Sugar-sweetened beverages (SSBs) and fruit juice consumption were positively associated with a higher risk of hypertension independent of diet quality, physical activity and other factors, according to results from the ongoing GUTS study published June 22 in Circulation.

The longitudinal cohort study included 25,479 participants (55% female, 96% White, mean BMI 20 kg) drawn from two enrollment waves: GUTS 1 (n=16,875; baseline 1996) and GUTS II (n=10,918; baseline 2004). Individuals were followed prospectively from childhood to adulthood through 2021 (mean ages 12 and 36 at baseline and end of follow-up). Participants provided information on lifestyle, health status and diet through validated food frequency questionnaires every one to four years.

Michelle Nguyen, PhD, et al., used multivariable adjusted Cox proportional hazards regression models to estimate the associations of total fructose and SSB, fruit juice and whole fruit intake (cumulative averages) with incident hypertension, adjusting for major diet and lifestyle factors. Substitutions of SSBs or fruit juice with whole fruit, milk and water were modeled.

During 25-year follow-up, 6.3% of participants reported a diagnosis of hypertension. Total fructose intake was not associated with incident hypertension (highest vs. lowest quintile hazard ratio [HR], 1.07; p_trend<0.001), but participants with the highest intake of SSBs and fruit juice had a higher risk of hypertension (HR, 1.52; p_trend<0.001 and HR, 1.35; p_trend=0.018, respectively).

Whole fruit was not associated with hypertension (highest vs. lowest category HR, 0.79; p_trend=0.08). Notably, replacing one serving a day of SSB with milk, water or whole fruit was associated with a 13%, 9% and 22% lower risk of hypertension, respectively, and replacing fruit juice with whole fruit was associated with a 19% lower risk of hypertension.

"The association between fruit juice consumption and cardiometabolic risk, including hypertension, remains an area of ongoing debate..." write the authors. Despite the ongoing discussion, Nguyen, et al., emphasize that their findings "support public health guidelines to limit the overconsumption of SSBs and fruit juice starting in childhood to protect against the development of hypertension."