Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men

Study Questions:

Sugar-sweetened beverage consumption is associated with weight gain and risk of type 2 diabetes. What is the relationship with coronary heart disease (CHD), or intermediate biomarkers, and sugar and artificially sweetened beverages?

Methods:

The authors performed an analysis of the Health Professionals Follow-up Study, a prospective cohort study including 42,883 men. Participants reported their usual intake (never to ≥6 times per day) of a standard 12 ounce serving of sugar-sweetened beverages, including juices and artificially-sweetened beverages. Incident CHD was defined as fatal and nonfatal myocardial infarction, which was examined using proportional hazard models.

Results:

At baseline, participants reported consuming less sugar-sweetened beverages (2.5/week; 0.36/day; standard deviation [SD] = 0.61) than artificially sweetened beverages (3.4/week; 0.49/day, SD = 0.94). Consumption of sugar-sweetened beverages was associated with a higher prevalence of current smoking, and a lower quality diet and lower physical activity. Artificially sweetened beverages were associated with an overall better quality diet. There were 3,683 CHD cases over 22 years of follow-up. Participants in the top quartile of sugar-sweetened beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (relative risk [RR], 1.20; 95% confidence interval [CI], 1.09-1.33; p for trend < 0.01) after adjusting for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, body mass index, pre-enrollment weight change, and dieting. Artificially sweetened beverage consumption was not significantly associated with CHD (multivariate RR, 1.02; 95% CI, 0.93-1.12; p for trend = 0.28). Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure, and diagnosed type 2 diabetes slightly attenuated these associations. Intake of sugar sweetened, but not artificially sweetened beverages was significantly associated with increased triglycerides, C-reactive protein, interleukin-6, tumor necrosis factor receptors 1 and 2, decreased high-density lipoprotein, lipoprotein(a), and leptin (p values < 0.02).

Conclusions:

The authors concluded that consumption of sugar-sweetened beverages was associated with increased risk of CHD and some adverse changes in lipids, inflammatory factors, and leptin. Artificially sweetened beverage intake was not associated with CHD risk or biomarkers.

Perspective:

What is the practical application of the data? For each additional serving per day, sugar-sweetened beverage consumption was associated with a 19-25% increased risk of CHD (p < 0.02). Similar results were found in the Nurses’ Health Study, where one serving per day increase in sugar-sweetened beverage intake was associated with a 15% increase in risk. Both studies also showed an increase in inflammatory biomarkers with fructose, known to be the worst offender.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Hypertension

Keywords: Myocardial Infarction, Interleukin-6, Lipids, Diabetes Mellitus, Type 2, Coronary Disease, Cholesterol, C-Reactive Protein, Body Mass Index, Biological Markers, Sweetening Agents, Energy Intake, Confidence Intervals, Lipoproteins, HDL, Fructose, Hypertension


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