Numerous studies have shown that a healthy lifestyle, including a healthy diet, influences the development of type 2 diabetes. In this context, the question arises to what extent sugar consumption has an impact on type 2 diabetes prevalence. In a much-noted editorial in the British Medical Journal, Gary Taubes sparked the discussion whether high sugar intake leads to overweight and thus increases the risk of type 2 diabetes, or whether sugar consumption is more than just "empty calories" and has a direct association – without mediation via the body mass index – on the development of type 2 diabetes.
The research team led by Schlesinger, head of the junior research group Systematic Reviews at the German Diabetes Center (DDZ), addressed this question and conducted a mediation analysis. The aim of this global mediation analysis was to differentiate the total association between per capita sugar consumption and type 2 diabetes prevalence into the indirect association – via the causal pathway of calorie overload and the resulting overweight – and the direct association. The results have now been published in the European Journal of Nutrition. In their ecological study (based on aggregated data collected for a whole population/group of individuals), the research team gathered and analyzed data from 192 countries extracted from publicly accessible databases of large organizations. A positive correlation between daily sugar intake and the prevalence of diabetes was observed worldwide. With an increase in sugar consumption of 100 kcal per capita, the diabetes prevalence increased by 1.6 percent.
The results of the mediation analysis show that the association between sugar intake and diabetes prevalence was largely (66 percent) explained by the body mass index, i.e. indirectly. "However, our results from the ecological study also suggest that – indicated by the remaining 34 percent – other mechanisms could influence the association and thus directly favor the development of diabetes," said Schlesinger. In a follow-up project, her research team wants to investigate whether this association also shows up on an individual level. In addition, further studies are needed to investigate which mechanisms play a role here in detail. "These in part surprising findings will contribute to a better understanding of the importance of diet in the development of diabetes mellitus," said Professor Michael Roden, scientific director and chairman of the board of the German Diabetes Center. "Subsequently, further research will need to investigate to what extent special dietary recommendations in this direction also directly influence the occurrence and progression of diabetes.”
Lang A, Kuss O, Filla T, Schlesinger S: Association between per capita sugar consumption and diabetes prevalence mediated by the body mass index: results of a global mediation analysis. Eur J Nutr. 2020. DOI: 10.1007/s00394-020-02401-2