PLOS ONE2014-01-02 8:34 PM

The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data 糖对人口水平糖尿病患病率的关系:重复横截面数据的计量分析

Abstract 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 <0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income. 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. 论文摘要 虽然实验和观察研究表明糖摄入与2型糖尿病的形成有关,而与它造成肥胖无关,但我们目前仍不清楚糖摄入量的变化是否可以解释整体人口糖尿病患病率的差异。在运用对糖尿病重复性横截面数据和来自175个国家的食物中营养成分所建的计量经济模型,和检验对其他类型食物(包括纤维,肉类,水果,油,谷物),总热量,超重和肥胖,周期效应,以及几个社会经济变量比如老龄化,城市化和收入等的潜在选择偏见和控制后,我们发现,每人每天每增加150千卡糖摄入(约为一罐汽水/天)就会使糖尿病患病率增长1.1%(p <0.001)。在控制肥胖和其他混杂因素后,没有任何其他食物种类表现出与糖尿病患病率显著的个体关联。糖摄入对糖尿病的影响与久坐行为和酒精摄入无关,肥胖或超重能对它造成的效果产生影响但两者的效应不会互相混淆。在剂量依赖的方式下,糖摄入的时长和程度与糖尿病患病率显著相关。糖摄入下降与糖尿病发病率随后的显著降低有关,而与其他社会经济,饮食和肥胖患病率的变化无关。糖摄入的差异在群体水平上统计性地解释了体育运动,超重或肥胖无法解释的糖尿病患病率的变化。

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