American adolescents have a nutrient-poor diet pattern, which is particularly high in added sugars, putting them at risk for obesity and type 2 diabetes (T2D). We aimed to assess dietary intake of added sugars in adolescents and relationships with glycemia and body mass index (BMI). Cross-sectional, baseline measures were obtained from an ongoing, randomized controlled behavioral intervention to prevent adolescent T2D. Participants, using the Technology Assisted Dietary Assessment system (TADA), created a mobile, imaged-based, four-day food record which the Nutrition Data System for Research (NDSR, University of Minnesota, Minneapolis, MN) analyzed. Glucose dynamics were measured at fasting and during an oral glucose tolerance test (OGTT), using point of care instruments (DCA Analyzer, Siemens Medical Solutions, Malvern, PA; YSI Analyzers, Xylem Inc., Yellow Springs, OH). High added sugar intake was defined as consuming above the recommendation of 10% of calories from the US Dietary Guidelines. Independent sample T-tests assessed the differences between groups consuming high versus recommended amounts of added sugars. Values are expressed as mean ± standard deviation. Thirty-one adolescents, ages 15.5 ± 2.4 years, were screened. The sample was composed of 12 boys and 19 girls, and 45% had prediabetes. The BMI of the sample was 34.3 ± 6.8 kg/m2 with no differences between normal status and prediabetes groups. Similarly, normal status (11.2 ± 4.6%) and prediabetes (11.3 ± 5.0%) groups each consumed excess amounts of added sugars with no differences between groups. There were no significant differences between glycated hemoglobin (HbA1c, 5.5 ± 0.5% and 5.3 ± 0.2%), 2 hour glucose concentrations (125.4 ± 28.7 mg/dL and 111.9 ± 22.0 mg/dL), or BMI (33.9 ± 6.0 kg/m2 and 34.9 ± 8.2 kg/m2) between the groups with high versus recommended intakes of added sugar, respectively. The fasting plasma glucose concentrations in the group with high intakes of added sugar tended to be higher compared to the group with recommended intake of added sugar (94.6 ± 5.7 mg/dL versus 90.8 ± 5.1 mg/dL, P = 0.095). Fasting glucose may be higher in adolescents consuming excess compared to recommended amounts of added sugars. This research highlights the need for additional research to clarify the metabolic consequences of high amounts of added sugars in the diets of adolescents with obesity and a risk for developing type 2 diabetes. McKinley Foundation, Indiana CTSI Project Development Team UL1TR002529.
Incidence rates of adolescents with type 2 diabetes are increasing rapidly; there was an increase of
30% between 2019 and 2009. Even more alarming is that studies show that the most effective
treatment, metformin monotherapy, is only effective at maintaining glycemic control in
approximately 50% of individuals. Additionally, adolescents with diabetes may experience serious
microvascular and macrovascular complications sooner than adults, which can impact the quality
of life of young adults across the globe. Therefore, diabetes in adolescents is a public health
concern, and there is very little research to guide treatment and prevention. It is widely known that
adolescents have a very poor dietary pattern, characterized by increased intakes of added sugars
from refined grains, and minimal amounts of fruits, vegetables, and fiber. There is conflicting
evidence in the literature connecting increased added sugar intake to insulin resistance and diabetes
development. Considering the very poor diets consumed by adolescents, and that nutrition is a
modifiable risk factor for diabetes, we aimed to examine the associations between added sugar
consumption, glycemic values, and measures of insulin resistance and beta-cell function. This pilot
study analyzed dietary and glycemic data from participants that were screened for an ongoing
randomized control trial which is an adolescent diabetes prevention program that uses health
coaching to improve diet and physical activity behaviors called the Dietary Intervention for
Glucose Tolerance in Teens (Dig It) Study. Fasting blood glucose, glycated hemoglobin (HbA1c),
and 2-hour glucose concentrations were collected during an oral glucose tolerance test that was
used to screen adolescents with obesity for diabetes. Consumption of added sugar and other dietary
intake data were collected from food records created by the Technology Assisted Dietary
Assessment (TADA) application. The homeostasis model assessment of insulin resistance
(HOMA-IR) was calculated from glucose and insulin concentrations in the fasting state (1)
obtained from an oral glucose tolerance test (OGTT). Whole-body insulin sensitivity index (WBISI), and the oral disposition index (DI) were calculated from measures obtained during oral
glucose tolerance testing(2, 3)
Statistical analysis was performed using SPSS software and included independent t-tests and
Pearson correlations. Of the 48 participants included in this analysis, 59.2% were female, 32%
were African American, 57% were white, and 8.2% were more than one race. The mean age was
16.20 ± 2.7 years, and 42% had prediabetes. Those with normoglycemia consumed 11.0 ± 5.1%
of energy from added sugars, compared to 9.4±5.1% energy from added sugars for individuals
with prediabetes. There was no significant correlation between HbA1c and percent calories coming
from added sugar (R= -0.237, P=0.063), percent calories coming from added sugar and fasting
blood glucose (R= 0.208, P= 0.090), or percent calories from added sugar and 2-hour glucose (R=
0.017, P= 0.457). There were no significant correlations found between percent calories from
added sugar and HOMA-IR (R= 0.129, P= 0.234), percent calories from added sugar and WBISI
(R= -0.069, P= 0.350), or percent calories from added sugar and DI (R= -0.118, P= 0.253). There
were also no significant differences between the mean values of HbA1c, fasting glucose, or 2-hour
glucose between individuals that consumed high vs. low amounts of added sugar, as measured by
an independent t-test. The p-values were 0.634, 0.434, and 0.234 respectively. To examine the
extent to which % calories from added sugar predicted variances in glycemic values, hierarchical
multiple regression analyses were performed. Once energy, physical activity, BMI Z-Score, and
age were entered into the model, % energy from added sugar accounted for an additional 9.6%
variance in HbA1c. In conclusion, we did not find significant associations between consumption
of added sugar and glycemic and insulin resistance or beta-cell function outcomes in adolescents
who are obese, however our study lacked sufficient power. While our findings were not definitive,
studies to identify dietary factors that promote or prevent hyperglycemia and insulin resistance are
needed to inform dietary intervention strategies that may be effective at decreasing T2D in
adolescents.
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