Table 2: Summary of Studies Investigating Sugar Intake in Relation to Type 2 Diabetes Incidence.
| Study | Sugar Type | Study Participants, Duration | Results | Adjustments | Reference |
|---|---|---|---|---|---|
| Sugars (Risk of T2DM) | |||||
| Nurses’ Health Study | Sucrose | 84,360 females (34–59 years) 6 years follow-up | No association with risk of type 2 diabetes: RR (95 % CI) for highest vs lowest quintile of sucrose intake (BMI <29) 1.16 (0.77–1.76) (p=0.76) and 0.90 (0.64–1.28) (p=0.20) (BMI ≥29) | Age, BMI, alcohol intake, family history of diabetes, prior weight change (1976–1980) and time period | Colditz et al. 199246 |
| The Melbourne Collaborative Cohort Study | Total sugar | 36,787 adults (40–69 years) ) 4 years follow-up | Negative association with incidence of type 2 diabetes: OR (95 % CI) for 100 g/day of sugars for highest vs lowest quartile of sugar intake 0.72 (0.56–0.93); p=0.01 | Country of birth, BMI, physical activity, family history of diabetes, alcohol intake, energy and education level, 5-year weight change, waist-to-hip ratio, sex and age | Hodge et al. 200443 |
| The Women's Health Study | Total sugar, sucrose, glucose, fructose | 38,480 females (45+ years) 6 years follow-up | No association with incidence of type 2 diabetes, RR (95 % CI) for highest vs lowest quintile of: total sugars 0.77 (0.521.15) (p=0.26); fructose 1.24 (0.84–1.85) (p=0.30); glucose 1.12 (0.76–1.65) (p=0.55); and a negative association for sucrose 0.59 (0.39–0.88) (p=0.05) | Age, smoking, BMI, vigorous exercise, alcohol use, postmenopausal hormone use, multivitamin use, history of hypertension, high cholesterol, family history of diabetes | Janket et al. 200344 |
| The Iowa Women's Health Study | Sucrose, fructose, glucose | 35,988 females (55–69 years) 6 years follow-up | Negative association with incidence of type 2 diabetes RR (95 % CI) for highest vs lowest quintile of: sucrose (25.8 vs 57.7 g/day) 0.81 (0.67, 0.99) (p=0.027), and a positive association for fructose (12.5 vs 35.5 g/day), RR 1.27 (1.06, 1.54) (p=0.0015) and glucose (11.1 g/day vs 30.0 g/day), RR 1.30 (1.08, 1.57) (p=0.0007) | Age, BMI, total energy intake, waist to hip ratio, education, pack-years of smoking, alcohol intake, physical activity and family history of diabetes (additional analyses) | Meyer et al. 200045 |
| Finnish Mobile Clinic Health Examination | Total sugar, sucrose, fructose, glucose | 4,304 adults (40-69 years) 12 years follow-up | Significant positive association with risk of type 2 diabetes: RR (95 % CI) for highest vs lowest quartile of: total sugars (24.8 vs 56.6 g/day) 1.42 (0.90, 2.24) (p=0.20); sucrose (33.0 vs 78.4 g/day) 1.22 (0.77, 1.92) (p=0.35); fructose (10.2 vs 26.3 g/day) 1.62 (1.01, 2.59) (p=0.03); glucose (9.2 vs 25.6 g/day) 1.68 (1.06, 2.65) (p=0.009); and fructose + glucose (19.4 vs 51.9 g/day) 1.57 (1.00, 2.48) (p=0.02) | Age, sex, BMI, energy intake, smoking, geographic area, physical activity, family history of diabetes, prudent/conservative dietary pattern score, serum cholesterol, blood pressure, history of infarction, history of angina pectoris, history of cardiac failure | Montonen et al. 200742 |
| SSBs (Risk of T2DM): | |||||
| Finnish Mobile Clinic Health Examination | Carbonated drinks | 2,360 adults (40-69 years) 12 years follow-up | Borderline positive association with risk of type 2 diabetes: RR (95 % CI) for highest vs lowest quartile of median SSB intake (50.7 vs 90.2 g/day): 1.60 (0.932.76) (p=0.01) | Age, sex, BMI, energy intake, smoking, geographic area, physical activity, family history of diabetes, prudent dietary score, conservative pattern score, serum cholesterol, hypertension, history of infarction, angina pectoris and cardiac failure | Montonen et al. 200742 |
| ARIC | SB (fruit punch, nondiet soda, orange or grapefruit juice) | 12,204 adults (4564 years) 9 years follow-up | Borderline positive association with risk of type 2 diabetes: HR (95% CI) for highest vs lowest quartile of SSB intake (<1 8 oz serving/day vs >2 8 oz serving/day) for men: 1.02 (0.76–1.36) (p=0.76). Women: 1.07 (0.79-1.43) (p=0.63) | Age, race, education, family history of diabetes, total caloric intake, dietary fibre, smoking, alcohol consumption, leisure activity and hypertension | Paynter et al. 2006119 |
| Nurses' Health Study II | Sugar-sweetened soft drinks | 91,249 adults (24-44 years) 8 years follow-up | Positive association with risk of type 2 diabetes: RR (95% CI) for highest vs lowest quartile of SSB intake (<1 serving/month vs >1 serving/day): 1.83 (1.42, 2.36) (p=0.001) | Age, alcohol intake, physical, activity, family history of diabetes, smoking, post-menopausal hormone use, oral contraceptive use, cereal fibre, magnesium, trans fat, ratio of polyunsaturated to saturated fat, diet soft drinks, fruit juice, fruit punch | Schulze et al. 200454 |
