Meta-analysisindependent cross-checkabstract checked★ key study I-SUG-105 in-depth review
Sugary drinks, not all sugar, linked to diabetes
Dietary Sugar Intake and Incident Type 2 Diabetes Risk: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.
Overview
Della Corte KA et al.. Adv Nutr 2025 · PMID 40122386 · DOI 10.1016/j.advnut.2025.100413
Each daily serving of sugary drinks was linked to 25% higher diabetes risk and fruit juice to 5%; total sugar from foods was not linked to higher risk.
Does the study support the specific claim? Yes · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Measure how different types and sources of sugar relate to type 2 diabetes.
- How was the study done?
Pooled 29 long-term cohort studies with dose-response analysis.
- How many people, animals or samples were studied?
More than half a million adults for the drink analyses.
- What was actually found?
Sugary drinks and fruit juice were linked to more diabetes; total sugar and sucrose were not.
- How large was the observed effect?
SSB RR 1.25 per serving; juice 1.05; total sugar 0.96 per 20 g.
- What do the results mean in everyday life?
Sugar in drinks matters most; juices are not a free pass.
- What are the study's limitations?
Observational; food-sugar findings may be confounded.
- What does it say about Elawady's specific claim?
Supports the soda-diabetes claim; does not support unlimited sugar.
- Do the results apply to Germany and Europe?
Many European cohorts included.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Della Corte KA et al.
- Journal
- Adv Nutr
- Year
- 2025
- Identifier
- PMID 40122386 DOI 10.1016/j.advnut.2025.100413
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Full text: 'The authors reported no funding received for this study'; co-author disclosures include public research grants and an editorial role at Adv Nutr.
2. Research question
What is the dose-response relationship between dietary sugar (total, free, added, fructose, sucrose) or beverage sugar sources and type 2 diabetes risk?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and dose-response meta-analysis of prospective cohorts (5 databases to July 2024), ROBINS-E, GRADE; PROSPERO CRD42023401800
- Population
Healthy adults in prospective cohorts
- Country
Europe (13), USA (11), Asia (6), Australia (4), Latin America (3)
- Period
Searched to 9 July 2024
- Sample size
29 cohorts; SSB 18 cohorts (n=541,288); fruit juice 14 (n=490,413); sucrose 7 (n=223,238)
- Inclusion and exclusion criteria
Prospective cohorts in healthy adults reporting relative risks by sugar categories
4. Methods and endpoints
- Exposure / intervention
SSB, fruit juice (per serving); total sugar, sucrose, fructose, added sugar (per 20 g/day)
- Comparator
Lower intake (dose-response)
- Endpoints
Incident type 2 diabetes
- Statistical methods
Linear and restricted cubic spline dose-response; GRADE
5. Actual results
- Results
Per additional serving: SSB RR 1.25 (95% CI 1.17-1.35) and fruit juice RR 1.05 (>1.00-1.11), both moderate certainty. Per 20 g/day: total sugar RR 0.96 (0.94-0.98; low certainty), sucrose RR 0.95 (0.91-<1.00; moderate certainty); added sugar RR 0.99 (0.96-1.01; low); fructose RR 0.98 (0.83-1.15; very low).
- Absolute risks
not reported in abstract
- Authors' conclusion
Sugar consumed as a beverage (SSB and fruit juice) is associated with T2D risk; results do not support that dietary sugar irrespective of type and amount is consistently associated with T2D.
6. Strengths
- Registered protocol
- Dose-response modelling
- GRADE and ROBINS-E
- Separate analysis of sugar sources
7. Weaknesses
- Observational data
- Inverse associations for total sugar/sucrose may reflect fruit/dairy sources and residual confounding
- Abstract and funding statement only reviewed
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- low
- Rationale
Well-conducted review; underlying cohorts at moderate risk of confounding.
9. Assessment of the statistical interpretation
CIs are log-symmetric (stats/C-SOD-01_ci_checks.py). The SSB estimate replicates Malik 2010 and Imamura 2015 with more cohorts. Total-sugar findings concern mostly sugar in foods, not beverages.
10. Relevance to the specific claim
Confirms the SSB-diabetes association (C-SOD-01) at moderate certainty; shows fruit juice is also associated (relevant to C-SUG-06); and shows that sugar in foods at usual intakes is not consistently associated with diabetes (nuance for C-SUG-01).
11. Independent contrary findings
EFSA 2022 (I-SUG-03) judged RCT evidence on surrogate endpoints for added sugars and T2D as low certainty.
12. Transferability to Germany and Europe
13 of 29 cohorts European; high.
13. Overall methodological judgement
Most recent high-quality dose-response synthesis; supports the beverage-specific concern and refines the general sugar message.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | low |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Why sugar in solid foods shows no or inverse associations; role of food matrix.
15. Linked fact checks
- Regular consumption of sugar-sweetened soft drinks increases the risk of type 2 diabetes (and metabolic syndrome); one to two cans per day raise type 2 diabetes risk by about 26%, and each daily serving by about 18%. – Studies supporting the claim
- White sugar is the greatest product humans ever made; any amount of sugar per day is beneficial, and one can eat a kilogram of white sugar or honey. – Studies with mixed or unclear results
- Implicit in the system's lists: sugar-cane juice, canned juices, honey, jam and sweets are acceptable while sugar-sweetened soft drinks are harmful. – Studies contradicting or limiting the claim