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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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“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 citing paper
“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]
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“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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“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
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“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 173
“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
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“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"
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“Furthermore, the consumption of added sugars is significantly associated with CVD mortality risk (37).”
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“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].”
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Association of Sugary Beverage Consumption With Mortality Risk in US Adults
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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 126
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“Some studies have even ascribed increased cardiovascular mortality rates to the excessive intake of added sugars (Malik et al., 2019; Yang et al., 2014).”
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Carbotoxicity—Noxious Effects of Carbohydrates
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The Impact of Free Sugar on Human Health—A Narrative Review
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“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).”
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“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
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“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.”
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“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
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“22–24 The ‘collision’ epidemic of HIV and CVDs in ∼ 2000 is also a possible cause of the rising local death burden.”
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Chinese Guideline on the Primary Prevention of Cardiovascular Diseases
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Metadata
- 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
- 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
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