Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Since 1964, average total carbohydrate intake in the US has increased from about 375 g/d to 500 g/d, but the percent of carbohydrate that is fiber has not substantially changed, reflecting increased refined carbohydrates and sugar sweetened beverages high in HIC.
“Since 1964, average total carbohydrate intake in the US has increased from about 375 g/d to 500 g/d (from 2 to 6 kg/year of ready-to-eat cereals), but the percent of carbohydrate that is fiber has not substantially changed over this time, reflecting increased refined carbohydrates and sugar sweetened beverages (SSBs) is high in HIC (54).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [54]
Ecological evidence from the US demonstrates an association of refined carbohydrate (as corn syrup) with type 2 diabetes and obesity.
“Ecological evidence from the US demonstrates an association of refined carbohydrate (as corn syrup) with type 2 diabetes (T2DM) and obesity (54).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [54]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 67 · Cited by 681
Research works printed but not linked: 5
- Food and Rural Economics Division, Economic Research Service, US Department of Agriculture. A century of change in America's eating patterns: America's fascination with nutrition. Food Rev 2000;23:32-7.
- Heliovaara M, Aromaa A, Klaukka T, Knekt P, Joukamaa M, Impivaara O. Reliability and validity of interview data on chronic diseases. J Clin Epidemiol 1993;46:181-91.
- Jenkins DA, Jenkins AL. The glycemic index, fiber, and the dietary treatment of hypertriglyceridemia and diabetes. J Am Coll Nutr 1987; 6:11-7.
- Liu S. Insulin resistance, hyperglycemia and risk of major chronic dis- eases-a dietary perspective. Proc Nutr Soc Australia 1998;22:140 -50.
- Liu S, Manson J, Buring J, Stampfer M, Willett W, Ridker P. A high glycemic diet in relation to plasma levels of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr 2002;75:492-8.
- Authors
- Gross, L. S., Li, L., Ford, E. S., & Liu, S.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Gross, Lee S
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2004-05
- Volume
- 79
- Issue
- 5
- Pages
- 774-779
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2150138040
- Cited by
- 681
- References
- 67
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 14 · 2023: 14 · 2022: 25 · 2021: 32 · 2020: 29 · 2019: 25 · 2018: 32 · 2017: 25 · 2016: 34 · 2015: 49 · 2014: 43 · 2013: 43 · 2012: 43
- FWCI
- 20.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Damon Runyon Cancer Research Foundation
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Keywords
- type 2 diabetes, refined carbohydrates, corn syrup, dietary fiber, carbohydrate intake, dietary fat, protein intake, total energy intake, nutrient density, diabetes prevalence trends, United States
- MeSH terms
- Adult, Analysis of Variance, Energy Intake, Edible Grain, Diabetes Mellitus, Diabetes Mellitus, Type 2, Diet, Dietary Carbohydrates, Dietary Fiber, Female, Fructose, Humans, Male, Nutrition Surveys, Obesity, Regression Analysis, Risk Factors, United States, Prevalence, Glycemic Index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
