Sweetened beverage consumption and risk of cardiovascular mortality: A systematic review and meta-analysis

Xylitol is prothrombotic and associated with cardiovascular risk

BACKGROUND AND AIMS

The pathways and metabolites that contribute to residual cardiovascular disease risks are unclear. Low-calorie sweeteners are widely used sugar substitutes in processed foods with presumed health benefits. Many low-calorie sweeteners are sugar alcohols that also are produced endogenously, albeit at levels over 1000-fold lower than observed following consumption as a sugar substitute.

METHODS

Untargeted metabolomics studies were performed on overnight fasting plasma samples in a discovery cohort (n = 1157) of sequential stable subjects undergoing elective diagnostic cardiac evaluations; subsequent stable isotope dilution liquid chromatography tandem mass spectrometry (LC-MS/MS) analyses were performed on an independent, non-overlapping validation cohort (n = 2149). Complementary isolated human platelet, platelet-rich plasma, whole blood, and animal model studies examined the effect of xylitol on platelet responsiveness and thrombus formation in vivo. Finally, an intervention study was performed to assess the effects of xylitol consumption on platelet function in healthy volunteers (n = 10).

RESULTS

In initial untargeted metabolomics studies (discovery cohort), circulating levels of a polyol tentatively assigned as xylitol were associated with incident (3-year) major adverse cardiovascular event (MACE) risk. Subsequent stable isotope dilution LC-MS/MS analyses (validation cohort) specific for xylitol (and not its structural isomers) confirmed its association with incident MACE risk [third vs. first tertile adjusted hazard ratio (95% confidence interval), 1.57 (1.12-2.21), P < .01]. Complementary mechanistic studies showed xylitol-enhanced multiple indices of platelet reactivity and in vivo thrombosis formation at levels observed in fasting plasma. In interventional studies, consumption of a xylitol-sweetened drink markedly raised plasma levels and enhanced multiple functional measures of platelet responsiveness in all subjects.

CONCLUSIONS

Xylitol is associated with incident MACE risk. Moreover, xylitol both enhanced platelet reactivity and thrombosis potential in vivo. Further studies examining the cardiovascular safety of xylitol are warranted.

Sugar-sweetened beverage intake and long-term mortality in individuals with metabolic dysfunction-associated steatotic liver disease: a longitudinal analysis of the National Health and Nutrition Examination Survey database

BACKGROUND

Consuming sugar-sweetened beverages (SSBs) has been linked to the development of various adverse health conditions, including metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated associations between SSB intake and long-term mortality among individuals with MASLD using a nationally representative database.

METHODS

This population-based, longitudinal study extracted data of adults aged 20-79 years with MASLD from the USA (US) National Health and Nutrition Examination Survey database 2003-2014. Associations between the amount of SSB intake and all-cause, cancer and cardiovascular disease mortality until the end of 2019 were determined using Cox proportional hazards regression analyses.

RESULTS

A total of 12 965 individuals aged 20-79 years who had MASLD were identified in the database. After exclusion, 5630 participants remained for the analyses. This cohort can be extrapolated to 43 420 321 individuals in the entire US after proper weighting. The mean age of the study cohort was 44.1 years. After adjusting for confounders, no significant association was observed between SSB intake (tertile 3 vs. tertile 1) and all-cause [adjusted hazard ratio (aHR): 1.03, 95% confidence interval (CI), 0.60-1.76) or cancer mortality (aHR, 0.41; 95% CI, 0.15-1.16). However, higher SSB intake (tertile 3 vs. tertile 1) was significantly associated with elevated cardiovascular disease mortality risk (aHR = 2.83; 95% CI, 1.01-7.91).

CONCLUSION

In US adults with MASLD, high SSB intake is associated with nearly three-fold increased cardiovascular disease mortality risk. The findings underscore the critical need for concerted action on the part of healthcare providers and policymakers.

Long-term aspartame and saccharin intakes are related to greater volumes of visceral, intermuscular, and subcutaneous adipose tissue: the CARDIA study

BACKGROUND

Artificial sweetener (ArtSw) intakes have been previously associated with higher BMI in observational studies and may promote visceral and skeletal muscle adipose tissue (AT) accumulation. This study aimed to determine whether habitual, long-term ArtSw or diet beverage intakes are related to greater AT depot volumes and anthropometry-related outcomes.

METHODS

A validated diet history questionnaire was administered at baseline, year 7, and year 20 examinations in 3088 men and women enrolled in the Coronary Artery Risk Development in Young Adults cohort (CARDIA), mean age of 25.2 years and mean BMI of 24.5 kg/m2 at baseline. Volumes of visceral (VAT), intermuscular (IMAT), and subcutaneous adipose tissue (SAT) were assessed by computed tomography at year 25. Linear regression evaluated associations of aspartame, saccharin, sucralose, total ArtSw, and diet beverage intakes with AT volumes, anthropometric measures, and 25-year change in anthropometry. Cox regression estimated associations of ArtSw with obesity incidence. Adjustments were made for demographic and lifestyle factors, total energy intake, and the 2015 healthy eating index.

RESULTS

Total ArtSw, aspartame, saccharin, and diet beverage intakes were positively associated with VAT, SAT, and IMAT volumes (all ptrend ≤ 0.001), but no associations were observed for sucralose intake (all ptrend > 0.05). In addition, total ArtSw, saccharin, aspartame, and diet beverage intakes were associated with greater body mass index, body weight, waist circumference, and their increases over a 25-year period. Except for saccharin (ptrend = 0.13), ArtSw, including diet soda, was associated with greater risks of incident obesity over a median 17.5-year follow-up (all ptrend < 0.05).

CONCLUSIONS

Results suggest that long-term intakes of aspartame, saccharin, or diet soda may increase AT deposition and risk of incident obesity independent of diet quality or caloric intake. Coupled with previous evidence, alternatives to national recommendations to replace added sugar with ArtSw should be considered since both may have health consequences.

Sugar-sweetened beverages consumption increases the risk of metabolic syndrome and its components in adults: Consistent and robust evidence from an umbrella review

BACKGROUND & AIMS

Sugar-sweetened beverages (SSBs) are potential modifiable risk factors for reducing the risk of metabolic syndrome (MetS); however, there is a lack of an umbrella review that robustly synthesizes the evidence. This review aims to synthesize the evidence linking habitual SSBs intake with MetS in adults, emphasizing the need for policy and regulatory actions.

METHODS

Four databases were comprehensively searched for relevant meta-analyses of prospective studies up to July 2023. Two authors independently conducted the screening for eligibility, data extraction, and quality assessment. The outcome of interest was MetS in adults, encompassing its component conditions. The present review was registered with PROSPERO (CRD42023402549).

RESULTS

Of the 16 eligible meta-analyses identified, 30 summary estimates were obtained for the impact of SSBs consumption on obesity, type 2 diabetes, hypertension, and MetS. Seven were rated as 'High' methodological quality, with the rest classified as 'Moderate' and 'Low' quality, consisting of three and six references, respectively. A comparison of the highest and lowest levels of SSBs consumption revealed an increased risk of 18% (95% CI: 13%-24%), 12% (95% CI: 11%-14%), 29% (95% CI: 25%-32%), and 29% (95% CI: 7%-52%) for obesity, hypertension, type 2 diabetes, and MetS, respectively. Consistently, the findings from dose-response analyses are in agreement with and corroborate the existing evidence that SSBs are a significant risk factor for the development of MetS and its related conditions. Noticeably, the quality of evidence was predominantly deemed as highly suggestive and convincing. Moreover, consensus on specific criteria to identify studies related to SSBs in literature searching was lacking, and most primary studies were conducted in developed countries and Europe.

CONCLUSIONS

Our findings suggest that more rigorous and targeted policy interventions are warranted to curtail SSBs consumption, in order to alleviate the global burden of MetS.

Artificial sweeteners and cardiovascular risk

PURPOSE OF REVIEW

Globalization and the increase in consumption of ultra-processed foods have led to a need for greater knowledge on the health impacts of certain nutrients such as artificial sweeteners. This review aims to analyse the role of artificial sweeteners (nutritive and nonnutritive) and their impact on cardiometabolic and cardiovascular disease (CVD) risk.

RECENT FINDINGS

The detrimental effects of a high-calorie, high-sugar diet have been well established. In light of this, health authorities recommend limiting sugar consumption. This has led the food industry to develop different artificial sweeteners with specific properties, such as flavour and stability (nutritive artificial sweeteners: NAS), and others aimed at limiting sugar in the diet (nonnutritive artificial sweeteners: nNAS). Likewise, recent evidence explores the influence of artificial sweeteners (NAS and nNAS) on CVD risk through risk factors such as obesity and type 2 diabetes mellitus, among others.

SUMMARY

This review aims to provide an updated overview of the impact of NAS and nNAS on cardiovascular health and provide recommendations regarding their consumption.

The Association between Sugar-Sweetened Beverages and Male Pattern Hair Loss in Young Men

We performed this study to investigate the association between sugar-sweetened beverage (SSB) consumption and male pattern hair loss (MPHL) in young men. We conducted this cross-sectional study from January to April 2022 in mainland China. Young people aged 18-45 years (n = 1951) were recruited from 31 provinces in China. We used a self-reported online survey for data collection. We explored the associations between the amount/frequency of SSB consumption and MPHL by using a binary logistic regression model, with adjustments for sociodemographic, hair status, dietary intake, lifestyle, and psychological factors. Among the 1028 participants (27.8 ± 7.2 years) in the final analysis, we found that high SSB consumption is associated with a higher risk of MPHL. We recommend more support to decrease SSB consumption among young people to minimize negative health outcomes.

Association between maternal sugar-sweetened beverage consumption and the social-emotional development of child before 1 year old: A prospective cohort study

BACKGROUND

Excessive consumption of sugar-sweetened beverages (SSBs) has become an international public health issue. Adverse effects of sugary beverage consumption on both mother and child during pregnancy continue to be found. However, evidence regarding maternal SSB consumption and social-emotional development of children is lacking.

METHODS

Based on the Shenzhen Birth Cohort Study (loss rate: 10.97%), we included 985 mother-infant pairs from 2018 to 2022. All mothers had a singleton live birth without hypertension, diabetes, tumor, or serious immune system disease before pregnancy. We used a chart of frequency distribution to show maternal SSB consumption, including non-diet soda, tea drinks (not 100% tea), fruit drinks, Sugar-sweetened coffee, bubble tea, or cocoa drinks, and total SSBs. A multivariate logistic regression model was used to estimate the odds ratios of the potential delay on social-emotional development of each child was monitored at both 6 months and 12 months of age based on maternal SSB consumption.

RESULTS

Among the mothers, 728 (73.91%) drank SSBs <1 time per week, 194 (19.70%) drank SSBs 1-2 times per week, 43 (4.37%) drank SSBs 3-4 times per week, and 20 (2.03%) drank SSBs 5 or more times per week. Children aged 12 months with mothers who drank SSBs five or more times per week during pregnancy had an increased risk of potential delay on social-emotional development compared to those with mothers who drank SSBs less than once per week [odds ratio: 3.08 (1.13-8.39)]. Regarding the specific kinds of SSBs, we found that tea drinks (not 100% tea) were positively associated with potential delay on social-emotional development in children aged 6 months.

CONCLUSION

Nearly three-quarters of mothers consumed almost no SSBs during pregnancy. High SSB intake during pregnancy was associated with an increased risk of the potential delay on social-emotional development of a child at 6 and 12 months of age.

Young Women Are Protected Against Vascular Insulin Resistance Induced by Adoption of an Obesogenic Lifestyle

Vascular insulin resistance is a feature of obesity and type 2 diabetes that contributes to the genesis of vascular disease and glycemic dysregulation. Data from preclinical models indicate that vascular insulin resistance is an early event in the disease course, preceding the development of insulin resistance in metabolically active tissues. Whether this is translatable to humans requires further investigation. To this end, we examined if vascular insulin resistance develops when young healthy individuals (n = 18 men, n = 18 women) transition to an obesogenic lifestyle that would ultimately cause whole-body insulin resistance. Specifically, we hypothesized that short-term (10 days) exposure to reduced ambulatory activity (from >10 000 to <5000 steps/day) and increased consumption of sugar-sweetened beverages (6 cans/day) would be sufficient to prompt vascular insulin resistance. Furthermore, given that incidence of insulin resistance and cardiovascular disease is lower in premenopausal women than in men, we postulated that young females would be protected against vascular insulin resistance. Consistent with this hypothesis, we report that after reduced ambulation and increased ingestion of carbonated beverages high in sugar, young healthy men, but not women, exhibited a blunted leg blood flow response to insulin and suppressed skeletal muscle microvascular perfusion. These findings were associated with a decrease in plasma adropin and nitrite concentrations. This is the first evidence in humans that vascular insulin resistance can be provoked by short-term adverse lifestyle changes. It is also the first documentation of a sexual dimorphism in the development of vascular insulin resistance in association with changes in adropin levels.

The Impacts of Sugar-Sweetened Beverages (SSB) on Cardiovascular Health

Cardiovascular disease (CVD) has been a prominent global health challenge in the last decade, and many risk factors and outcomes of CVD have been studied in that timeframe. Recent research has explored the association between sugar-sweetened beverage (SSB) consumption and CVD; however, there is a lack of updated reviews regarding SSB consumption impacts on CVD outcomes and the possible mechanisms affecting the disease state. In turn, this review aims to summarize the relevant published research from the last decade regarding linkages between SSB consumption and CVD outcomes and the potential underlying mechanisms, as well as to highlight opportunities for future exploration with respect to those outcomes and mechanisms. In this review, we searched PubMed, Embase, and Web of Science for peer-reviewed articles published from January 2012 to March 2022 regarding SSB consumption and its association with CVD.

The results of our search reveal strong evidence that the consumption of SSB is positively associated with increased risks of CVD and that the magnitude of that risk is increased in a dose-dependent manner. These increased risks range from elevated triglyceride levels to inclined risk of CVD-related mortality. Although the depth of the mechanisms responsible for these increased risks have been less explored thus far, there is some evidence supporting SSB implications in cardiovascular factors, including vascular function, coronary artery calcification, triglyceride levels, inflammatory processes, arterial stiffness, and genetic polymorphisms.