Influences of added sugar consumption in adults with type 2 diabetes risk: A principle-based concept analysis

Diabetic Patients: Why Stop Sugar?

Diet plays an important role in the complete management of type 1 and type 2 diabetes. The aim of nutritional management of diabetes is to optimize glycemic control, help in achieving ideal body weight, and correct any lipid abnormalities to reduce the risk of long-term complications. However, there are varied and many unscientific beliefs about diet among patients with diabetes as well as in physicians, which very often makes nutritional management challenging. The most common misconception is that patients with diabetes should not consume sugar at all. The taste of food plays an important role in food choices, eating behaviors, food intake, and associated satisfaction. The more distant a recommended change is from the person's actual eating habits, the more difficult it will be to achieve long-term compliance to the recommended change. It is important to provide therefore achievable and sustainable dietary modifications that will encourage people to adopt healthier food choices without compromising their taste preferences. Special attention needs to be given to the nutrition intake in gestational diabetes mellitus. Consensus guidelines have recommended a low glycemic index, high fiber, and protein diet in gestational diabetes mellitus. Alcohol intake in nonpregnant women and supplements rich in micronutrients are both key considerations. There is clearly a need for conducting educational programs for physicians as well as patients to dispel misconceptions regarding the consumption of carbohydrates, especially added sugar, in patients with diabetes. The focus should be on balancing the calorie intake rather than placing unnecessary and inappropriate restrictions.

Associations of Intake of Free and Naturally Occurring Sugars from Solid Foods and Drinks with Cardiometabolic Risk Factors in a Quebec Adult Population: The PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) Study

BACKGROUND

Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented.

OBJECTIVE

The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada.

METHODS

Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates.

RESULTS

In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models.

CONCLUSIONS

Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality.