Countries that use large amounts of high fructose corn syrup have higher rates of type 2 diabetes

BMJ 2012; 345 doi: (Published 27 November 2012) Cite this as: BMJ 2012;345:e7994
  1. Zosia Kmietowicz
  1. 1London

Countries that use high fructose corn syrup (HFCS) in their food supply have a significantly higher prevalence of type 2 diabetes than countries that do not use the sweetener, an analysis has found.

The research, published in Global Public Health, looked at average body mass index, diabetes prevalence, sugar intake, and HFCS intake in 42 countries around the world.1 The information came from a variety of sources, including the International Diabetes Federation and the UN Food and Agricultural Organization.

It found that of the 42 countries studied the United States had the highest per capita consumption of HFCS at a rate of 25 kg (55 lb) a year. Second was Hungary, with an annual consumption of 16 kg per person. Canada, Slovakia, Bulgaria, and Belgium, were also relatively high consumers of HFCS.

Countries with per capita consumption of less than 0.5 kg a year included Australia, China, Denmark, France, India, Ireland, Italy, Sweden, the United Kingdom, and Uruguay. Altogether 14 countries, including India, Ireland, Sweden, Denmark, and Austria, consumed no HFCS.

The analysis found that countries with high use of HFCS had an average prevalence of type 2 diabetes of 8%, whereas in countries that didn’t use HFCS prevalence was 6.7% (P=0.03). High consumption countries also had a higher average fasting plasma glucose concentration (5.34 versus 5.22 mmol/L (P=0.03)). The results were independent of total sugar intake and prevalence of obesity.

The lead author, Michael Goran, professor of preventive medicine and co-director of the Diabetes and Obesity Research Institute at the University of Southern California, said, “The study adds to a growing body of scientific literature that indicates HFCS consumption may result in negative health consequences distinct from and more deleterious than natural sugar.”

Commenting on the research, Tim Lobstein, director of policy for the International Association for the Study of Obesity, said, “If HFCS is a risk factor for diabetes—one of the world’s most serious chronic diseases—then we need to rewrite national dietary guidelines and review agriculture trade policies. HFCS will join trans fats and salt as ingredients to avoid, and foods should carry warning labels.”

The article suggests that the link with diabetes is driven by higher amounts of fructose in foods and beverages made with HFCS. Fructose and glucose are both found in ordinary sugar (sucrose) in equal amounts, but previous work by the researchers found that drinks made with HFCS have 30% more fructose than if they were made with sucrose.

Evidence is growing that the body metabolises fructose differently from glucose: independently of insulin and primarily in the liver, where it is converted to fat. This may be contributing to the rise in the prevalence of non-alcoholic fatty liver disease, a condition that is increasing among Hispanic people in the US and Mexico.

In terms of the effect on risk of diabetes, Goran told the BMJ, “Liver fat contributes to greater insulin resistance. And this pathway [of metabolism] produces uric acid and other by-products which affect metabolism in negative ways, [such as] cellular ATP depletion, which can cause oxidative stress and cellular damage.”

Currently the European Union sets quotas on HFCS. Although some countries, such as Sweden and the UK, do not take their allotted amounts, others, such as Hungary and Slovakia, purchase extra quotas from countries that do not accept them.

The authors concluded, “Trade and agricultural policies aimed at sugar and especially HFCS supply should be considered as a means to tackle the increasing global prevalence of diabetes.”


Cite this as: BMJ 2012;345:e7994


View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to to receive unlimited access to all content on for 14 days.
Sign up for a free trial