Cited by 947Diet, Metabolism, and DiseaseNutritional Studies and DietObesity, Physical Activity, Diet

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Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults

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Yang, Quanhe, Zhang, Zefeng, Gregg, Edward W., Flanders, W. Dana, Merritt, Robert, Hu, Frank B.·2014·JAMA Internal Medicine

DOI 10.1001/jamainternmed.2013.13563PMC PMC10910551

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Abstract

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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Type of supplemented simple sugar, not merely calorie intake, determines adverse effects on metabolism and aortic function in female rats
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“Long-term diets characterized by low intakes of fruit, vegetables, whole grains and Ca, and high intakes of fast foods, sugar-sweetened beverages and processed foods, can contribute to chronic conditions including diabetes and CVD even in the absence of a higher weight status(35,36).”
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Decreased risk of all-cause and heart-specific mortality is associated with low-fat or skimmed milk consumption compared with whole milk intake: A cohort study
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“Studies now show that excess sugar consumption is associated with obesity,(104) cardiometabolic risk,(105) and CV diseases.(106) However, controversies remain as to whether the metabolic properties of fructose or the fact that it simply constitutes excess energy intake is responsible for its deleterious effects on CV…”
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Free radical scavenging reverses fructose-induced salt-sensitive hypertension
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“Introduction Rats fed a high-fructose diet have been characterized as a model of insulin resistance and associated hypertension.(1,2) An animal model was first reported by Hwang et al(3) in rats fed with very high fructose (66% of their caloric intake) which developed type 2 diabetes, hyperinsulinemia, hypertriglyceri…”
Total and Free Sugar Content of Pre-Packaged Foods and Non-Alcoholic Beverages in Slovenia
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Exploring changes in the human gut microbiota and microbial-derived metabolites in response to diets enriched in simple, refined, or unrefined carbohydrate-containing foods: a post hoc analysis of a randomized clinical trial
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“In addition, studies have confirmed that tinned fruit and blended juice contain added sugars, which may increase the risk of obesity [77].”
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“Thus, they have a higher risk for dental caries and for being overweight and obesity-related diseases, including cardiovascular diseases [30], diabetes and cancers [1].”
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Adherence to international dietary recommendations in association with all-cause mortality and fatal and non-fatal cardiovascular disease risk: a prospective analysis of UK Biobank participants
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“Individually, there is strong evidence that free sugars are associated with increased risk of weight gain [6], while saturated fats increase total blood cholesterol and low-density lipoprotein (LDL) cholesterol concentrations, which may increase the risk of cardiovascular disease (CVD) [7].”
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A Machine Learning Approach to Predict the Added-Sugar Content of Packaged Foods
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Changes in the Healthy Beverage Index in Response to an Intervention Targeting a Reduction in Sugar-Sweetened Beverage Consumption as Compared to an Intervention Targeting Improvements in Physical Activity: Results from the Talking Health Trial
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“Extensive research has investigated changes in beverage consumption, especially sugar-sweetened beverages (SSB) [1,2], due to the health consequences associated with excessive intake, obesity [3–5], diabetes [4,6–8], and cardiovascular disease [5].”
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Differential metabolic and multi-tissue transcriptomic responses to fructose consumption among genetically diverse mice
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Sugar-Sweetened Beverage Warning Labels: Lessons Learned From the Tobacco Industry
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“Information on total energy intake, alcohol consumption, calories from added sugar/carbohydrate and Healthy Eating Index(38) (HEI 1994–96 for 1988–94 and HEI-2010 for 1999–2010) were derived from 24-h dietary recalls.(26) History of diabetes, hypertension, high cholesterol and angina was defined using self-reported di…”
Do thrifty genes exist? Revisiting uricase
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“ethnic minorities are ingesting higher amounts, with some individuals ingesting 25% of their total caloric intake from added sugars [78].”
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Diabetes and Kidney Disease in American Indians: Potential Role of Sugar-Sweetened Beverages
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Compared to Sucrose, Previous Consumption of Fructose and Glucose Monosaccharides Reduces Survival and Fitness of Female Mice
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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
ORCID: Yang, Quanhe
Zhang, Zefeng
Gregg, Edward W.
Flanders, W. Dana
Merritt, Robert
Hu, Frank B.
Venue: JAMA Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2014-04-01
Volume: 174
Issue: 4
Pages: 516
ISSN: 2168-6106 (ISSN-L)
DOI: 10.1001/jamainternmed.2013.13563
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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Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults

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