Added sugar, total sugar, some fructose associated with higher coronary heart disease risk

Key takeaways:

• Consumption of added sugar, total sugar, total glucose equivalent and fructose from added sugar and juice were linked to a higher risk for coronary heart disease.
• Fructose from vegetables and fruits was not.

Added sugar, total sugar and fructose from some sources were all linked to a higher risk for coronary heart disease, according to the results of research published in the American Journal of Clinical Nutrition.

Kristine K. Dennis, PhD, MPH, a nutrition scientist and data analyst at Emory University, told Healio that, although increased total sugar intake has been associated with risk for coronary heart disease (CHD), the role that individual sugars play — especially fructose — is unknown.

“We were interested in this topic given mechanistic differences in the regulation of sugar monosaccharide metabolism including glucose and fructose and how this may ultimately contribute to coronary heart disease risk,” Dennis said. “Whether high fructose intake is particularly harmful compared to other sugar types has been a source of confusion. More longitudinal studies were needed with sufficiently detailed dietary information in order to help understand this question.”

So, the researchers conducted a prospective cohort study to evaluate the connections between CHD risk and individual dietary sugars.

They analyzed data from 28,878 men enrolled in the Health Professionals Follow-up Study from 1986 to 2016 and 76,815 women enrolled in the Nurses’ Health Study from 1980 to 2020, documenting 9,723 incident CHD cases over 40 years. Every 2 to 4 years, a semiquantitative food frequency questionnaire was used to measure carbohydrate and sugar intake.

Dennis and colleagues found that intake of added sugar, total sugar, total glucose equivalents (TGEs), and fructose from juice and added sugar were linked to higher CHD risk, but total fructose equivalents (TFEs) and fructose from vegetables and fruits were not.

More specifically, added sugar and total sugar intake were positively associated with CHD risk, with HRs of 1.08 (95% CI, 0.99-1.16) and 1.16 (95% CI, 1.07-1.26), respectively. TFE from juice and added sugar was also associated with CHD risk (HR = 1.12, 95% CI, 1.04-1.2), but TFE from vegetables and fruits was not (P _trend = .7). Notably, “of total TFE intake, over half was from sources of added sugar and juice,” Dennis and colleagues wrote.

“For prevention of CHD, diets emphasizing whole fruits and vegetables while limiting added sugars and refined starches should be encouraged,” Dennis said. “Our research aligns with other evidence that whole fruit appears to have a protective role, regardless of fructose content, while it also aligns with other evidence suggesting that carbohydrate quality is important for cardiovascular disease risk.”

The researchers also found that, in isocaloric substitution models that compared extreme quintiles of intake and had total fat as a comparison nutrient, TFE’s HR for CHD risk was 1.03 (95% CI, 0.94-1.1) and TGE’s was 1.31 (95% CI, 1.2-1.42).

“Patients should be encouraged to limit added sugars, refined starches, and fructose from added sugar, juice, and sugar-sweetened beverages,” Dennis said. “The overall dietary pattern over time is what matters for CHD prevention; our findings align with current dietary recommendations that emphasize eating a variety of fruit, vegetables and whole grains.”