| SSBs (Risk of T2DM): | |||||
| Black Women's Health Study | Sugar-sweetened soft drinks; sweetened fruit drinks | 43,960 women (21-69 years) 10 years follow-up | Positive association with risk of type 2 diabetes: IRR (95 % CI) for highest vs lowest quintile of SSB intake (<1 12 oz serving/month vs >2 12 oz serving/day): 1.24 (1.06-1.45) (p=0.002) | Age, family history of diabetes, physical activity, smoking, education, sweetened fruit drinks, orange and grapefruit juice, fortified fruit drinks, Kool-Aid®, other fruit juices, red meat, processed meat, cereal fibre, coffee and glycaemic index | Palmer et al. 2008123 |
| Nurses' Health Study I | Fruit juices | 71,346 women (38-63 years) 18 years follow-up | Borderline positive association with risk of type 2 diabetes: HR (95 % CI) for highest vs lowest quintile of SSB intake (<1 12 oz serving/month vs >4 12 oz servings/day): 1.35 (1.22-1.50)(p<0.001) Age, BMI, physical activity, family history of diabetes, post-menopausal hormone use, alcohol use, smoking, total energy intake, intake of: whole grains, nuts, processed meats, coffee, potatoes, sugar-sweetened soft drinks | Bazzano et al. 2008121 | |
| Singapore Chinese Health Study | Soft drinks (i.e. Coca-Cola®, 7UP®) | 43,580 adults (45-74 years) 5.7 years follow-up | Positive association with risk of type 2 diabetes: RR (95 % CI) for highest vs lowest quartile of SSB intake (none vs 2 to >3 8 oz servings/week): 1.34 (1.17-1.52) (p<0.0001) | Age, sex, dialect, year of interview, educational level, smoking, alcohol, physical activity, saturated fat, dietary fibre, dairy, juice, coffee, BMI, energy intake | Odegaard et al. 2010125 |
| HPFS | SSBs (colas, carbonated SSBs and NC SSBs [fruit drinks]) | 40,389 men (40-75 years) 20 years follow-up | Positive association with risk of type 2 diabetes: HR (95 % CI) for highest vs lowest quintile of median SSB intake (0 vs 0.93 serving/day): 1.12 (0.99-1.26) (p=0.04) | Age, energy intake, smoking, physical activity, family history of type 2 diabetes, alcohol intake, multivitamin use, high triglycerides (in 1986), high blood pressure, use of diuretics | De Koning et al. 201156 |
| MESA | Regular soft drinks, soda, SMW (not diet), non-alcoholic beer | 5,011 adults (45-84 years) 5 years follow-up | Borderline positive association with risk of type 2 diabetes: RR (95 % CI) for highest vs lowest quartile of SSB intake (0 vs >1 serving/day): 0.86 (0.62, 1.17) (p=0.09) | Study site, age, sex, race, energy intake, education, physical activity, smoking, at least weekly supplement use, waist circumference and BMI | Nettleton et al. 200952,124 |
| SSBs (Risk of MetS): | |||||
| MESA | Regular soft drinks, soda, SMW (not diet), nonalcoholic beer | 3,878 adults (45-84 years) 5 years follow-up | Borderline positive association with risk of MetS: RR for highest vs lowest quartile of SSB intake (0 vs >1 serving/day): 1.15 (0.92,1.42) (p=0.65) | Study site, age, sex, race, energy intake, education, physical activity, smoking, at least weekly supplement use, waist circumference and BMI | Nettleton et al. 200952,124 |
| Framingham Offspring Study | Soft drinks (Coca- Cola, Pepsi®, Sprite® or other carbonated soft drink [regular or diet]) | 6,039 adults (52.9 years) 4 years follow-up | Positive association with risk of MetS: OR (95% CI) for highest vs lowest quartile of SSB intake (0 vs >2 12 oz serving/day): 1.67 (1.38, 2.01) | Age, sex, physical activity index, smoking, dietary consumption of saturated fat, trans fat, fibre, magnesium, total calories and glycaemic index | Dhingra et al. 2007120 |
| ARIC | Regular soda and sweetened fruit- flavored punch or NC beverages | 9,514 adults (45-64 years) 9 years follow-up | Borderline positive association with risk of MetS: HR (95% CI) for highest vs lowest tertile of SSB intake (0 vs 1 median serving/day): 1.09 (0.99-1.19) (p=0.07) | Age, sex, race, education centre, total calories, smoking, physical activity, intake of meat, dairy, fruits and vegetables, whole grains and refined grains | Lutsey et al. 2008122 |
p for trend. ARIC = Atherosclerosis Risk in Communities Study; BMI = body mass index; CI = confidence interval; HPFS = Health Professionals Follow-Up Study; HR = hazard ratio; IRR = incidence rate ratio; MESA = Multi-Ethnic Study of Atherosclerosis; MetS = the metabolic syndrome; NC = non-carbonated; OR = odds ratio; RR = relative risk; SB = sweetened beverage; SSB = sugar-sweetened beverage; SMW = sweetened mineral water; T2DM = type 2 diabetes mellitus; UMW = unsweetened mineral water.