Added sugar intake and cardiovascular diseases mortality among US adults
- PMID: 24493081
- PMCID: PMC10910551
- DOI: 10.1001/jamainternmed.2013.13563
Added sugar intake and cardiovascular diseases mortality among US adults
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.
Conflict of interest statement
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Comment in
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New unsweetened truths about sugar.JAMA Intern Med. 2014 Apr;174(4):525-6. doi: 10.1001/jamainternmed.2013.12991. JAMA Intern Med. 2014. PMID: 24493006 No abstract available.
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Higher sugar intake linked to raised risk of cardiovascular mortality, study finds.BMJ. 2014 Feb 4;348:g1352. doi: 10.1136/bmj.g1352. BMJ. 2014. PMID: 24501228 No abstract available.
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Public health: Increased risk of cardiovascular death in adults who eat high levels of added sugar.Nat Rev Cardiol. 2014 Apr;11(4):187. doi: 10.1038/nrcardio.2014.17. Epub 2014 Feb 25. Nat Rev Cardiol. 2014. PMID: 24569363 No abstract available.
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Why are we consuming so much sugar despite knowing too much can harm us?JAMA Intern Med. 2015 Jan;175(1):145-6. doi: 10.1001/jamainternmed.2014.6968. JAMA Intern Med. 2015. PMID: 25560952 No abstract available.
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Why are we consuming so much sugar despite knowing too much can harm us?-Reply.JAMA Intern Med. 2015 Jan;175(1):146. doi: 10.1001/jamainternmed.2014.6994. JAMA Intern Med. 2015. PMID: 25560953 Free PMC article. No abstract available.
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The link between dietary sugar intake and cardiovascular disease mortality: an unresolved question.JAMA. 2015 Mar 3;313(9):959-60. doi: 10.1001/jama.2014.18267. JAMA. 2015. PMID: 25734737 No abstract available.
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