Added dietary sugar poses no risk to prediabetes

Researchers published The study included in this summary on as a preliminary publication that has not yet been peer-reviewed.

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  • Added sugar as a proportion of total energy intake averaged 13.9% for both adults with prediabetes and those with low blood sugar levels.

  • Total intake of added sugar or percentage of diet were not significantly associated with prevalence of prediabetes in a representative nationwide study of 5,306 US adults aged <20 years, with no significant differences in the relationship by race or Sweat.

  • The results indicate that after controlling for total calorie intake, body mass index, related health behaviors, and sociodemographic factors, the amount of total added sugar consumed as part of a typical diet does not significantly increase a person’s likelihood of developing prediabetes.

Why is this important

  • Most previous studies evaluating the direct effects of added sugar on prediabetes have been limited to examining alternatives to added sugar such as sugar-sweetened beverages, high-fructose corn syrup and fructose-sweetened beverages, rather than total added sugar from all food sources.

  • The authors said this is the first study they know of to examine associations between habitual intake of total added sugar and prevalent prediabetes in a large, nationally representative sample of adults in the United States.

study design

  • A cross-sectional analysis of diet recall information from three cycles from the National Health and Nutrition Examination Survey (NHANES) in 2013-2018, including 2,154 adults aged 20 years with hypoglycemia (41%) and 3,152 adults with prediabetes (59%), defined as A1c From 5.7%-6.4% or fasting plasma glucose 100-125 mg/dL.

  • The researchers defined added sugars as sugars, syrups, fruit juice concentrates, or sweeteners with calories added during processing, preparation, or before the consumption of food and drink, and the excluded natural sugars found in dairy and fruit products. Use estimates for added sugar in the Food Pattern Equivalency Database in Food and Nutrient Database for Nutritional Studies.

Main results

  • Study group averaged 47 years, 51% of women, 66% of non-Hispanic whites, 15% of Hispanics, 11% of non-Hispanic blacks, 37% had obesityAnd 55% said they engage in moderate or vigorous physical activity. The mean A1c was 5.4%, and the mean fasting plasma glucose was 101 mg/dL.

  • The total sample reported consuming 13.9% of total daily calories from added sugar, with no significant differences between those with prediabetes and those with normal blood glucose and A1c levels.

  • The average usual intake of total calories was 2,067 kcal per day, and the usual intake of total added sugar was 72 grams (290 kcal per day). Mean intake levels for both scales did not differ significantly between the two subgroups.

  • Results from both unadjusted and modified models indicated that total intake of added sugar is not significantly associated with the prevalence of prediabetes. Consumption of different percentages of added sugar was also not significantly associated with the prevalence of prediabetes.

  • The association between total and intake of added sugar and prevalence of prediabetes did not differ significantly by race or ethnicity. However, some racial or ethnic groups had higher rates of prediabetes in the adjusted models: those identified as Hispanic, Asian American, or other race, with Asian Americans having the highest rate estimates.


  • The cross-sectional study design does not allow for assessment of causal relationships.

  • Self-reports by participants about last intake are subject to under- or over-reporting.

  • Various factors can make measuring A1c levels in the prediabetes range unreliable.


This is a summary of Research study before printing “Total added sugar consumption not significantly associated with risk of prediabetes among US adults: National Health and Nutrition Examination Survey, 2013-2018,” by researchers predominantly based at the University of Alabama Birmingham on medRxiv brought to you by Medscape. The study has not yet been peer-reviewed. The full text of the study can be found at

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