Limiting sugar-sweetened beverage consumption may lower cardiometabolic risks
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Despite warnings about health risks associated with sugar-sweetened beverages, greater efforts are needed to decrease their consumption in the U.S., according to a speaker.
In a presentation at the virtual Heart in Diabetes Conference, Alice H. Lichtenstein, DSc, Gershoff Professor of Nutrition Science and Policy and director of the cardiovascular nutrition laboratory at Tufts University, outlined findings from a study published last year in Circulation, for which she wrote an editorial, that found that sugar-sweetened beverage consumption was associated with higher all-cause mortality, largely through increased CVD mortality. The researchers found artificially sweetened beverages associated with mortality only among women with high levels of consumption.
Sugar used to sweeten beverages encompasses several forms, such as sucrose, honey, dextrose, high fructose corn syrup and concentrated fruit juice. This also applies for artificial sweeteners; the category includes products termed low-calorie sweeteners, sugar substitutes and zero- and reduced-energy sweeteners, Lichtenstein said during her presentation.
Cardiometabolic risks
In the study, researchers found that intake of sugar-sweetened beverages was also associated with an increased risks for CHD, greater body weight, stroke, type 2 diabetes and metabolic syndrome. The highest consumers of sugar-sweetened beverages were younger; engaged in the least amount of physical activity; were more likely to smoke; consumed the most red and processed meats and the least vegetables and whole grains; and had the lowest diet quality and highest rates of hypertension, according to Lichtenstein.
“The cluster is important to take into consideration because it’s difficult to isolate just the intake of sugar-sweetened beverages,” Lichtenstein said. “We have to look at the whole dietary pattern and the whole lifestyle pattern.”
In a fully adjusted model, researchers found positive dose-dependent associations between sugar-sweetened beverage intake and risks for CVD, all-cause and cancer mortality. As sugar-sweetened beverage intake increased, so did these risks regardless of diet quality, activity level, BMI and age.
“These are observational studies, and association does not necessarily guarantee causation,” Lichtenstein said. “It’s probably a constellation of all these factors. However, the important thing is that it’s one important marker and a modifiable marker. There is no good reason to consume sugar-sweetened beverages and good reason not to consume them.”
Less risk with artificial sweeteners
Study participants who consumed higher amounts of artificially sweetened beverages were more likely to be younger and have a high BMI and hypertension, and were less likely to smoke and more likely to take aspirin and multivitamins and to consume alcohol. Women, in particular, had a lower diet quality. Only women in the highest artificially sweetened beverage intake category had an increased risk for all-cause and CVD mortality. These increased risks did not differ by diet quality, activity level, BMI and age.
“This is very important to dissect and look at because you hear a lot that people should decrease their intake of sugar-sweetened beverages and substitute water,” Lichtenstein said. “We know that for most people, that’s not going to be acceptable.”
One way to encourage lower consumption of sugar-sweetened beverages is to substitute an artificially sweetened beverage. The researchers found that this substitution was associated with a 5% lower risk for CVD mortality, a 4% lower risk for all-cause mortality and a 4% lower risk for cancer mortality. A similar calculation for substituting water was not possible due to limitations in the data.
Decreasing consumption
In an editorial accompanying the study in Circulation, Lichtenstein wrote that there is no benefit to consuming sugar-sweetened beverages within the current food landscape, and that a benefit is derived from a decrease in sugar-sweetened beverage consumption.
U.S. dietary guidelines published in 1980 recommended limited sugar intake, and the recommendation was updated in 2000 to include an emphasis on sugar-sweetened beverages due to their high intake in the United States, Lichtenstein said.
Lichtenstein emphasized the importance of understanding the drivers of sugar-sweetened beverage intake.
“That really means going out of our comfort zones,” Lichtenstein said. “A lot of us are clinical and basic scientists, and we’re not really focused on more of the behavioral science. That’s really how we need to segue. We’ve identified the problem. We now need to focus on fixing the problem.”
Education may play a role in this, as people can learn about how much sugar is in the sugar-sweetened beverages they are consuming. There are trends showing that intake in sugar-sweetened beverages is starting to decline, though more improvement is needed.
“Although sugar-sweetened beverage intake has declined over the past few decades, it remains high, and more emphasis needs to be focused on understanding the drivers and societal barriers that cause sugar-sweetened beverage intake to remain high,” Lichtenstein said.
References:
- Lichtenstein AH. Circulation. 2019;doi:10.1161/CIRCULATIONAHA.119.040245.
- Malik VS, et al. Circulation. 2019;doi:10.1161/CIRCULATIONAHA.118.037401.
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Lichtenstein AH. Sugar-sweetened and artificially sweetened beverages and cardiometabolic risk: reason for concern? Presented at: Heart in Diabetes CME Conference; Aug. 21-24, 2020 (virtual).
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