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Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis
Open accessAbstract
A number of prospective cohort studies have investigated the associations between consumption of sugar-sweetened beverages (SSB) and the risk of hypertension, CHD and stroke, but revealed mixed results. In the present study, we aimed to perform a dose-response meta-analysis of these prospective studies to clarify these associations. A systematic literature search was conducted using the PubMed and Embase databases up to 5 May 2014. Random- or fixed-effects models were used to calculate the pooled relative risks (RR) with 95 % CI for the highest compared with the lowest category of SSB consumption, and to conduct a dose-response analysis. A total of six prospective studies (240 726 participants and 80 411 incident cases of hypertension) from four publications on hypertension were identified. A total of four prospective studies (194 664 participants and 7396 incident cases of CHD) from four publications on CHD were identified. A total of four prospective studies (259 176 participants and 10 011 incident cases of stroke) from four publications on stroke were identified. The summary RR for incident hypertension was 1·08 (95 % CI 1·04, 1·12) for every additional one serving/d increase in SSB consumption. The summary RR for incident CHD was 1·17 (95 % CI 1·10, 1·24) for every serving/d increase in SSB consumption. There was no significant association between SSB consumption and total stroke (summary RR 1·06, 95 % CI 0·97, 1·15) for every serving/d increase in SSB consumption. The present meta-analysis suggested that a higher consumption of SSB was associated with a higher risk of hypertension and CHD, but not with a higher risk of stroke.
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“SSBs are also associated with incidence of diabetes and CHD (Figure 6).257, 258”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [258]
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“In a meta-analysis of prospective studies of SSB and hypertension, CHD, and stroke, the RR for a 1-serving increase in SSB/d was 1.17 (95 % CI 1.10, 1.24) for CHD and 1.08 (95% CI: 1.04 to 1.12) for incident hypertension, but no clear effect was seen for total stroke (RR 1.06, 95 % CI 0.97, 1.15) (123).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [123]
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Food as Medicine for Hypertension: Microbiota as Mediators
Kret, Z. S., Akinola, O. M., Ahlidja, W., & Joe, B. (2025) · Hypertension · doi:10.1161/hypertensionaha.125.17950 · Cited by 9
“72,73 The World Health Organization describes free sugars as all monosaccharides and disaccharides that are added to foods and drinks, as well as the natural sugars found in fruits and honey.”
Børresen, K. Ø., Rosendahl-Riise, H., Brantsæter, A. L., & Egeland, G. M. (2022) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2022-000426 · Cited by 8
Alves, K. R., Hermsdorff, H. H. M., Miranda, A. E. D. S., Bressan, J., Mendonça, R. D. D., de Oliveira, F. L. P., & Pimenta, A. M. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000003311 · Cited by 8
Rauzon, S., Randel-Schreiber, H. R., Kuo, E. S., Schwartz, P. M., Reed, A. L., & Thompson, H. R. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101128 · Cited by 8
Li, Y., Zhang, D. “., Rajbhandari‐Thapa, J., Li, W., Chen, Z., Mu, L., Liu, J., & Pagán, J. A. (2021) · Population Health Management · doi:10.1089/pop.2021.0260 · Cited by 9
Associations of plant-based dietary patterns with cardiovascular risk factors in women
Shirzadi, Z., Daneshzad, E., Motlagh, A. D., Surkan, P. J., & Azadbakht, L. (2022) · Journal of Cardiovascular and Thoracic Research · doi:10.34172/jcvtr.2022.01 · Cited by 8
Chen, M., Xu, Y., Wang, X., Shan, S., & Cheng, G. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1131126 · Cited by 10
Adeoye, I. A. (2023) · BMC Public Health · doi:10.1186/s12889-023-15828-z · Cited by 8
“Additionally, SSBs adversely affect metabolism by causing sudden elevation of blood glucose and insulin levels (spikes), particularly when taken in large volumes, resulting in high glycemic load leading to decreased insulin sensitivity, insulin resistance, inflammation, and beta-cell dysfunction [21, 22] which increas…”
Backgrounddo Vale, M. R. L., Buckner, L., Mitrofan, C. G., Tramontt, C. R., Kargbo, S. K., Khalid, A., Ashraf, S., Mouti, S., Dai, X., Unwin, D., et al. (2021) · Nutrition Research Reviews · doi:10.1017/s0954422421000378 · Cited by 7
“…such as sugar-sweetened beverages, were associated with increased coronary heart disease incidence in previous meta-analysis of prospective studies (260) , and whole grains, which are high in complex carbohydrates, were associated with decreased CVD mortality and risk of coronary heart disease,…”
Pinho‐Gomes, A., Dunford, E., & Jones, A. (2022) · Public Health Nutrition · doi:10.1017/s1368980022002300 · Cited by 7
“Excessive intake of free sugars has been associated not only with overweight/obesity in children and adults(4–6) but also cardiometabolic diseases(7,7,8) and dental caries(9).”
BackgroundControlled trial of a workplace sales ban on sugar-sweetened beverages
Schmidt, J. M., Epel, E. S., Jacobs, L. M., Mason, A. E., Parrett, B., Pickett, A. M., Mousli, L. M., & Schmidt, L. A. (2023) · Public Health Nutrition · doi:10.1017/s1368980023001386 · Cited by 7
Kim, K., & Lee, Y. (2021) · Journal of Nutrition and Health · doi:10.4163/jnh.2021.54.4.355 · Cited by 6
Impuestos selectivos al consumo de bebidas azucaradas en América Latina y el Caribe
Sandoval, R. C., Roche, M., Belausteguigoitia, I., Alvarado, M., Galicia, L., Gomes, F. D. S., & Paraje, G. R. (2021) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2021.124 · Cited by 6
“…ha señalado como el principal factor de la epidemia de obesidad (7) y en exámenes sistemáticos se ha demostrado que su consumo se vincula con el aumento de peso en niños y adultos (8), un riesgo mayor de hipertensión y cardiopatías coronarias (9), y una mayor inci-dencia de diabetes de tipo 2 (10).”
