Written by Joyce Smith, BS. A greater intake of sugar-sweetened beverages (SSBs) was associated with a higher risk of cardiovascular and total mortality and a modest risk for cancer mortality.
Studies have shown that carbonated and non-carbonated SSBs, fruit drinks, energy drinks, and sports drinks are the single largest source of added sugar in the United States diet 1,2. SSBs have decreased in the United States in the past decade 3; however, according to national survey data, adults in most age groups are almost exceeding the dietary recommendations of consuming no more than 10% of one’s total energy from all added sugar. In developing countries, intake of SSBs is increasing dramatically because of population growth and beverage marketing 4. Associations between sugar and SSBs and cardiovascular disease (CVD) mortality have been inconsistent and while substituting artificially sweetened beverages (ASBs) for SSBs has increased in the US, the long term health effects have not been well documented. Thus researchers 5 investigated a potential association between SSBs and ASBs with respect to total and cause specific mortality in two large ongoing prospective cohort studies: the NHS (Nurses’ Health Study of 80,647 women, 1980-2014), and the HPFS (Health Professionals Follow-up Study of 37,716 men, 1986-2014).
Researchers used mailed questionnaires every second year to assess lifestyle factors and health status and validated self-administered food frequency questionnaire (FFQ) every 4 years to assess diet. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression. The results were as follows:
Association between SSB intake and total mortality, CVD mortality, and cancer.
- SSBs intake and total mortality were positively associated. There was a graded association of SSBs intake and CVD mortality and a modest association for cancer mortality. After adjusting for major diet and lifestyle factors, researchers found that increasing SSBs consumption increased risk of early death from any cause. Compared to those who drank SSBs less than once per month, drinking one to four SSBs per month was associated with a 1% increased risk of early death; two to six per week with a 6% increase; one to two per day with a 14% increase; and two or more per day with a 21% increase. The increased early death risk associated with SSB consumption was more prevalent among women than among men.
The association between SSBs intake and increased risk of early death from cardiovascular disease was strong.
- Compared with infrequent SSB drinkers, those who drank two or more servings per day of SSBs had a 31% higher risk of early death from CVD. Each additional serving per day of SSBs was linked with a 10% increased higher risk of CVD-related death.
The association between SSBs intake and early death risk from cancer was modest.
The effect of replacing SSBs with ASBs:
- Researchers also investigated a potential association between drinking artificially sweetened beverages (ASBs) and risk of early death. Replacing SSBs with ASBs was linked with a moderately lower risk of early death. For example substituting one serving per day of SSB with one serving of ASB was associated with a 4% lower risk of total mortality, a 5% lower risk of CVD mortality and a 4 % lower risk of cancer mortality.
These results support recommendations and policies to limit consumption of SSBs and to consume ASBs in moderation to improve overall health and longevity.
Source: Malik, Vasanti S., Yanping Li, An Pan, Lawrence De Koning, Eva Schernhammer, Walter C. Willett, and Frank B. Hu. “Long-term consumption of sugar-sweetened and artificially sweetened beverages including soft drinks, fruit drinks, energy drinks, and sports drinks and risk of mortality in US adults.” Circulation 139, no. 18 (2019): 2113-2125.
© 2019 American Heart Association, Inc.
Posted November 6, 2019.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
- Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. 2010;100(1):47-54.
- NIH. Sources of Calories from Added Sugars among the US population, 2005-2006. 2013; https://epi.grants.cancer.gov/diet/foodsources/added_sugars/.
- Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States. The American journal of clinical nutrition. 2011;94(3):726-734.
- Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9(1):13-27.
- Malik VS, Li Y, Pan A, et al. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139(18):2113-2125.
