Written by Chrystal Moulton, Science Writer. Individuals in the low fructose/ low sodium group also had higher odds of coronary calcification if they were diagnosed with high blood pressure at baseline (P<0.001).
In the United states, cardiovascular disease is a leading cause of death1. Various animal studies have shown that increases in dietary sugar and sodium over a short period of time resulted in increased blood pressure, increased aortic stiffness, and diastolic dysfunction2-4. Although there are various studies in humans linking dietary fructose and sodium individually to cardiovascular related diseases, there are no studies that assess the link between dietary fructose and sodium and hypertensive targeted organ damage. In the current trial, researchers investigated the association between dietary fructose and sodium on hypertensive organ damage and blood pressure in the middle-aged white and black adults5.
Data from the CARDIA study was used for this retrospective cohort study. Researchers pulled data from a subset of participants who were matched in both socioeconomic and demographic factors. The CARDIA study is being conducted to evaluate lifestyle and behavioral factors that can lead to cardiovascular disease. Participants were recruited from young adulthood [since 1985] and followed until now. So far, 10 examination cycles have been done [35 years of follow up]. Records from 3116 participants from examination cycle 9 was used for this study. Dietary data from examination cycle 7 [year 20 of follow up] was also used since at that time the participants were between the ages of 38 and 50. Researchers of the CARDIA study calculated the average daily intake of fructose and sodium through the dietary questionnaires and interviews conducted each month. These calculations were used create four groups based on fructose and sodium consumption. The four groups were low fructose/ low sodium, low fructose/ high sodium, high fructose/ low sodium, and high fructose/high sodium. Researchers in this current trial also reported the occurrence of high blood pressure [> 130/ 80 MmHg] in cycle 1 and cycle 9. Exercise was evaluated across at examination cycle 9. Hypertensive target organ damage was also assessed at cycle 9, specifically:
- Diastolic dysfunction- measured by ratio of early to late peak inflow of mitral velocities [E/ a ratio the]
- Albuminuria- defined as creatinine ratio [UACR] >30mg/g
- Coronary calcification- defined Agatston’s score ≥100
Researchers used this data to assess the association between dietary fructose and sodium on hypertensive targeted organ damage, diagnosis of high blood pressure and incidence of cardiovascular related diseases.
Of the 3116 individuals matched in this cohort study, 46.7% were black and 53.3% were white; also, 43.1% were male and 56.9% were female. In cycle 1, the average age of these participants was 25.1 years old and average BMI was 24.3. At baseline 13.1% of the total cohort [408], had stage 1 hypertension [BP >130/80 mmHg]. By examination cycle 7, at year 20 follow up [median age = 46 years old], researchers observed that participants in the low fructose/low sodium group had lower systolic blood pressure compared to those in the high fructose/high sodium group and the low fructose /high sodium groups (P<0.05). Furthermore, researchers also observed higher diastolic blood pressure in the high fructose/low sodium group compared to those in the low fructose/low sodium group (P<0.05). At examination cycle 9, when the median age was 56 years old, systolic blood pressure, diagnosis of high blood pressure, albuminuria (UACR >30 mg/g), coronary calcification (Agatston’s score ≥100), and diastolic dysfunction (E/A abnormal) were significantly different across the four groups. [See Table 1]
Table 1. Examination cycle 9 cardiovascular disease related endpoints
| Category | low FRU/low SOD | low FRU/high SOD | high FRU/ Low S0D | High FRU/ High SOD | P value |
| UACR >30 mg/g [No. (%)] | 35 (6.0) | 64 (9.0) | 43 (6.0) | 56 (9.8) | 0.016 |
| E/A abnormal [No. (%)] | 79 (14.0) | 92 (13.4) | 120 (17.5) | 100 (18.2) | 0.042 |
| Agatston’s score ≥100 [No. (%)] | 43 (7.5) | 90 (12.7) | 48 (7.0) | 49 (8.7) | < 0.001 |
| BMI [mean (SD)] | 29.4 (6.2) | 30.4 (6.5) | 31.0 (7.1) | 29.9 (6.5) | 0.001 |
| HBP diagnosis [No. (%)] | 188 (32.5) | 278 (39.0) | 296 (41.2) | 217 (38.0) | 0.012 |
| SBP [mean (SD)] | 117 (15) | 120 (15) | 120 (17) | 119 (15) | 0.004 |
Researchers further evaluated the association of dietary fructose and sodium against hypertensive targeted organ damage at examination cycle 9 [median age= 56 years old] in two different models. In Model 1, researchers adjusted for race, sex and diagnosis of heart disease, high cholesterol, kidney disease, and hypertension. According to Model 1 logistical regression analysis, among participants in the low fructose/low sodium group, individuals who were white had lower odds of diastolic dysfunction (P=0.001); individuals with high blood pressure at baseline were high risk of developing coronary calcification (P<0.001), and females had lower odds of coronary calcification (P<0.001) and albuminuria (P=0.017). In fact, females had significantly lower odds of coronary calcification across all four groups (P<0.05). In model 2, researchers adjusted for physical activity including swimming, running, biking, and racquet sports. After adjusting for physical activity, females across all that dietary group had significantly lower odds of developing coronary calcification (P<0.05). Females also have significantly lower odds of albuminuria in all 4 dietary groups except the high fructose/ high sodium. In the low fructose/ low sodium group, even after adjusting for physical activity, individuals who were white had lower odds of diastolic dysfunction (P=0.016). Individuals in the low fructose/ low sodium group also had higher odds of coronary calcification if they were diagnosed with high blood pressure at baseline (P<0.001).
Results demonstrated that sodium and fructose contribute to hypertensive target organ damage and increase blood pressure. Furthermore, researchers observed protective effects based on race and biological sex. Additional studies will be needed to verify these findings.
Source: Komnenov, Dragana, Mohammad Al-Hadidi, Hamza Ali, Malik Al-Jamal, Kassim Salami, Samy Shelbaya, Kareem Tayeb, Daniel Domin, and Rana Elhamzawy. “Dietary Fructose and Sodium Consumed during Early Mid-Life Are Associated with Hypertensive End-Organ Damage by Late Mid-Life in the CARDIA Cohort.” Nutrients 16, no. 7 (2024): 913.
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Posted April 11, 2024.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
References:
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- Soncrant T, Komnenov D, Beierwaltes WH, Chen H, Wu M, Rossi NF. Bilateral renal cryodenervation decreases arterial pressure and improves insulin sensitivity in fructose-fed Sprague-Dawley rats. American journal of physiology Regulatory, integrative and comparative physiology. Sep 1 2018;315(3):R529-r538. doi:10.1152/ajpregu.00020.2018
- Komnenov D, Levanovich PE, Rossi NF. Hypertension Associated with Fructose and High Salt: Renal and Sympathetic Mechanisms. Nutrients. Mar 7 2019;11(3)doi:10.3390/nu11030569
- Komnenov D, Levanovich PE, Perecki N, Chung CS, Rossi NF. Aortic Stiffness and Diastolic Dysfunction in Sprague Dawley Rats Consuming Short-Term Fructose Plus High Salt Diet. Integrated blood pressure control. 2020;13:111-124. doi:10.2147/ibpc.S257205
- Komnenov D, Al-Hadidi M, Ali H, et al. Dietary Fructose and Sodium Consumed during Early Mid-Life Are Associated with Hypertensive End-Organ Damage by Late Mid-Life in the CARDIA Cohort. Nutrients. 2024;16(7):913.