BackgroundAdherence to a Healthy Beverage Score Is Associated with Lower Frailty Risk in Older Adults
Dominguez, L. J., Donat‐Vargas, C., Banegas, J. R., Barbagallo, M., Rodríguez‐Artalejo, F., & Guallar‐Castillón, P. (2022) · Nutrients · doi:10.3390/nu14183861 · Cited by 6
“Accumulated evidence shows that ASBs and SSBs are associated with an increased risk of death [49], depression [50], non-alcoholic liver disease [51], type 2 diabetes [52], hypertension, and cardiovascular disease [53].”
BackgroundFujiwara, A., Okada, E., Okada, C., Matsumoto, M., & Takimoto, H. (2020) · Nutrients · doi:10.3390/nu12123624 · Cited by 6
“The majority of studies included in the meta-analysis have investigated the effects of free sugars from soft drinks [3], and previous findings suggested that liquid sugars influence blood pressure [42,43].”
BackgroundMeisterling, K., Vo, J., Garvey, K. A., Brown, H. E., Tumbleson, M. T., & Cleveland, D. A. (2022) · Cleaner and Responsible Consumption · doi:10.1016/j.clrc.2022.100049 · Cited by 7
Sharman, J. E., O'Brien, E. T., Alpert, B. S., Schutte, A. E., Delles, C., Olsen, M. H., Asmar, R. G., Atkins, N., Barbosa, E. C. D., Calhoun, D. A., et al. (2020) · PubMed · doi:10.26633/rpsp.2020.21 · Cited by 1
Sweetened beverages and cardiovascular outcomes: an umbrella review of mortality and health outcomes
Jamali, M., Anvarifard, P., Hosseini, B., Razaghi, M., Khorraminezhad, L., Alvandi, E., Albadawy, M., Zarezadeh, M., & Saedisomeolia, A. (2025) · Nutrix Journal · doi:10.1186/s12937-025-01242-1 · Cited by 5
“Specifically, five studies were classified as high quality [10, 21, 26, 27, 31], four studies as moderate quality [17, 18, 23, 24], nine studies as low quality [4, 9, 16, 19, 20, 22, 28–30] and one study was considered critically low quality [25].”
TV exposure and food consumption patterns–evidence from Indonesia
Oberländer, L. (2021) · Health Economics · doi:10.1002/hec.4384 · Cited by 7
Health and Distributional Impacts of a Tax on Sugar-Sweetened Beverages in Kazakhstan
Fuchs, A., Mandeville, K., & Alonso-Soria, A. C. (2020) · World Bank, Washington, DC eBooks · doi:10.1596/33970 · Cited by 5
Smyth, A., Hankey, G. J., Damasceno, A. A. M., Iversen, H. K., Oveisgharan, S., Alhussain, F., Langhorne, P., Xavier, D., López-Jaramillo, P. A., Oğuz, A., et al. (2024) · Journal of Stroke · doi:10.5853/jos.2024.01543 · Cited by 5
“In particular, SSB are associated with higher cardiometabolic risk, 8 weight gain, metabolic syndrome, diabetes, 23 hypertension, 24 plaque stability, and thrombosis.”
BackgroundRakmanee, S., Kulthinee, S., Wyss, J. M., & Roysommuti, S. (2017) · Advances in experimental medicine and biology · doi:10.1007/978-94-024-1079-2_3 · Cited by 5
Seferidi, P., Laverty, A. A., Pearson‐Stuttard, J., Guzman-Castillo, M., Collins, B., Capewell, S., O’Flaherty, M., & Millett, C. J. (2018) · Public Health Nutrition · doi:10.1017/s1368980018002367 · Cited by 5
“Such reductions can have significant health benefits to the population, given the abundance of evidence associating SSB intake with the risk of being overweight or obese((5)) and of developing diabetes((6)) and CVD((7)).”
InfluentialEffects of Western Style Foods on Risk of Noncommunicable Diseases
Isaza, A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813148-0.00011-6 · Cited by 5
Mazhaeva, T. V. (2020) · ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT · doi:10.35627/2219-5238/2020-330-9-19-25 · Cited by 6
Metadata
- Authors
- Xi, B., Huang, Y., Reilly, K. H., Li, S., Zheng, R., Barrio-Lopez, M. T., Martinez-Gonzalez, M. A., & Zhou, D.
- Affiliations
- Shandong University (CN)
- Tianjin Medical University Cancer Institute and Hospital (CN)
- Jiangyin People's Hospital (CN)
- Linyi People's Hospital (CN)
- Corresponding author
- Zhou, Donghao
- Venue
- British Journal Of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-03-04
- Volume
- 113
- Issue
- 5
- Pages
- 709-717
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W2115654907
- Cited by
- 292
- References
- 36
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 24 · 2023: 34 · 2022: 41 · 2021: 34 · 2020: 40 · 2019: 31 · 2018: 29 · 2017: 17 · 2016: 16 · 2015: 3
- FWCI
- 3.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Natural Science Foundation of Shandong Province
- 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 › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- sugar-sweetened beverages, hypertension, cardiovascular disease, coronary artery disease, stroke, dose-response relationship, beverage consumption, prospective cohort
- MeSH terms
- Beverages, Coronary Disease, Humans, Hypertension, Prospective Studies, Risk, Cohort Studies, Evidence-Based Medicine, Dietary Sucrose, Stroke
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