Recommendations Summary
PDM: Sugar and Prevention of Type 2 Diabetes 2014
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
PDM: Sugar and Prevention of Type 2 Diabetes
If avoiding the consumption of sugar is proposed for the prevention of type 2 diabetes, the registered dietitian nutritionist (RDN) should advise individuals who are at high risk for type 2 diabetes that limiting sugar consumption, without weight loss, may or may not be beneficial. There were no studies identified to evaluate the impact of sugar intake, independent of weight loss, on outcomes in adults with metabolic syndrome or individuals with prediabetes. However, higher intake of added sugars may contribute to higher energy intake and increased body weight, and therefore increase the risk of type 2 diabetes.
Rating: Insufficient Evidence
Conditional-
Risks/Harms of Implementing This Recommendation
None.
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Conditions of Application
- This recommendation applies when avoiding the consumption of sugar is proposed for the prevention of type 2 diabetes
- Research on synergistic effects of nutrients was not evaluated.
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Potential Costs Associated with Application
The costs of medical nutrition therapy (MNT).
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Recommendation Narrative
No studies were included in the evidence analysis for this recommendation.
In Adults With Metabolic Syndrome
- Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C):
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on glycemic-related outcomes in adults with metabolic syndrome
- Intervention studies are needed to ascertain the effects of sugars intake on glycemic-related outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for impaired glucose tolerance and impaired fasting glucose.
- Lipid outcomes (TG, HDL):
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on lipid outcomes in adults with metabolic syndrome
- Intervention studies are needed to ascertain the effects of sugars intake on lipid outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for lipid levels.
- Anthropometric outcomes (WC, WHR):
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on anthropometric outcomes in adults with metabolic syndrome
- Intervention studies are needed to ascertain the effects of sugars intake on anthropometric outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for anthropometric measures.
- Blood pressure outcomes:
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on blood pressure in adults with metabolic syndrome
- Intervention studies are needed to ascertain the effects of sugars intake on blood pressure in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for blood pressure.
- Renal outcomes:
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on renal outcomes in adults with metabolic syndrome
- Intervention studies are needed to ascertain an effect of sugars intake on renal outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for urinary albumin excretion rate or albumin:creatinine ratio.
In Individuals With Prediabetes
- Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C):
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on glycemic-related outcomes in individuals with prediabetes
- Intervention studies are needed to ascertain the effects of sugars intake on glycemic outcomes in individuals with prediabetes.
- Lipid outcomes (TG, HDL):
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on lipid outcomes in individuals with prediabetes
- Intervention studies are needed to ascertain the effects of sugars intake on lipid outcomes in individuals with prediabetes.
- Anthropometric outcomes (WC, WHR):
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on anthropometric outcomes in individuals with prediabetes
- Intervention studies are needed to ascertain the effects of sugars intake on anthropometric outcomes in individuals with prediabetes.
- Blood pressure outcomes:
- There were no studies identified to evaluate the impact of sugars intake, independent of weight loss, on blood pressure in individuals with prediabetes
- Intervention studies are needed to ascertain the effects of sugars intake on blood pressure in individuals with prediabetes.
From the 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews:
- In adults, what is the association between intake of sugar-sweetened beverages and energy intake?
- Limited evidence shows that intake of sugar-sweetened beverages is linked to higher energy intake in adults.
- In adults, what is the association between intake of sugar-sweetened beverages and body weight?
- A moderate body of epidemiologic evidence suggests that greater consumption of sugar-sweetened beverages is associated with increased body weight in adults. A moderate body of evidence suggests that under isocaloric controlled conditions, added sugars, including sugar-sweetened beverages, are no more likely to cause weight gain than any other source of energy.
- Glycemic-related outcomes (FBG, random BG, two-hour post-prandial BG, A1C):
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Recommendation Strength Rationale
For Adults with Metabolic Syndrome
- Grade V evidence is available for the conclusion statements regarding the impact of sugars intake, independent of weight loss, on the following outcomes:
- Glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)
- Lipid (TG, HDL)
- Anthropometric measures (WC, WHR)
- Blood pressure
- Renal outcomes.
For Individuals with Prediabetes
- Grade V evidence is available for the conclusion statements regarding the impact of sugars intake, independent of weight loss, on the following outcomes:
- Glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two two-hour post-prandial blood glucose, A1C)
- Lipid (TG, HDL)
- Anthropometric measures (WC, WHR)
- Blood pressure.
- Grade V evidence is available for the conclusion statements regarding the impact of sugars intake, independent of weight loss, on the following outcomes:
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Minority Opinions
Consensus reached.
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Risks/Harms of Implementing This Recommendation
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
In individuals with prediabetes, what is the impact of sugars intake, independent of weight loss, on glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)?
In individuals with prediabetes, what is the impact of sugars intake, independent of weight loss, on lipid outcomes (TG, HDL)?
In individuals with prediabetes, what is the impact of sugars intake, independent of weight loss, on anthropometric outcomes (WC, WHR)?
In individuals with prediabetes, what is the impact of sugars intake, independent of weight loss, on blood pressure?
In adults with metabolic syndrome, what is the impact of sugars intake, independent of weight loss, on glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)?
In adults with metabolic syndrome, what is the impact of sugars intake, independent of weight loss, on lipid outcomes (TG, HDL)?
In adults with metabolic syndrome, what is the impact of sugars intake, independent of weight loss, on anthropometric outcomes (WC, WHR)?
In adults with metabolic syndrome, what is the impact of sugars intake, independent of weight loss, on blood pressure?
In adults with metabolic syndrome, what is the impact of sugars intake, independent of weight loss, on renal outcomes?- References
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References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Fitch C, Keim KS, Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: Use of nutritive and nonnutritive sweeteners. J Acad Nutr Diet. 2012; 112(5): 739-758.
US Departments of Agriculture and Health and Human Services. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/dgas2010-dgacreport.htm and http://www.nutritionevidencelibrary.com/category.cfm?cid=21.