A Prospective Study of Sugar Intake and Risk of Type 2 Diabetes in Women

  1. Sok-Ja Janket, DMD, MPH1,
  2. JoAnn E. Manson, MD, DRPH123,
  3. Howard Sesso, SCD13,
  4. Julie E. Buring, SCD14 and
  5. Simin Liu, MD, SCD13
  1. 1Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  2. 2Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  3. 3Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts
  4. 4Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts


    OBJECTIVE—To investigate prospectively whether intake of total or type of sugar is associated with the risk of developing type 2 diabetes. The contribution of sugar intake to the pathogenesis of type 2 diabetes has not been settled in the context of primary prevention because of limited prospective data.

    RESEARCH DESIGN AND METHODS—The Women’s Health Study is a randomized controlled trial of aspirin and vitamin E in the prevention of cardiovascular disease and cancer. A validated semiquantitative food frequency questionnaire was completed by 39,345 women aged 45 years and older. The main outcome was the incidence of type 2 diabetes. The predictor was sugar intake, including sucrose, glucose, fructose, and lactose. Using Cox proportional hazard models, multivariate RRs of type 2 diabetes for increasing quintiles of sugar intake compared with the lowest quintile were estimated.

    RESULTS—Compared with the lowest quintile of sugar intake, the RRs and 95% CIs for the highest quintiles were 0.84 (0.67–1.04) for sucrose, 0.96 (0.78–1.19) for fructose, 1.04 (0.85–1.28) for glucose, and 0.99 (0.80–1.22) for lactose, after adjustment for known risk factors for type 2 diabetes. Similar findings of no association were obtained in subgroup analyses stratified by BMI.

    CONCLUSIONS—Intake of sugars does not appear to play a deleterious role in primary prevention of type 2 diabetes. These prospective data support the recent American Diabetes Association’s guideline that a moderate amount of sugar can be incorporated in a healthy diet.


    • Address correspondence and reprint requests to Simin Liu, Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave. East, Boston, MA 02215. E-mail: sliu{at}rics.bwh.harvard.edu.

      Received for publication 18 November 2002 and accepted in revised form 2 January 2003.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    | Table of Contents