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Greatest Contributor to Diabetes: Obesity or Sugar?

Results of a recent large epidemiological study suggest that it is amount of dietary calories from sugar that plays the most pivotal role in diabetes risk…. 

The study also found that how many calories consumed isn’t as important as what makes up those calories — calories from sugar are more damaging than calories from other foods.

Researchers looked at the correlation between sugar availability and diabetes in 175 countries over the last ten years and controlled for such factors as obesity, calories consumed, diet, economic development, activity level, urbanization, tobacco and alcohol use, and aging.

They found the more sugar a population ate the higher the incidence of diabetes, independent of obesity rates. According to Sanjay Basu, MD, PhD, the study’s lead author, "We’re not diminishing the importance of obesity at all, but these data suggest…additional factors contribute to diabetes risk besides obesity and total calorie intake, and that sugar appears to play a prominent role." The study provides the first large-scale, population-based evidence for the idea that perhaps it’s not just calories, but the type of calories, that matter when looking at diabetes risk.

One thing is clear from the study – although by definition all calories give off the same amount of energy when burned, sugar is uniquely damaging to the body.

The study showed an additional 150 calories from any food source caused a 0.1 percent increase in the population’s diabetes rate whereas an additional 150 calories of sugar caused it to raise a full 1 percent. To put it into perspective, a can of soda contains roughly 150 calories of sugar. Considering that the average American consumes 22 teaspoons of added sugar a day, or about 350 calories’ worth, and it’s clear why diabetes is the fastest growing disease in history.

The study also showed that the longer a population was exposed to excess sugar, the higher the diabetes rates were, and when sugar availability dropped, diabetes rates dropped, independent of changes in calorie intake, physical activity, or obesity rates.

It’s too early to say definitively, whether sugar causes diabetes but this study clearly shows a correlation and spotlights the need for more research. Dr. Basu suggested sugar affects the liver and pancreas in ways that need more exploration.

Practice Pearls:
  • Population-level variations in diabetes prevalence that are unexplained by other common variables appear to be statistically explained by sugar.
  • It is thought that much of the FAO data on foods and nutrients in the food supply have limits to their reliability.
  • Sugar should be investigated further for its role in diabetes pathogenesis apart from its contributions to obesity.

Plos One, Feb 2014