Intake of Sugar-Sweetened Beverages Not Associated with Atherosclerotic Plaques in the Coronary Arteries

by | Aug 9, 2021 | 2021, Cardiovascular Health, Sweeteners

Written by Angeline A. De Leon, Staff Writer. Data from the current trial does not appear to support a relationship between sugar-sweetened beverage consumption and prevalence of coronary artery calcium.

sugar sweetened drinksSugar-sweetened beverages (SSB) are drinks with added sugar and range from flavored juice drinks and sodas to energy drinks and electrolyte replacement drinks. Their popularity over recent decades remains consistently high 1, but studies continue to warn against the numerous health effects associated with SSB consumption, including cardiovascular disease (CVD) and metabolic disorders 2,3. Even beverages sweetened with sugar substitutes have been found to be tied to cardiometabolic disruption 4,5. The relationship between SSB consumption and coronary heart disease is a growing area of research, with prospective trials suggesting an increased risk of ischemic stroke and all-cause mortality 6,7. The Nurses’ Health Study in 2009 reported that one serving of SSB per day was linked to a 23% increased risk for incident coronary heart disease, while 2 servings were associated with a 35% increased risk 8. The physiological mechanism involved in the association between SSB consumption and cardiovascular risk is still under study, but is thought to relate to inflammatory pathways 9. Given the need to directly explore the potential relationship between SSB intake and atherosclerosis, researchers at Harvard University (2021) carried out an investigation to assess whether SSB consumption is indeed linked to higher prevalence of atherosclerotic plaque 10.

A total of 1,991 subjects (mean age = 55 years) with no known history of coronary heart disease were enrolled in an observational trial. Dietary consumption of SSB was assessed using a semi-quantitative Food Frequency Questionnaire (FFQ), and all participants underwent a cardiac Computed Tomography (CT) examination to measure coronary artery calcium (CAC), a subclinical marker of atherosclerosis 11. Additional data on lifestyle factors such as smoking, alcohol consumption, and physical activity level were also collected.

After adjusting for potential confounding variables like age, sex, and body mass index (BMI), analyses revealed that higher intake of SSB was not associated with prevalence of CAC [for SSB consumption of almost never, 1-3 per month, 1 per week, 2-6 per week, 1 per day, and 2 or more per day, corresponding prevalence ratios (95% Confidence Interval) were 1.0 (reference), 1.36 (0.70 to 2.63), 1.69 (0.93 to 3.09), 1.21 (0.69 to 2.12), 1.05 (0.60 to 1.84), and 1.58 (0.85 to 2.94) (p for linear trend 0.32)]. In a sensitivity analysis using different CAC cut points, findings remained the same, indicating non-existent associations between prevalent CAC and consumption of regular soda, diet soda, fruit punch, or Kool Aid.

Data from the current trial do not appear to support a relationship between SSB consumption and prevalence of CAC. Based on null findings, the possibility that SSB intake increases the risk of CVD through means other than atherosclerosis must be considered. Several study limitations in the current trial must also be taken into account, including the employment of a cross-sectional study design which precludes the direct establishment of causal relationships, the administration of the FFQ at only one time point (baseline) which prevents measurement of dietary changes over time, and the assessment of SSB consumption based on self-report measures. Thus, based on available data from the current study, additional work is needed to explore the relationship between SSB consumption and atherosclerosis, especially in populations at risk of CVD.

Source: Patel YR, Imran TF, Ellison RC, et al. Sugar-sweetened beverage consumption and calcified atherosclerotic plaques in the coronary arteries: the NHLBI family heart study. Nutrients. 2021; 13: 1775. DOI: 10.3390/nu13061775.

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

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Posted August 9, 2021.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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