Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies

Much remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women’s Health Initiative, we assessed a...

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Main Authors: Bo Yang, Andrea J. Glenn, Qing Liu, Tracy Madsen, Matthew A. Allison, James M. Shikany, JoAnn E. Manson, Kei Hang Katie Chan, Wen-Chih Wu, Jie Li, Simin Liu, Kenneth Lo
Format: Article
Language:English
Published: MDPI AG 2022-10-01
Series:Nutrients
Subjects:
Online Access:https://www.mdpi.com/2072-6643/14/20/4226
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author Bo Yang
Andrea J. Glenn
Qing Liu
Tracy Madsen
Matthew A. Allison
James M. Shikany
JoAnn E. Manson
Kei Hang Katie Chan
Wen-Chih Wu
Jie Li
Simin Liu
Kenneth Lo
author_facet Bo Yang
Andrea J. Glenn
Qing Liu
Tracy Madsen
Matthew A. Allison
James M. Shikany
JoAnn E. Manson
Kei Hang Katie Chan
Wen-Chih Wu
Jie Li
Simin Liu
Kenneth Lo
author_sort Bo Yang
collection DOAJ
description Much remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women’s Health Initiative, we assessed average intakes of added sugar, SSB and ASB, and conducted Cox regression to estimate the hazard ratios (HRs) and their 95% confidence intervals for CVD risk. The consistency of findings was compared to a network meta-analysis of all available cohorts. During an average of 17.4 years of follow-up, 11,597 cases of total CVD (nonfatal myocardial infarction, coronary heart disease (CHD) death, stroke, coronary revascularization, and/or incident heart failure) were confirmed. Added sugar as % energy intake daily (%EAS) at ≥15.0% was positively associated with total CVD (HR = 1.08 [1.01, 1.15]) and CHD (HR = 1.20 [1.09, 1.32]). There was also a higher risk of total CVD associated with ≥1 serving of SSB intake per day (HR = 1.29 [1.17, 1.42]), CHD (1.35 [1.16, 1.57]), and total stroke (1.30 [1.10, 1.53]). Similarly, ASB intake was associated with an increased risk of CVD (1.14 [1.03, 1.26]) and stroke (1.24 [1.04, 1.48]). According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, ASB, or SSB in CVD outcomes. A diet containing %EAS ≥15.0% and consuming ≥1 serving of SSB or ASB may be associated with a higher CVD incidence. The relative contribution of added sugar, SSB, and ASB to CVD risk warrants further investigation.
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spelling doaj.art-7fb590fe788740009396e07236fe97682023-11-24T01:42:41ZengMDPI AGNutrients2072-66432022-10-011420422610.3390/nu14204226Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective StudiesBo Yang0Andrea J. Glenn1Qing Liu2Tracy Madsen3Matthew A. Allison4James M. Shikany5JoAnn E. Manson6Kei Hang Katie Chan7Wen-Chih Wu8Jie Li9Simin Liu10Kenneth Lo11Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, ChinaDepartment of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, CanadaCentre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USADepartment of Emergency Medicine, Brown University, Providence, RI 02912, USADepartment of Family Medicine, University of California San Diego, La Jolla, CA 92093, USADivision of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USADivision of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USACentre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USACentre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USAGlobal Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, ChinaGlobal Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, ChinaGlobal Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, ChinaMuch remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women’s Health Initiative, we assessed average intakes of added sugar, SSB and ASB, and conducted Cox regression to estimate the hazard ratios (HRs) and their 95% confidence intervals for CVD risk. The consistency of findings was compared to a network meta-analysis of all available cohorts. During an average of 17.4 years of follow-up, 11,597 cases of total CVD (nonfatal myocardial infarction, coronary heart disease (CHD) death, stroke, coronary revascularization, and/or incident heart failure) were confirmed. Added sugar as % energy intake daily (%EAS) at ≥15.0% was positively associated with total CVD (HR = 1.08 [1.01, 1.15]) and CHD (HR = 1.20 [1.09, 1.32]). There was also a higher risk of total CVD associated with ≥1 serving of SSB intake per day (HR = 1.29 [1.17, 1.42]), CHD (1.35 [1.16, 1.57]), and total stroke (1.30 [1.10, 1.53]). Similarly, ASB intake was associated with an increased risk of CVD (1.14 [1.03, 1.26]) and stroke (1.24 [1.04, 1.48]). According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, ASB, or SSB in CVD outcomes. A diet containing %EAS ≥15.0% and consuming ≥1 serving of SSB or ASB may be associated with a higher CVD incidence. The relative contribution of added sugar, SSB, and ASB to CVD risk warrants further investigation.https://www.mdpi.com/2072-6643/14/20/4226added sugarsugar-sweetened beveragesartificially sweetened beveragescardiovascular diseasenetwork meta-analysisprospective cohort
spellingShingle Bo Yang
Andrea J. Glenn
Qing Liu
Tracy Madsen
Matthew A. Allison
James M. Shikany
JoAnn E. Manson
Kei Hang Katie Chan
Wen-Chih Wu
Jie Li
Simin Liu
Kenneth Lo
Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies
Nutrients
added sugar
sugar-sweetened beverages
artificially sweetened beverages
cardiovascular disease
network meta-analysis
prospective cohort
title Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies
title_full Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies
title_fullStr Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies
title_full_unstemmed Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies
title_short Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies
title_sort added sugar sugar sweetened beverages and artificially sweetened beverages and risk of cardiovascular disease findings from the women s health initiative and a network meta analysis of prospective studies
topic added sugar
sugar-sweetened beverages
artificially sweetened beverages
cardiovascular disease
network meta-analysis
prospective cohort
url https://www.mdpi.com/2072-6643/14/20/4226
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