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Response to article by Basu et al. in PLoS ONE

February 2013

"Expert reviews of the scientific evidence are clear and in agreement - sugar does not cause diabetes. It is deeply disappointing that the press release sensationalises and over-states the findings of the study. We are also bewildered by the claim that this is the first study in this area, when in fact there have been numerous studies over the last 40 years. Cause and effect cannot be determined from this analysis, which contains a substantial number of limitations such as having no measure of how much sugar a person eats."

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February 2013

Response to article by Basu et al. in PLoS ONE

Sugar Nutrition UK welcomes the opportunity to respond to the article by Basu and colleagues, published in PLoS ONE, and its press release.

This study does not investigate causation, but instead looks at possible correlations between sugar availability and estimated diabetes risk. There are a significant number of limitations to the study and to what can be implied from its findings.

One major weakness is that the paper does not use any measure of how much sugar people eat, but instead uses figures for sugar availability. These values do not take into account factors such as the magnitude of wastage and losses within the food chain. Therefore availability data is an inappropriate, over-estimation of consumption levels. Additionally a further shortcoming of the study is the use of estimates of diabetes prevalence rather than a measure of the rates of diagnosed diabetes.

With these major limitations, and the fact that the study does not investigate any cause and effect relationship, the papers authors quite correctly state that they are unable to make any mechanistic conclusions and that “any of the findings we observe here are meant to be exploratory in nature, helping us to detect broad population patterns that deserve further testing through prospective longitudinal cohort settings…”.

This paper does not show that sugar consumption causes diabetes, but instead calls for more robust studies to be performed. Therefore it is disappointing that the press release makes statements beyond the findings of the paper’s research.

Diabetes UK state on their website that: ‘Type 2 diabetes develops when the body does not produce enough insulin to maintain a normal blood glucose level, or when the body is unable to effectively use the insulin that is being produced’. In addition, Diabetes UK clearly state that ‘eating sweets and sugar does not cause diabetes’.

Likewise major Expert Committees* including the World Health Organisation and UK Department of Health have reviewed the scientific evidence in relation to sugar and diabetes, and have all concluded that the evidence does not implicate sugar consumption with the causation of diabetes. Additionally, experts including the British Dietetic Association and the World Health Organisation agree that a moderate amount of sugar can be eaten as part of a healthy balanced diet.

In the UK we have reliable information on dietary intake and the rates of diabetes. These show that in the last decade alone intakes of sugars have decreased by 6%, whilst the number of people diagnosed with diabetes in England has more than doubled.

 

References 

  • Basu et al. (2013) The relationship of sugar to population-level diabetes prevalence: An econometric analysis of repeated cross-sectional data PLoS ONE 8(2): e57873.
  • British Dietetic Association - Food Facts: Sugar www.bda.uk.com/foodfacts/Sugar.pdf
  • Diabetes UK – www.diabetes.org.uk
  • *Department of Health (1989) Dietary Sugars and Human Disease. Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects No 37. HMSO, London.
  • Department of Health (2012) National Diet and Nutrition Survey: Headline results from Years 1, 2 and 3 (combined) of the rolling programme 2008 – 2011.
  • *European Food Safety Authority (2010) Scientific Opinion on dietary reference values for carbohydrates and dietary fibre The EFSA Journal 2010 8(3) 1462.
  • *FAO Rome (1998) Report of a Joint FAO/WHO Expert Consultation. Carbohydrates in Human Nutrition. FAO Food and Nutrition Paper No 66.
  • Henderson L, Gregory J, Irving K & Swan G (2003) The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years. vol. 2: Energy, Protein, Carbohydrate, Fat and Alcohol Intake. HMSO, London.
  • *Institute of Medicine of the National Academies (2002) Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) The National Academies Press, Washington.
  • NHS Information Center for health and social care (2011) Health Survey for England 2010 – Trend Tables.
  • Stanford University Medical Centre (2013) Press Release: Quantity of sugar in food supply linked to diabetes rates, Stanford researcher says. www.eurekalert.org/pub_releases/2013-02/sumc-qo022113.php
  • *World Health Organization and Food and Agriculture Organization (2003) Diet, nutrition and the prevention of chronic diseases. Report of a Joint FAO/WHO Expert Consultation. WHO Technical Report Series 916. WHO Geneva, Switzerland.

Media queries to media@sugarnutrition.org.uk

Sugar Nutrition UK is an association principally funded by UK sugar manufacturers and is involved in promoting nutrition research and raising awareness among academics, health professionals, the media and the public about sugars and their role in health.

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