Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment.
BACKGROUND
Type 2 diabetes is an epidemic that is affecting an ever-increasing proportion of the US population. Although consumption of refined carbohydrates has increased and is thought to be related to the increased risk of type 2 diabetes, the ecologic effect of changes in the quality of carbohydrates in the food supply on the risk of type 2 diabetes remains to be quantified.


OBJECTIVE
The objective was to examine the correlation between consumption of refined carbohydrates and the prevalence of type 2 diabetes in the United States.


METHODS
In this ecologic correlation study, the per capita nutrient consumption in the United States between 1909 and 1997 obtained from the US Department of Agriculture was compared with the prevalence of type 2 diabetes obtained from the Centers for Disease Control and Prevention.


RESULTS
In a univariate analysis, a significant correlation with diabetes prevalence was observed for dietary fat (r = 0.84, P < 0.001), carbohydrate (r = 0.55, P < 0.001), protein (r = 0.71, P < 0.001), fiber (r = 0.16, P = 0.03), corn syrup (r = 0.83, P < 0.001), and total energy (r = 0.75, P < 0.001) intakes. In a multivariate nutrient-density model, in which total energy intake was accounted for, corn syrup was positively associated with the prevalence of type 2 diabetes (beta = 0.0132, P = 0.038). Fiber (beta = -13.86, P < 0.01) was negatively associated with the prevalence of type 2 diabetes. In contrast, protein (P = 0.084) and fat (P = 0.79) were not associated with the prevalence of type 2 diabetes when total energy was controlled for.


CONCLUSIONS
Increasing intakes of refined carbohydrate (corn syrup) concomitant with decreasing intakes of fiber paralleled the upward trend in the prevalence of type 2 diabetes observed in the United States during the 20th century.
Gross
Lee S
LS
Inter-Medic Medical Group, 2630 Bobcat Village Center Road, North Port, FL 34288, USA. leegross@msn.com
Li
Li
L
Ford
Earl S
ES
Liu
Simin
S
D000328:Adult; D000704:Analysis of Variance; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004043:Dietary Fiber / Q000008:administration & dosage* / Q000378:metabolism; D002523:Edible Grain; D002149:Energy Intake; D005260:Female; D005632:Fructose / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D038321:Glycemic Index; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D005632:Fructose