News Releases & Statements
No One Food Increases the Risk For Type 2 Diabetes
FOR IMMEDIATE RELEASE: August 24, 2004
ABA Media Room
NO ONE FOOD INCREASES THE RISK FOR TYPE 2 DIABETES
UNHEALTHY LIFESTYLES, NOT SOFT DRINKS, ARE TO BLAME
Washington, DC—It is scientifically indefensible to blame any one food or beverage for increasing the risk of type 2 diabetes, a disease which is commonly known to have multiple causes and risk factors.
A new study by Matthias Schulze et al. in the August 25 edition of The Journal of the American Medical Association (JAMA) irresponsibly proposes an association between sugar-sweetened soft drink consumption and type 2 diabetes in women. This interpretation of the results reflects neither reality nor even this study’s own results. In addition to soft drinks, this study found significant correlations between low cereal fiber intake, low protein intake, low magnesium intake, smoking, low physical activity, increased total caloric consumption and type 2 diabetes.
“It is inexplicable that the authors have chosen to focus solely on sugar-sweetened beverages in this way,” said Dr. Richard Adamson, Vice President for Scientific and Technical Affairs at the American Beverage Association. “Neither soft drinks nor fruit juice consumption nor sugar intake are listed by the National Institutes of Health, the American Diabetes Association or the majority of published medical literature as risk factors for type 2 diabetes. This study provides no evidence to support the inflammatory allegation that sugar-sweetened beverages are a cause of type 2 diabetes.”
“A careful reading of the paper reveals that it was an unhealthy lifestyle, not consumption of a particular food or beverage, that increased the women’s risk for type 2 diabetes. In addition to the statistical findings of this study being weak, the study also did not adjust for all known diabetic risk factors,” Adamson said.
No proven association between increased sugar intake and obesity
Sugar intake and a higher Body Mass Index (BMI) are not directly linked. As recently summarized by the Institute of Medicine (IOM), studies have not shown a direct link between increased sugar intake and increased obesity rates. The IOM report also states that the effects of increased intake of total sugar or energy are not consistent and that “there is no clear and consistent association between increased intake of added sugars and BMI.”
Epidemiological evidence from other studies also indicates that sugar consumption is not an independent risk factor for type 2 diabetes. A recent literature review by Rob van Dam (European Journal of Epidemiology 2003;18:1115-1125) notes that “Contrary to popular belief, data do not suggest that a higher proportion of sucrose in the diet increases risk for type 2 diabetes independent of body fatness.”
It should also be noted that in the Nurses’ Health Study I it was concluded that sucrose intake was not related to risk of type 2 diabetes (Colditz et al., American Journal of Clinical Nutrition 1992;55:1018-1023). This previous finding was ignored in the Schulze study, which has many of the same authors.
Study data illogically suggests not much difference between women who drink regular drinks and those who consume diet drinks
In the current study the correlations between increased sugared soft drink intake and type 2 diabetes did not differ significantly from those between diet soft drinks and type 2 diabetes. There is no reasonable scientific basis for any association between diet soft drink consumption and either weight gain or obesity. The lack of difference between regular and diet soft drinks brings into question the validity of the analytical methods used in the current report.
Methodological problems with dietary assessment tools
In a key paragraph of the comment section the authors note that errors in dietary assessment can solely account for a lack of association. However, dietary self-assessment tools are known to produce errors of omission and errors in both underestimation and overestimation of quantities consumed. Dietary self-assessment can result in bias errors both in failing to find associations that do exist and in falsely finding associations that do not exist. Because in this study consumption of sugar-sweetened beverages was associated with several demonstrated diabetes risk factors (e.g. cigarette smoking, low physical activity, low cereal fiber consumption and low magnesium intake), it is impossible to determine which of these variables was most important as a factor linked with incidence of diabetes.
Epidemiological studies often have these types of issues (Smith and Ebrahim, British Medical Journal 2002;325:1437-1438), but in this study the authors chose to ignore many of the factors found to be linked to diabetes incidence and instead focus solely on a link with increased sweetened beverage intake. In addition, no association with weight gain or type 2 diabetes was found in those women who regularly consumed soft drinks throughout the study. The only association was found between weight gain or type 2 diabetes and women who dramatically increased their soft drink intake during the study. This lack of correlation between disease and constant soft drink intake suggests that soft drinks were not the most important factor. The narrow focus on soft drinks in light of many associated factors is faulty science. It is the total unhealthy lifestyle of the subjects, not a single factor, that seemed to lead to greater risk for overweight and type 2 diabetes.
Soft drink industry offers variety of beverages and consumers respond
To maintain a healthy lifestyle, it is important to consume a variety of foods and beverages in moderation and to get daily exercise. Soft drink companies offer consumers a variety of beverages, including bottled water, teas, sports drinks, fruit juices, fruit drinks, regular soft drinks, mid-calorie soft drinks and diet drinks. According to Beverage Digest, an industry trade publication, U.S. sales of diet soft drinks, water and sports drinks have grown dramatically, with diet drinks up 6.3 percent last year, water up 21.5 percent and sports drinks (which have less sugar and fewer calories than regular soft drinks) up 17.9 percent.
In its August 13 edition, Beverage Digest estimated that “…from 1998 to 2003, overall calories per serving in what the beverage industry sells has declined by about –12 %.”
“Soft drink companies have provided more consumer choice by expanding their no-calorie and low-calorie options dramatically and introducing new, smaller packaging options, including eight-ounce cans and 13.2 and 14 ounce plastic bottles, to help consumers manage their caloric intake while still enjoying great taste,” said Kathleen Dezio, a spokeswoman for the ABA.
The American Beverage Association (National Soft Drink Association) is the trade association representing the broad spectrum of companies that manufacture and distribute non-alcoholic beverages in the United States. Reflective of its members growing array of beverage products, NSDA recently changed its name to encompass all products of member companies.
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