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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]
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“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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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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