The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data

Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, California, United States of America.
PLoS ONE (Impact Factor: 3.23). 02/2013; 8(2):e57873. DOI: 10.1371/journal.pone.0057873
Source: PubMed


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. Using econometric models of repeated cross-sectional data on diabetes and nutritional components of food from 175 countries, we found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p <0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income. No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other confounders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight. Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.

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Available from: Nancy Hills, Sep 02, 2014
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    • "This RCS design was also used in a recent study on the relationship between sugar and occurrence of population - level diabetes ( Basu et al . 2013 ) . In our study , there are five time points according to the year of survey : Time point 1 covers DHS data from 1991 to 1992 ; 1996 is Time point 2 ; 1999 is Time point 3 ; Time point 4 is 2004 – 05 and Time point 5 is 2009 – 10 according to the survey year . The survey is conducted every 5 years taking 3 – 5 months at each time perio"
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    ABSTRACT: There is a known high disparity in access to perinatal care services between urban and rural areas in Tanzania. This study analysed repeated cross-sectional (RCS) data from Tanzania to explore the relationship between antenatal care (ANC) visits, facility-based delivery and the reasons for home births in women who had made ANC visits. We used data from RCS Demographic and Health Surveys spanning 20 years and a cluster sample of 30 830 women from ∼52 districts of Tanzania. The relationship between the number of ANC visits (up to four) and facility delivery in the latest pregnancy was explored. Regional changes in facility delivery and related variables over time in urban and rural areas were analysed using linear mixed models. To explore the disconnect between ANC visits and facility deliveries, reasons for home delivery were analysed. In the analytic model with other regional-level covariates, a higher proportion of ANC (>2-4 visits) and exposure to media related to an increased facility delivery rate in urban areas. For rural women, there was no significant relationship between the number of visits and facility delivery rate. According to the fifth wave result (2009-10), the most frequent reason for home delivery was 'physical distance to facility', and a significantly higher proportion of rural women reported that they were 'not allowed to deliver in facility'. The disconnect between ANC visits and facility delivery in rural areas may be attributable to physical, cultural or familial barriers, and quality of care in health facilities. This suggests that improving access to ANC may not be enough to motivate facility-based delivery, especially in rural areas. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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    • "Excessive consumption of high sugar foods and drinks, which are both cheap and readily available, plays a central role in development of obesity in humans. Increasing sugar consumption affects the majority of the developed and developing world (Lustig et al. 2012; Basu et al. 2013) and a major contributor to this increase is the widespread availability of relatively cheap sugar sweetened beverages or soft drinks (Guthrie and Morton 2000; Popkin and Nielsen 2003). Consumption of soft drinks has been shown to contribute to 80% of the increase in added sugar consumption during the period 1962–2000 in the USA (Popkin and Nielsen 2003) and today are the largest single source of added sugar consumption (Yang et al. 2014). "
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    • "However, the consumption of high calorie sugars has resulted in various nutritional and clinical problems including obesity, type 2 diabetes mellitus and metabolic syndrome in humans [1]-[3]. Therefore, the food industry has witnessed a rise in demand, especially from diet-conscious people, for a natural, high intensity, low caloric , non-nutritive and stable sweetener that can be used as a sugar (sucrose) substitute in food and nutraceuti- cals. "

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