Sugar, Artificially Sweetened Beverages and Stroke, Dementia Risks

Study Questions:

Is sugar- or artificially sweetened beverage consumption associated with the prospective risks of incident stroke or dementia in the community-based Framingham Heart Study Offspring cohort?


The authors studied 2,888 participants aged >45 years for incident stroke (mean age 62 [standard deviation, 9] years; 45% men) and 1,484 participants aged >60 years for incident dementia (mean age 69 [SD, 6] years; 46% men). Beverage intake was quantified 3 times between 1991 and 2001 using a food-frequency questionnaire. Surveillance for incident events commenced in 1998 and continued for 10 years.


There were 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer’s disease). After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia. When comparing daily cumulative intake to 0 per week (reference), the hazard ratios were 2.96 (95% confidence interval [CI], 1.26–6.97) for ischemic stroke and 2.89 (95% CI, 1.18–7.07) for Alzheimer’s disease. Sugar-sweetened beverages were not associated with stroke or dementia. There was no interaction for either type of sweetener with waist-to-hip ratio or diabetes status.


Artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia. There was no relationship with sugar sweetened soft drinks.


Surprisingly, the prevalence of cardiovascular disease and diabetes decreased with more frequent consumption of total sugary beverages (including sugar supplemented, fruit juices, and artificially sweetened soft drinks), but increased with greater consumption of the artificially sweetened drinks. The risk ratio is high and considering the effect of stroke and dementia on quality of life, the absolute risk is relatively high as well. For 0/wk artificially sweetened beverages, the 10-year all cause stroke rate was 1% and all-cause dementia was 1.8%, and for ≥1/day of artificially sweetened beverages, the stroke rate was 3.2% and dementia was 5%.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise, Smoking, Sleep Apnea

Keywords: Alzheimer Disease, Carbonated Beverages, Dementia, Diabetes Mellitus, Diet, Energy Intake, Exercise, Primary Prevention, Quality of Life, Risk, Smoking, Stroke, Sweetening Agents

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