Objective: A high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk factors and events. Design: The article search was performed in August 2013. Two independent researchers performed the article search and selection, data extraction and quality assessment. Eligible studies reported the intake of SSB and one of the following outcomes: change in blood pressure, blood lipid or blood sugar, or CVD events such as stroke or myocardial infarction. Only intervention and longitudinal studies were included. Subjects: Only studies in adults (aged 18 + years old) were considered. Results: Two of four prospective studies found clear direct associations between SSB consumption and CHD, while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood pressure, blood lipid or blood sugar. Conclusions: The reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength of the evidence is still limited and hence more studies are needed before firm conclusions can be made.
Keywords
Sugar-sweetened beverages Vascular disease ReviewDietary carbohydrates are essential for body functions as they are the main source of energy. To ensure a balanced diet, the Institute of Medicine, Food and Nutrition Board recommends that 45-55 % of the total energy intake is provided by carbohydrates (1) . Added sugar (table sugar) is added to foods and beverages during industrial processing, and hence refers to sugars that are not naturally occurring (2) . Studies show that added sugar (over-) consumption, specifically in the form of sugar-sweetened beverages (SSB), seems to be linked to different harmful health outcomes such as obesity and diabetes (3)(4)(5) . SSB may also potentially increase the risk of CVD through their high amount of rapidly absorbable carbohydrates that may, via an elevated hepatic de novo lipogenesis, result in hypertension, accumulation of visceral and ectopic fat, and increased TAG and LDL cholesterol (LDL-C) and decreased HDL cholesterol (HDL-C) levels (6,7) . The increased glycaemic load caused by a high SSB intake may lead to inflammation, β-cell dysfunction and insulin resistance, as suggested by who, in their pooled meta-analysis from three prospective cohorts, reported that participants in the highest category of SSB intake had a 20 % greater risk of developing metabolic syndrome than those in the lowest category of intake (4) . Most previous literature reviews on potentia...