title: Per capita sugar consumption and prevalence of diabetes mellitus--global and regional associations.
abstract: BACKGROUND
  Diabetes mellitus (DM) is a rampant epidemic worldwide. Causative factors and predisposition is postulated to be multi-factorial in origin and include changing life styles and diet. This paper examines the relationship between per capita sugar consumption and diabetes prevalence worldwide and with regard to territorial, economic and geographical regions.
  
  
  METHODS
  Data from 165 countries were extracted for analysis. Associations between the population prevalence of diabetes mellitus and per capita sugar consumption (PCSC) were examined using Pearson's correlation coefficient (PCC) and multivariate linear regression analysis with, infant mortality rates (IMR, as an general index maternal and child care), low birth weight (LBW, as an index of biological programming) and obesity prevalence included in the model as confounders.
  
  
  RESULTS
  Despite the estimates for PCSC being relatively crude, a strong positive correlation coefficient (0.599 with p < 0.001) was observed between prevalence of diabetes mellitus and per capita sugar consumption using data from all 165 countries. Asia had the highest correlation coefficient with a PCC of 0.660 (p < 0.001) with strongest correlation noted in Central (PCC = 0.968; p < 0.001), South (PCC = 0.684; p = 0.050) and South East Asia (PCC = 0.916; p < 0.001). Per capita sugar consumption (p < 0.001; Beta = 0.360) remained significant at the last stage as associations of DM prevalence (R2 = 0.458) in the multivariate backward linear regression model. The linear regression model was repeated with the data grouped according to the continent. Sugar was noted to be an independent association with DM only with regard to Asia (p < 0.001 Beta = 0.707) and South America (p = 0.010 Beta 0.550). When countries were categorized based on income PCS and DM demonstrated significant association only for upper middle income countries (p < 0.001 Beta 0.656).
  
  
  CONCLUSIONS
  These results indicate independent associations between DM prevalence rates and per capita sugar consumption both worldwide and with special regard to the Asian region. Prospective cohort studies are proposed to explore these associations further.
authors.affiliation: University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka. prav782@yahoo.com.
authors.forename: Praveen
authors.initials: P
authors.lastname: Weeratunga
authors.forename: Sayumi
authors.initials: S
authors.lastname: Jayasinghe
authors.forename: Yashasvi
authors.initials: Y
authors.lastname: Perera
authors.forename: Ganga
authors.initials: G
authors.lastname: Jayasena
authors.forename: Saroj
authors.initials: S
authors.lastname: Jayasinghe
mesh_terms: D001208:Asia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D019422:Dietary Sucrose; D005247:Feeding Behavior; D005523:Food Supply; D014943:Global Health; D006801:Humans; D016014:Linear Models; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D013020:South America / Q000453:epidemiology
chemical_list: D019422:Dietary Sucrose