Associations Between Added Sugar Intake and Risk of Four Different Cardiovascular Diseases in a Swedish Population-Based Prospective Cohort Study

Abstract

Aims: Although diet is one of the main modifiable risk factors of cardiovascular disease, few studies have investigated the association between added sugar intake and cardiovascular disease risk. This study aims to investigate the associations between intake of total added sugar, different sugar-sweetened foods and beverages, and the risks of stroke, coronary events, atrial fibrillation and aortic stenosis.Methods: The study population consists of 25,877 individuals from the Malmö Diet and Cancer Study, a Swedish population-based prospective cohort. Dietary data were collected using a modified diet history method. National registers were used for outcome ascertainment.Results: During the mean follow-up of 19.5 years, there were 2,580 stroke cases, 2,840 coronary events, 4,241 atrial fibrillation cases, and 669 aortic stenosis cases. Added sugar intakes above 20 energy percentage were associated with increased risk of coronary events compared to the lowest intake category (HR: 1.39; 95% CI: 1.09–1.78), and increased stroke risk compared to intakes between 7.5 and 10 energy percentage (HR: 1.31; 95% CI: 1.03 and 1.66). Subjects in the lowest intake group for added sugar had the highest risk of atrial fibrillation and aortic stenosis. More than 8 servings/week of sugar-sweetened beverages were associated with increased stroke risk, while ≤2 servings/week of treats were associated with the highest risks of stroke, coronary events and atrial fibrillation.Conclusion: The results indicate that the associations between different added sugar sources and cardiovascular diseases vary. These findings emphasize the complexity of the studied associations and the importance of considering different added sugar sources when investigating health outcomes.

Association between Sugar Intake and Intima Media Thickness as a Marker for Atherosclerosis: A Cross-Sectional Study in the Malmö Diet and Cancer Study (Sweden)

“…So, while the evidence between diet and subclinical atherosclerosis measured via IMT or other methods has been previously explored in the literature, the evidence behind a possible association between sugar intake, often associated with unhealthy dietary patterns, and IMT seems elusive. However, the tendency to higher IMTcca in the highest added sugar category observed in our sample coincides with previous findings in the MDCS, where the highest sugar intake was associated with a higher risk for certain CVDs [ 10 ]. These tendencies might point towards the need for further research, preferably in larger populations, with a higher added sugar intake and with a longitudinal design to confirm our results.…”

“…We recently observed that a high intake of added sugar was associated with increased risk of stroke and coronary events in the Malmö Diet and Cancer Study (MDCS). However, while the consumption of sugar-rich foods was negatively associated with several CVDs, the intake of sugar-sweetened beverages (SSBs) was associated with increased risk of stroke [ 10 ]. Although a high sugar consumption has been suggested to be linked to the development of several CVDs and their risk factors, there is a lack of studies looking at the association between sugar consumption and prevalence of atherosclerosis.…”

Gut microbiota composition in relation to intake of added sugar, sugar-sweetened beverages and artificially sweetened beverages in the Malmö Offspring Study

“…The participants entered their consumption data into the web-based 4DFR method Riksmaten2010, developed by the Swedish National Food Agency. Added sugar intake was estimated from total intake of monosaccharides and sucrose, subtracting for the amount naturally occurring in fruit, vegetables and fruit juices, as previously described in detail [ 18 ]. Added sugar intake as a percentage of non-alcohol energy intake (E%) from 4DFR was grouped into three groups < 10E%, 10-20E% and > 20 E%.…”

“…Urine samples were stored for a maximum of 4 h in fridge at the research clinic before aliquoted and frozen at – 80 °C. In a subsample, urinary sucrose and fructose concentrations were measured using liquid chromatography–tandem mass spectrometry as described previously [ 18 ]. The urinary sucrose and fructose concentrations were divided by urine osmolality to adjust for urine dilution and further investigated as their sum (U-sugars).…”

“…The urinary sucrose and fructose concentrations were divided by urine osmolality to adjust for urine dilution and further investigated as their sum (U-sugars). The reported added sugar intake from 4DFR was combined with the U-sugars for improved added sugar intake assessment using their first principle component (PC) according to Freedman et al [ 18 , 19 ]. The urinary fructose measurement was further used to find potential malabsorbers of fructose.…”