title: Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment.
abstract: 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.
authors.affiliation: Inter-Medic Medical Group, 2630 Bobcat Village Center Road, North Port, FL 34288, USA. leegross@msn.com
authors.forename: Lee S
authors.initials: LS
authors.lastname: Gross
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Earl S
authors.initials: ES
authors.lastname: Ford
authors.forename: Simin
authors.initials: S
authors.lastname: Liu
mesh_terms: 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
chemical_list: D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D005632:Fructose