This study is as close as we will ever come. It is the same scrutiny of analysis that we used to implicate cigarettes as the cause of lung cancer and done with the same criteria,” says Lustig.
Though the researchers used a sophisticated analysis, the findings are of limited value because this type of study is not designed to prove that a sugary diet is a risk factor for diabetes, counters Elizabeth Mayer-Davis, PhD, professor of nutrition and medicine at the University of North Carolina at Chapel Hill, who was not involved with the study. Still, she says the results are in line with previous research. "This is not a game changer, it's not a new concept. There are stronger study designs that have given similar conclusions."
"At the end of the day, I think there is increasing evidence that added sugar, particularly sugar-sweetened beverages, may very well increase risk for diabetes. These findings are consistent with that," says Dr. Mayer-Davis.
The study authors call for more research to understand the role sugar may play in the development of type 2 diabetes, but some experts are urging health organizations to begin emphasizing sugar reduction to the public now. “How much circumstantial evidence do you need before you take action?” Marion Nestle, PhD, a professor of nutrition, food studies and public health at New York University, who did not contribute to the research, wrote in the study press release. “At this point we have enough circumstantial evidence to advise people to keep their sugar a lot lower than it normally is.”
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