Sugar vs Obesity: Looking for the Culprit in Diabetes

A study published recently in PLoS One suggests the availability of sugar at the population level is a significant statistical determinant of type 2 diabetes prevalence rates, independent of its role in obesity. In looking at obesity levels and sugar availability levels in different countries around the world and controlling for other factors, the study’s authors were able to conclude that obesity is not the only cause of diabetes. The availability of sugar is also a cause, whether or not obesity is present. And increased rates of obesity do not always lead to increased rates of diabetes, whereas increased rates of sugar availability do.

According to the study, “Each 150 kilocalories/person/day increase in total calorie availability related to a 0.1 percent rise in diabetes prevalence (not significant), whereas a 150 kilocalories/person/day rise in sugar availability (one 12-ounce can of soft drink) was associated with a 1.1 percent rise in diabetes prevalence.”

Mark Bittman, who interviewed Robert Lustig, pediatric endocrinologist at the University of California, San Francisco, and one of the study’s authors, said the study demonstrates sugar’s connection to diabetes “with the same level of confidence that linked cigarettes and lung cancer in the 1960s.”

The authors looked at United Nations Food and Agricultural Organization food supply data to capture market availability of different food items and International Diabetes Federation estimates of diabetes prevalence among persons aged 20 to 79 years old from 2000 through 2010, while controlling for current income, changes in income, urbanization, aging, obesity, and the consumption of other foods as well as periodic effects (secular correlations that may have occurred simply due to surveillance changes or economic development). They found that “diabetes prevalence rates rose 27% on average from 2000 to 2010, with just over one-fourth of the increase explained by a rise in sugar availability in this model.”

In his opinion piece, Bittman calls on the FDA to re-evaluate the toxicity of sugar, set a daily value, and remove fructose from the “generally recognized as safe” list.

Click here to read the study in PLoS One and here to read Mark Bittman’s take on the findings.

Lesser mit Lupe, painting by Lesser Ury / Wikimedia

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