Sugar-sweetened beverages, vascular risk factors and events: a systematic literature review

Abstract

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...

Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies

“…There is evidence that SSB intake is related to vascular risk factors, whereas associations with CVD were less consistent (Keller et al 2015) and possibly a consequence of SSB consumption being a surrogate for adverse health behaviours (Narain et al 2016). Our meta-analyses add moderate evidence for a risk-increasing association between SSB intake and CHD and stroke.…”

Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

“…An analysis from the NHS showed that compared with consumption of less than 5% of calories from added sugar, intakes of 10–24%, and ≥25% of total calories increased the risk of CVD mortality by 30% and 275%, respectively, after adjustment for traditional CVD risk factors [93]. Further, sugar-sweetened beverage consumption has been positively associated with hypertension and CHD [94,95,96]. A meta-analysis of randomized controlled trials found that higher intake of sugar significantly increased triglycerides, total cholesterol, LDL cholesterol and HDL cholesterol [97].…”

Micronutrient Dilution and Added Sugars Intake in U.S. Adults: Examining This Association Using NHANES 2009–2014

“…Concerns about high added sugars intake, and hence the call for dietary restrictions, stem from the scientific literature on added sugars and health. The majority of the evidence is from studies of sugar-sweetened beverages, which have been shown to be associated with weight gain [5], type 2 diabetes [6], cardiometabolic risk factors, such as elevated blood pressure and lipids [7,8], and mortality from cardiovascular diseases [9]. Micronutrient dilution of the diet at higher added sugars intakes is also a concern; however, the evidence is not consistent and limited by methodological constraints [10] and/or has been studied mainly in children and adolescents [11][12][13].…”