Do Nutrition Labels Tell the Whole Story?: Analysis of Total Sugar, Added Sugar and Free Sugar on HbA1c

Type II diabetes mellitus (T2DM) contributes significantly to the burden of disease in the United States and globally. Previous research has shown that nutrition labeling is an effective prevention strategy for T2DM. Furthermore, a growing body of evidence suggests that free sugar (sugars present in added sugar, 100% fruit juice, and syrups) as opposed to total and added sugar, may be more predictive of negative health outcomes than total or added sugar. Thus, free sugar may be a more informative sugar type for labeling purposes. The purpose of the present study was to examine associations between total, added and free sugar calculated from beverages reported in the 24h dietary recall in NHANES 2016-2017 (N = 2168), and HbA1c, a diagnostic test for T2DM. Total sugar and added sugar were calculated using NHANES supplemental data sets detailing the nutritional information for food items reported, and free sugar was calculated through a validated 10-step method which involved examining the ingredients of each beverage. Multiple regression modeling was utilized to examine the associations of each sugar type on HbA1c while controlling for confounding variables. As hypothesized, total sugar intake was not significantly associated with HbA1c. Inconsistent with hypotheses, intakes of free sugar and added sugar were not significantly associated with HbA1c. There is a complex relationship between obesity, sugar consumption and T2DM, and further research is needed to investigate these complexities in order to best inform future public health decisions regarding nutrition labeling.