Food and Behaviour Research

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

Basu S, Yoffe P, Hills N, Lustig RH  (2013) PLoS ONE  8(2)  e57873. doi:10.1371/journal.pone.0057873 

Web URL: View this article via PLoS One here - Free full text is available online


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

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.


This study shows for the first time a direct link between sugar consumption and diabetes. The link is independent of obesity, and holds both across countries and over time, as well as when controlling for many other factors known to influence diabetes rates.

For accessible explanations of these findings and their implications see the following news articles: