Added sugar intake and cardiovascular diseases mortality among US adults
Open accessAbstract
IMPORTANCE Epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease (CVD) risk factors. Few prospective studies have examined the association of added sugar intake with CVD mortality. OBJECTIVE To examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with CVD mortality. DESIGN, SETTING, AND PARTICIPANTS National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III], 1999-2004, and 2005-2010 [n = 31,147]) for the time trend analysis and NHANES III Linked Mortality cohort (1988-2006 [n = 11 733]), a prospective cohort of a nationally representative sample of US adults for the association study. MAIN OUTCOMES AND MEASURES Cardiovascular disease mortality. RESULTS Among US adults, the adjusted mean percentage of daily calories from added sugar increased from 15.7% (95% CI, 15.0%-16.4%) in 1988-1994 to 16.8% (16.0%-17.7%; P = .02) in 1999-2004 and decreased to 14.9% (14.2%-15.5%; P < .001) in 2005-2010. Most adults consumed 10% or more of calories from added sugar (71.4%) and approximately 10% consumed 25% or more in 2005-2010. During a median follow-up period of 14.6 years, we documented 831 CVD deaths during 163,039 person-years. Age-, sex-, and race/ethnicity-adjusted hazard ratios (HRs) of CVD mortality across quintiles of the percentage of daily calories consumed from added sugar were 1.00 (reference), 1.09 (95% CI, 1.05-1.13), 1.23 (1.12-1.34), 1.49 (1.24-1.78), and 2.43 (1.63-3.62; P < .001), respectively. After additional adjustment for sociodemographic, behavioral, and clinical characteristics, HRs were 1.00 (reference), 1.07 (1.02-1.12), 1.18 (1.06-1.31), 1.38 (1.11-1.70), and 2.03 (1.26-3.27; P = .004), respectively. Adjusted HRs were 1.30 (95% CI, 1.09-1.55) and 2.75 (1.40-5.42; P = .004), respectively, comparing participants who consumed 10.0% to 24.9% or 25.0% or more calories from added sugar with those who consumed less than 10.0% of calories from added sugar. These findings were largely consistent across age group, sex, race/ethnicity (except among non-Hispanic blacks), educational attainment, physical activity, health eating index, and body mass index. CONCLUSIONS AND RELEVANCE Most US adults consume more added sugar than is recommended for a healthy diet. We observed a significant relationship between added sugar consumption and increased risk for CVD mortality.
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Certain plant foods, such as refined grains and sugar-sweetened beverages, are associated with higher cardio-metabolic risk.
“Additionally, in studies of vegetarian diets all plant foods are treated equally, even though certain plant foods, such as refined grains and sugar-sweetened beverages (SSBs) are associated with higher cardio-metabolic risk.(11–13)”
From Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults (2017) · cites this paper as [12]
In the National Health and Nutrition Examination Survey III, with 831 CVD deaths during 163,039 person-years of follow-up, consumption of ≥7 SSB servings/week was associated with a 29% increased CVD mortality risk compared with <1 serving/week, with no increased risk up to 6 drinks/week.
“In the National Health and Nutrition Examination Survey III (NHANES III), with 831 CVD deaths during 163,039 person-years of follow-up, consumption of ≥ 7 SSB servings/week was associated with a 29% increased CVD mortality risk compared with < 1 serving/week (120), with no increased risk up to 6 drinks/week.”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [120]
Sugar-sweetened beverage consumption accounts for up to 50% of added sugar in the American diet.
“Sugar-sweetened beverage (SSB) consumption accounts for up to 50% of added sugar in the American diet (120,121).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [120]
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“In the NHANES III (National Health and Nutrition Examination Survey III) study, with 831 CVD deaths during 163,039 person-years of follow-up, consumption of $7 SSB servings/week was associated with a 29% increased CVD mortality risk compared with <1 serving/week (120), with no increased risk up to 6 drinks/week.”
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Malik, V. S., Li, Y., Pan, A., De Koning, L., Schernhammer, E., Willett, W. C., & Hu, F. B. (2019) · Circulation · doi:10.1161/circulationaha.118.037401 · Cited by 421 · see citing works
Self-citationHorn, L. V., Carson, J. A. S., Appel, L. J., Burke, L. E., Economos, C. D., Karmally, W., Lancaster, K. J., Lichtenstein, A. H., Johnson, R. K., Thomas, R. J., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000462 · Cited by 431 · see citing works
Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood
Drożdż, D., Pitti, J. Á., Wójcik, M., Borghi, C., Gabbianelli, R., Mazur, A., Herceg-Čavrak, V., López‐Valcárcel, B. G., Brzeziński, M., Lurbe, E., et al. (2021) · Nutrients · doi:10.3390/nu13114176 · Cited by 441 · see citing works
“The analysis of the data from the National Health and Nutrition Examination Surveys (NHANES) 1988–1994, 1999–2004, and 2005–2010 (n = 31,147) revealed a significant direct relationship between added sugar consumption and increased risk for CV morbidity and mortality in adults [17].”
MethodSugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence
Malik, V., & Hu, F. B. (2019) · Nutrients · doi:10.3390/nu11081840 · Cited by 419 · see citing works
“60) comparing participants who consumed seven or more servings of SSBs per week to those who consumed one serving per week or less [60].”
BackgroundFructose and Cardiometabolic Health
Malik, V. S., & Hu, F. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.025 · Cited by 408 · see citing works
Self-citationSchnabel, L., Kesse-Guyot, E., Allès, B., Touvier, M., Srour, B., Hercberg, S., Buscail, C., & Julia, C. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.7289 · Cited by 390 · see citing works
“Likewise, ultraprocessed foods tend to contribute to excessive intake of added sugar,(33)whereas added sugar consumption has beenassociatedwithan increasedrisk forCVDmortality.(39)Sugarybeverages andprocessedmeatsmay likelybe factors in the observed correlation between ultraprocessed foods andmortality, as they have b…”
BackgroundFood Deserts and the Causes of Nutritional Inequality*
Allcott, H., Diamond, R., Dubé, J.-P., Handbury, J., Rahkovsky, I. M., & Schnell, M. K. (2019) · The Quarterly Journal of Economics · doi:10.1093/qje/qjz015 · Cited by 390 · see citing works
(2017) · doi:10.3390/healthcare5020029 · Cited by 410 · see citing works
“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].”
MethodGuo, J., Astrup, A. V., Lovegrove, J. A., Gijsbers, L., Givens, D. I., & Soedamah‐Muthu, S. S. (2017) · European Journal of Epidemiology · doi:10.1007/s10654-017-0243-1 · Cited by 388 · see citing works
“…with mortality and CVD risk could be because of replacement by other foods, for example, those with high intake of dairy products may consume less sugar sweetened beverages which could lead to lower CVD mortality [66] or consume more processed meat which could lead to higher CVD risks [67, 68].”
Sugar in Infants, Children and Adolescents
Mis, N. F., Braegger, C., Bronský, J., Campoy, C., Domellöf, M., Embleton, N. D., Hojsak, I., Hulst, J. M., Indrio, F., Lapillonne, A., et al. (2017) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001733 · Cited by 358 · see citing works
The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease
DiNicolantonio, J. J., Lucan, S. C., & O’Keefe, J. H. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.11.006 · Cited by 354 · see citing works
“Moreover, a diet high in added sugars has been found to cause a 3-fold increased risk of death due to CV disease.(136)”
BackgroundThe environmental costs and benefits of high-yield farming
Balmford, A., Amano, T., Bartlett, H., Chadwick, D., Collins, A., Edwards, D., Field, R., Garnsworthy, P., Green, R., Smith, P., et al. (2018) · Nature Sustainability · doi:10.1038/s41893-018-0138-5 · Cited by 343 · see citing works
Plant-based diets to manage the risks and complications of chronic kidney disease
Carrero, J. J., González-Ortíz, A., Avesani, C. M., Bakker, S. J. L., Bellizzi, V., Chauveau, P., Clase, C. M., Cupisti, A., Espinosa-Cuevas, Á., Molina, P., et al. (2020) · Nature Reviews Nephrology · doi:10.1038/s41581-020-0297-2 · Cited by 334 · see citing works
Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake
Moynihan, P. J. (2016) · Advances in Nutrition · doi:10.3945/an.115.009365 · Cited by 320 · see citing works
Excessive intake of sugar: An accomplice of inflammation
Ma, X., Nan, F., Liang, H., Shu, P., Fan, X., Song, X., Hou, Y., & Zhang, D. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.988481 · Cited by 337 · see citing works
“A growing body of research suggests that excessive consumption of processed foods containing dietary sugars or HFCS is strongly linked to the development of obesity (14, 15), T2D (16, 17), metabolic syndrome (16) and cardiovascular disease (18).”
BackgroundEuropean Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics
Timmis, A., Aboyans, V., Vardas, P. E., Townsend, N. P., Torbica, A., Kavousi, M., Boriani, G., Huculeci, R., Kazakiewicz, D., Scherr, D., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae466 · Cited by 337 · see citing works
Sweeteners as food additives in the XXI century: A review of what is known, and what is to come
Carocho, M., Morales, P., & Ferreira, I. C. F. R. (2017) · Food and Chemical Toxicology · doi:10.1016/j.fct.2017.06.046 · Cited by 317 · see citing works
Mooradian, A. D., Smith, M., & Tokuda, M. (2017) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2017.01.004 · Cited by 303 · see citing works
“Among the sugars, the availability of high-fructose corn syrup has independently predicted greater cardiovascular risk and diabetes prevalence [49,50].”
BackgroundCharchar, F. J., Prestes, P. R., Mills, C. E., Ching, S. M., Neupane, D., Marques, F. Z., Sharman, J. E., Vogt, L., Burrell, L. M., Коростовцева, Л. С., et al. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003563 · Cited by 352 · see citing works
Zhang, D., Jin, W., Wu, R., Jia, L., Park, S.-A., Tu, E., Zanvit, P., Xu, J., Liu, O., Cain, A., et al. (2019) · Immunity · doi:10.1016/j.immuni.2019.08.001 · Cited by 276 · see citing works
Stanhope, K. L., Medici, V., Bremer, A. A., Lee, V., Lam, H. D., Nunez, M. V., Chen, G. X., Keim, N. L., & Havel, P. J. (2015) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.114.100461 · Cited by 270 · see citing works
“D were significantly affected by HFCS-group.”
BackgroundInfluentialSiri‐Tarino, P. W., Chiu, S., Bergeron, N., & Krauss, R. M. (2015) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-071714-034449 · Cited by 267 · see citing works
A review of total & added sugar intakes and dietary sources in Europe
Azaı̈s-Braesco, V., Sluik, D., Maillot, M., Kok, F. J., & Moreno, L. A. (2017) · Nutrition Journal · doi:10.1186/s12937-016-0225-2 · Cited by 258 · see citing works
“These concerns are justified by studies and reports indicating that high intakes of sugars are associated with an increased risk of dental caries [3], overweight [4] and cardio-metabolic risk factors and mortality [5, 6].”
BackgroundDebras, C., Chazelas, E., Sellem, L., Porcher, R., Druesne‐Pecollo, N., Esseddik, Y., de Edelenyi, F. S., Agaësse, C., Sa, A. D., Lutchia, R., et al. (2022) · BMJ · doi:10.1136/bmj-2022-071204 · Cited by 260 · see citing works
Aragno, M., & Mastrocola, R. (2017) · Nutrients · doi:10.3390/nu9040385 · Cited by 239 · see citing works
“On the other hand, results from experimental models confirm that the consumption of sugar-added foods is associated with increased risk for obesity [7], as well as cardiovascular diseases [8,9], metabolic disorders [10], non-alcoholic fatty liver disease (NAFLD) [11,12], and cognitive decline [13].”
BackgroundRippe, J. M., & Angelopoulos, T. J. (2016) · Nutrients · doi:10.3390/nu8110697 · Cited by 234 · see citing works
“[106] NHANES data analysis CVD risk increased to 1.”
MethodChanges in Plant-Based Diet Quality and Total and Cause-Specific Mortality
Baden, M. Y., Liu, G., Satija, A., Li, Y., Sun, Q., Fung, T. T., Rimm, E. B., Willett, W. C., Hu, F. B., & Bhupathiraju, S. N. (2019) · Circulation · doi:10.1161/circulationaha.119.041014 · Cited by 228 · see citing works
Functionality of sugars in foods and health
Clemens, R. A., Jones, J. M., Kern, M., Lee, S., Mayhew, E. J., Slavin, J. L., & Zivanovic, S. (2016) · Comprehensive Reviews in Food Science and Food Safety · doi:10.1111/1541-4337.12194 · Cited by 224 · see citing works
Sugar-Sweetened Beverages Are the Main Sources of Added Sugar Intake in the Mexican Population
Sánchez-Pimienta, T. G., Batis, C., Lutter, C. K., & Rivera, J. Á. (2016) · Journal of Nutrition · doi:10.3945/jn.115.220301 · Cited by 216 · see citing works
Yin, J., Zhu, Y., Malik, V., Li, X., Peng, X., Zhang, F. F., Shan, Z., & Liu, L. (2021) · Advances in Nutrition · doi:10.1093/advances/nmaa084 · Cited by 197 · see citing works
“omitted several key studies (13, 14) that were eligible and included 1 study that combined SSBs and LCSBs (15).”
BackgroundInfluentialPimpin, L., Wu, J. H. Y., Haskelberg, H., Gobbo, L. C. D., & Mozaffarian, D. (2016) · PLoS ONE · doi:10.1371/journal.pone.0158118 · Cited by 212 · see citing works
Diet quality is associated with disability and symptom severity in multiple sclerosis
Fitzgerald, K. C., Tyry, T. M., Salter, A. R., Cofield, S. S., Cutter, G., Fox, R. J., & Marrie, R. A. (2017) · Neurology · doi:10.1212/wnl.0000000000004768 · Cited by 208 · see citing works
Gehring, J., Touvier, M., Baudry, J., Julia, C., Buscail, C., Srour, B., Herçberg, S., Péneau, S., Kesse‐Guyot, E., & Allès, B. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa196 · Cited by 211 · see citing works
Added Sugars Intake Across the Distribution of US Children and Adult Consumers: 1977-2012
Powell, E. S., Smith-Taillie, L. P., & Popkin, B. M. (2016) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.06.003 · Cited by 178 · see citing works
The development of sweet taste: From biology to hedonics
Mennella, J. A., Bobowski, N. K., & Reed, D. R. (2016) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-016-9360-5 · Cited by 188 · see citing works
Lustig, R. H., Mulligan, K. M., Noworolski, S. M., Tai, V., Wen, M., Erkin‐Cakmak, A., Gugliucci, A., & Schwarz, J. (2015) · Obesity · doi:10.1002/oby.21371 · Cited by 185 · see citing works
“Epidemiological studies have linked dietary fructose consumption, either as sucrose or high-fructose corn syrup, with the various comorbidities of metabolic syndrome, including CVD, T2DM, and NAFLD (4,20,21).”
BackgroundInfluentialDevelopment pathways toward “zero hunger”
Blesh, J., Hoey, L., Jones, A. D., Friedmann, H., & Perfecto, I. (2019) · World Development · doi:10.1016/j.worlddev.2019.02.004 · Cited by 181 · see citing works
Soltani, S., Arablou, T., Jayedi, A., & Salehi-Abargouei, A. (2020) · Nutrition Journal · doi:10.1186/s12937-020-00554-8 · Cited by 179 · see citing works
A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?
Diab, A., Dastmalchi, L. N., Gulati, M., & Michos, E. D. (2023) · Vascular Health and Risk Management · doi:10.2147/vhrm.s379874 · Cited by 202 · see citing works
“For example, probiotics use has shown benefits in mild reduction in blood pressure, blood glucose, and TMAO levels.106 Higher fiber intake is associated with increased diversity of the gut microbiota,38 and a higher fiber diet is associated with lower risk of hypertension and CVD.107 Individuals with hypertension were…”
BackgroundInfluentialDrewnowski, A., & Rehm, C. D. (2014) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.114.089458 · Cited by 176 · see citing works
Man, A. W. C., Li, H., & Xia, N. (2020) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2020/1496462 · Cited by 173 · see citing works
“A prospective study has shown that people who got 17% to 21% of their calories from added sugar had a 38% higher risk of dying from cardiovascular disease compared with those who consumed 8% of their calories as added sugar [74].”
BackgroundO’Connor, L., Imamura, F., Lentjes, M. A. H., Khaw, K., Wareham, N. J., & Forouhi, N. G. (2015) · Diabetologia · doi:10.1007/s00125-015-3572-1 · Cited by 170 · see citing works
“While not directly comparable, a study in the USA reported an association between the contribution of added sugar above 10% of TEI and higher mortality from cardiovascular disease [28].”
Johnson, C. B., Davis, M. K., Law, A., & Sulpher, J. A. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.04.008 · Cited by 164 · see citing works
Johnson, R. J., Sánchez‐Lozada, L. G., Andrews, P., & Lanaspa, M. A. (2017) · Advances in Nutrition · doi:10.3945/an.116.014654 · Cited by 162 · see citing works
“Thus, fructose activates a process that leads to fat storage, and indeed fructose (or sugar) intake is strongly linked with the development of obesity, diabetes, fatty liver, and heart disease (2, 3, 89, 90).”
Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review
Weisman, A., Fazli, G. S., Johns, A., & Booth, G. L. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.03.002 · Cited by 161 · see citing works
Food consumption changes in South Africa since 1994
Ronquest-Ross, L.-C., Vink, N., & Sigge, G. O. (2015) · South African Journal of Science · doi:10.17159/sajs.2015/20140354 · Cited by 158 · see citing works
DiNicolantonio, J. J., O’Keefe, J. H., & Lucan, S. C. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2014.12.019 · Cited by 154 · see citing works
“Reducing fructose consumption may protect against diabetes and its complications,(40,76) including early mortality from cardiovascular causes.(125)”
BackgroundDietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review
Chareonrungrueangchai, K., Wongkawinwoot, K., Anothaisintawee, T., & Reutrakul, S. (2020) · Nutrients · doi:10.3390/nu12041088 · Cited by 158 · see citing works
“For instance, our study found no benefit of a low-fat diet for CVD prevention, which may have resulted from the excess intake of other high-risk foods, such as refined carbohydrates and sugar to substitute the energy from fat [66,67].”
BackgroundMonocytes re-enter the bone marrow during fasting and alter the host response to infection
Janssen, H., Kahles, F., Liu, D., Downey, J., Koekkoek, L. L., Roudko, V., D’Souza, D., McAlpine, C. S., Halle, L., Poller, W. C., et al. (2023) · Immunity · doi:10.1016/j.immuni.2023.01.024 · Cited by 142 · see citing works
Drapkina, O. M., Васильевна, К. А., Калинина, А. М., Avdeev, S. M., Викторович, А. М., Alexandrova, L. M., Анциферова, А. А., Dm, A., Ахмеджанов, Н. М., Balanova, Y. А., et al. (2022) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2022-3235 · Cited by 172 · see citing works
Gadgil, M. D., Anderson, C. A. M., Kandula, N. R., & Kanaya, A. M. (2015) · Journal of Nutrition · doi:10.3945/jn.114.207753 · Cited by 134 · see citing works
“Certain food patterns high in refined carbohydrates, such as the fried snacks, sweets, and high-fat dairy pattern, and red and processed meats, such as the animal protein pattern in this study, have been identified as particular contributors to adiposity, b cell dysfunction and overall weight gain (5, 6, 24, 25).”
BackgroundThe Diet, Health, and Environment Trilemma
Clark, M., Hill, J., & Tilman, D. G. (2018) · Annual Review of Environment and Resources · doi:10.1146/annurev-environ-102017-025957 · Cited by 134 · see citing works
Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents
Muth, N. D., Dietz, W. H., Magge, S. N., Johnson, R. K., OBESITY, S. O., Bolling, C. F., Armstrong, S., Haemer, M. A., Rausch, J. C., Rogers, V. W., et al. (2019) · PEDIATRICS · doi:10.1542/peds.2019-0282 · Cited by 153 · see citing works
“by physicians and other health care providers, hospitals, and many other members of civil society.(6,97,98)”
BackgroundINTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES"
Dedov, I. I., Shestakova, M. V., Mel'nichenko, G. A., Mazurina, N. V., Andreeva, E. N., Bondarenko, I. Z., Руслановна, Г. З., Dzgoeva, F. K., Елисеев, М. С., Ershova, E. V., et al. (2021) · Obesity and metabolism · doi:10.14341/omet12714 · Cited by 162 · see citing works
Review: The Consumption of Ultra-Processed Foods and Non-communicable Diseases in Latin America
Matos, R. A. C., Adams, M., & Sabaté, J. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.622714 · Cited by 126 · see citing works
“Furthermore, the consumption of added sugars is significantly associated with CVD mortality risk (37).”
BackgroundThe Race to Bash NASH: Emerging Targets and Drug Development in a Complex Liver Disease
Romero, F. A., Jones, C. T., Xu, Y., Fenaux, M., & Halcomb, R. L. (2020) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.9b01701 · Cited by 126 · see citing works
Joh, H.-K., Lee, D. H., Hur, J., Nimptsch, K., Chang, Y., Joung, H., Zhang, X., Rezende, L. F. M., Lee, J. E., Ng, K., et al. (2021) · Gastroenterology · doi:10.1053/j.gastro.2021.03.028 · Cited by 122 · see citing works
Total and Free Sugar Content of Canadian Prepackaged Foods and Beverages
Bernstein, J. T., Schermel, A., Mills, C. M., & L’Abbé, M. R. (2016) · Nutrients · doi:10.3390/nu8090582 · Cited by 123 · see citing works
“Excess consumption of free sugar (see Box 1 for definitions) has been associated with increased risk of obesity, cardiovascular disease, diabetes, and dental caries [1–5].”
BackgroundShivappa, N., Steck, S. E., Hussey, J. R., Ma, Y., & Hébert, J. R. (2015) · European Journal of Nutrition · doi:10.1007/s00394-015-1112-x · Cited by 121 · see citing works
“A significant positive association was observed between sodium intake and sugar intake and CVD mortality [16, 64], while no association was observed between meat intake and mortality [65].”
Association of Sugary Beverage Consumption With Mortality Risk in US Adults
Collin, L. J., Judd, S. E., Safford, M. M., Vaccarino, V., & Welsh, J. A. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.3121 · Cited by 121 · see citing works
Milk fat: opportunities, challenges and innovation
Mohan, M. S., O’Callaghan, T. F., Kelly, P. M., & Hogan, S. A. (2020) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2020.1778631 · Cited by 123 · see citing works
Andrés-Hernando, A., Orlicky, D. J., Kuwabara, M., Ishimoto, T., Nakagawa, T., Johnson, R. J., & Lanaspa, M. A. (2020) · Cell Metabolism · doi:10.1016/j.cmet.2020.05.012 · Cited by 120 · see citing works
“Some studies have even ascribed increased cardiovascular mortality rates to the excessive intake of added sugars (Malik et al., 2019; Yang et al., 2014).”
BackgroundPiernas, C., Perez‐Cornago, A., Gao, M., Young, H., Pollard, Z., Mulligan, A. A., Lentjes, M. A. H., Carter, J. L., Bradbury, K. E., Key, T. J., et al. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02535-x · Cited by 120 · see citing works
Carbotoxicity—Noxious Effects of Carbohydrates
Kroemer, G., López-Otı́n, C., Madeo, F., & de Cabo, R. (2018) · Cell · doi:10.1016/j.cell.2018.07.044 · Cited by 117 · see citing works
Vreman, R. A., Goodell, A. J., Rodríguez, L. A., Porco, T. C., Lustig, R. H., & Kahn, J. G. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013543 · Cited by 115 · see citing works
The Impact of Free Sugar on Human Health—A Narrative Review
Gillespie, K. M., Kemps, E., White, M. J., & Bartlett, S. E. (2023) · Nutrients · doi:10.3390/nu15040889 · Cited by 123 · see citing works
“Studies that investigated the impacts of carbohydrates are mixed but more strongly support a refined carbohydrate and SSB contribution to heart disease [18,131] (see Table 2).”
BackgroundWitek, K., Wydra, K., & Filip, M. (2022) · Nutrients · doi:10.3390/nu14142940 · Cited by 128 · see citing works
“Clinical trials and epidemiologic studies have shown that individuals who consume greater amounts of added sugar, especially sugar-sweetened beverages, tend to gain more weight and have a higher risk of obesity, type 2 diabetes mellitus, dyslipidaemia, hypertension, and cardiovascular disease [22].”
BackgroundReplacement of refined sugar by natural sweeteners: focus on potential health benefits
Arshad, S., Rehman, T., Saif, S., Rajoka, M. S. R., Ranjha, M. M. A. N., Hassoun, A., Cropotova, J., Trif, M., Younas, A., & Aadil, R. M. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e10711 · Cited by 117 · see citing works
DiNicolantonio, J., & Lucan, S. (2014) · Open Heart · doi:10.1136/openhrt-2014-000167 · Cited by 104 · see citing works
“Compared to patients who consume less than 10% of their calories from added sugars, those who consumed 10.0 – 24.9% of their calories from added sugars have a 30% increased risk of mortality from CVD. 62 Those who consume 25% or more calories from added sugars have an almost threefold increased risk.”
BackgroundInfluentialReichelt, A. C., Killcross, S., Hambly, L. D., Morris, M. J., & Westbrook, R. F. (2015) · Learning & Memory · doi:10.1101/lm.038000.114 · Cited by 114 · see citing works
“Consumption of soft drinks has been shown to contribute to 80% of the increase in added sugar consumption during the period 1962–2000 in the U.S. (Popkin and Nielsen 2003) and today are the largest single source of added sugar consumption (Yang et al. 2014).”
BackgroundBurden of cardiovascular disease among elderly: based on the Global Burden of Disease Study 2019
Qu, C., Liao, S., Zhang, J., Cao, H., Zhang, H., Zhang, N., Yan, L., Cui, G., Luo, P., Zhang, Q., et al. (2023) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcad033 · Cited by 111 · see citing works
“22–24 The ‘collision’ epidemic of HIV and CVDs in ∼ 2000 is also a possible cause of the rising local death burden.”
BackgroundGao, M., Jebb, S. A., Aveyard, P. N., Ambrosini, G. L., Perez‐Cornago, A., Carter, J. L., Sun, X., & Piernas, C. (2021) · BMC Medicine · doi:10.1186/s12916-021-01958-x · Cited by 109 · see citing works
“High dietary energy density and free sugars are associated with increased risk of weight gain [8] which can further increase CVD and mortality risk [8, 9], while SFAs increase total blood cholesterol and LDL [10, 11].”
BackgroundResultVorster, H. H., Kruger, A., Wentzel‐Viljoen, E., Kruger, H. S., & Margetts, B. (2014) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.069005 · Cited by 107 · see citing works
Vézina-Im, L.-A., Beaulieu, D., Bélanger-Gravel, A., Boucher, D., Sirois, C., Dugas, M., & Provencher, V. (2017) · Public Health Nutrition · doi:10.1017/s1368980017000076 · Cited by 106 · see citing works
“SSB consumption contributes to excessive intake of sugar among adolescents, which is related to many health problems such as heart diseases, stroke((7)), obesity, type 2 diabetes, hypercholesterolaemia((21,22)), cancer((23)) and tooth decay((24)).”
Chinese Guideline on the Primary Prevention of Cardiovascular Diseases
Chinese Society of Cardiology of Chinese Medical Association, C. D. P. A. R. C. O. C. A. O. R. M. (2021) · Cardiology Discovery · doi:10.1097/cd9.0000000000000025 · Cited by 109 · see citing works
The Ketogenic Diet and Cardiovascular Diseases
Dyńka, D., Kowalcze, K., Charuta, A., & Paziewska, A. (2023) · Nutrients · doi:10.3390/nu15153368 · Cited by 113 · see citing works
Diet, lipids, and cardiovascular disease
Siri‐Tarino, P. W., & Krauss, R. M. (2016) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000310 · Cited by 101 · see citing works
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Pharmacologic inhibition of ketohexokinase prevents fructose-induced metabolic dysfunction
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- Authors
- Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt, R., & Hu, F. B.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Emory University (US)
- Harvard University (US)
- Corresponding author
- Yang, Quanhe
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2014-04-01
- Volume
- 174
- Issue
- 4
- Pages
- 516
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC10910551
- OpenAlex
- W2115321988
- Cited by
- 947
- References
- 49
- Citations by year
- 2026: 29 · 2025: 47 · 2024: 51 · 2023: 93 · 2022: 89 · 2021: 88 · 2020: 136 · 2019: 96 · 2018: 68 · 2017: 75 · 2016: 78 · 2015: 58 · 2014: 38 · 2012: 1
- FWCI
- 66.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- added sugar intake, cardiovascular mortality, sugar consumption, prospective cohort, cardiovascular risk factors, sociodemographic disparities, United States adults, sugar-sweetened beverages, fruit and vegetable intake, alcohol consumption, physical activity, smoking, body mass index, blood pressure
- MeSH terms
- Adult, Aged, Energy Intake, Carbohydrates, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prospective Studies, Risk, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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