(P19-031-23) Associations of Types of Dietary Sugar With Risk of Type 2 Diabetes in US Men and Women

Objectives: To examine the association between specific types of dietary sugar and the incidence of type 2 diabetes (T2D).

Methods: We prospectively followed 198,447 men and women in the Nurses’ Health Study (1980-2016), Nurses’ Health Study II (1991-2017), and Health Professionals Follow-Up Study (1986-2016) who were free from cardiovascular disease, cancer, and diabetes at baseline. Intakes of sugar, including total glucose equivalents (TGE., from glucose monosaccharides and sucrose, maltose, lactose, and starch), total fructose equivalents (TFE, from fructose monosaccharides and sucrose), added sugar, sugar intrinsic to food, sucrose, lactose, and starch, were measured by food frequency questionnaires at baseline and updated every 2-4 years. Incident T2D cases were first self-reported and then confirmed by a supplementary questionnaire.

Results: During 3,839,854 person-years of follow-up, we documented 16,846 T2D cases. After adjustment for potential confounding factors and major risk factors, participants in the highest quintile (Q5) of both TGE and TFE had a 14% higher risk of T2D compared to those in the lowest quintile (HR: 1.14; 95% CI: 1.07, 1.21 for TGE and HR: 1.14; 95% CI: 1.08, 1.21 for TFE; both P-trend < 0.001). TFE from fruits and vegetables was not associated with T2D risk (HR _{Q5 vs. Q1}: 0.96; 95% CI: 0.91, 1.02; P-trend=0.18), whereas a higher intake of TFE from non-fruit and vegetable sources was associated with a higher T2D risk (HR _{Q5 vs. Q1}: 1.18, 95% CI: 1.11, 1.25; P-trend < 0.001). We found positive associations of added sugar and starch intakes with T2D risk (HR _{Q5 vs. Q1}: 1.12, 95% CI: 1.05, 1.19; P-trend < 0.001 for added sugar and HR _{Q5 vs. Q1}: 1.07, 95% CI: 1.01, 1.14; P-trend=0.006 for starch). In contrast, intakes of sugar intrinsic to food and lactose were inversely associated with T2D risk (HR _{Q5 vs. Q1}: 0.94, 95% CI: 0.88, 0.99; P-trend=0.005 for SITF and HR _{Q5 vs. Q1}: 0.91, 95% CI: 0.86, 0.96; P-trend < 0.001 for lactose). Replacing 5% of energy from TGE, TFE, or added sugar with equivalent energy from vegetable fat was associated with risk reductions of 7, 8, and 5% for T2D.

Conclusions: Higher intakes of TGE, TFE, added sugar, and starch were associated with a higher T2D risk. Fructose from fruits and vegetables was not associated with T2D risk, but fructose from added sugar was associated with a higher risk.

Funding Sources: National Institutes of Health