Study challenges link between added sugar intake and prediabetes risk

By Pooja Toshniwal PahariaReviewed by Benedette Cuffari, M.Sc.Jun 22 2023

In a recent study published in PLoS ONE, researchers evaluate the association between total added sugar intake and prediabetes risk among adult United States residents.

Study: Total added sugar consumption is not significantly associated with risk for prediabetes among U.S. adults: National Health and Nutrition Examination Survey, 2013-2018. Image Credit: Eviart / Shutterstock.com

Background

Prediabetes, a serious and asymptomatic medical condition characterized by intermittently elevated blood glucose levels and insulin resistance, is prevalent among adult U.S. residents. Previous studies have reported positive and dose-dependent associations between sweetened beverage consumption and type 2 diabetes; however, it remains unclear whether the total dietary consumption of added sugars similarly increases the risk of prediabetes.

Most of these studies used added sugar proxies, such as high-fructose corn and fructose- and sugar-sweetened beverages, rather than determining total added sugar intake from all dietary sources, including beverages and foods. In addition, ethnicity- and race-based differences in prediabetes risk have not been well-characterized.

About the study

In the present cross-sectional study, researchers investigate whether total added sugar consumption was associated with prediabetes risk among U.S. adults. The researchers also determined whether prediabetes risk estimates differed by ethnicity or race and the total added sugar consumption, which was expressed as a percentage of total energy intake.

Publicly accessible and de-identified data were analyzed from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2018. U.S. adults 20 years and older with one to two days of diet recall data were also included in the analysis. Prediabetes was described as glycated hemoglobin (HbA1c) levels ranging between 5.7% and 6.4% or fasting blood glucose levels between 100-125 mg/dL.

Survey-weighted-type logistic regression modeling was used to calculate the odds ratios (ORs) for prediabetes development based on the added sugar intake, according to the National Cancer Institute (NCI). Adjusted covariates included age, sex, ethnicity or race, body mass index (BMI), total calorie intake, physical exercise, smoking habits, educational attainment, poverty-to-income ratios (PIRs), and dietary variables, including saturated fat, total fat, total antioxidant capacity, and dietary fiber.

The study participants included Hispanic Mexican Americans and other Latinos, non-Hispanic Blacks and Whites, and Asian Americans. Those who were excluded from the study included 115 pregnant and breastfeeding women, 963 individuals consuming insulin or antidiabetic medications, 167 diabetes type 2 patients with HbA1c levels exceeding 6.5% or fasting blood glucose levels greater than 126 mg/dL, and 415 adults due to a lack of one or more days of diet recall data comprising added sugar values from the analysis.

Trained personnel performed dietary recalls using the U.S. Agricultural Department’s automated multiple-pass method (AMPM). The initial recall was administered face-to-face at the center, whereas the second recall was performed over the phone after three to 10 days.

Added sugars included those present in concentrated fruit juices, syrups, and caloric sweeteners incorporated during food preparation, processing, and consumption, excluding natural sugars in fruit and dairy products. Added sugar estimates were derived from the Food and Nutrient Database for Dietary Studies’ Food Patterns Equivalents Database (FPED).

Study findings

The sample size comprised 5,306 adult individuals, 3,152 of whom had prediabetes, and 2,154 had normal blood glucose levels. The mean participant age was 47 years, 51% of whom were female.

Among the participants, 66%, 15%, 11%, 5%, and 4% were non-Hispanic Whites, Hispanic Mexican Americans and Latinos, non-Hispanic Blacks, Asian Americans, and individuals of other races, respectively.

Individuals with prediabetes were more likely to be older, averaging 51 years. Prediabetics were also more likely to be male (54%), overweight (35%), obese (44%), non-smokers (78%), have high school-level education (26%), have family PIRs above 1.85 (68%), belong to Hispanic ethnicity inclusive of Mexican Americans (16%), Asian Americans (5.0%), or of other races (4.0%).

The regular total calorie intake was 2,067 kcal daily, whereas the regular total added sugar intake was 72 grams or 290 kcal/day. The total calorie intake from added sugars in the sample population was 14%.

There were no significant associations between the total and percent added sugar intakes and an increased prediabetes risk. Likewise, the sensitivity analysis did not identify any significant differences in prediabetes risk by ethnicity or race.

Conclusions

Among adults 20 years or older with normal blood sugar levels or prediabetes, the total consumption of added sugars did not significantly increase their risk of prediabetes, with estimated risks not differing significantly by ethnicity or race.