Association of Sweetened Beverage Intake with Incident Hypertension

Abstract

BACKGROUND: Consumption of sugar-sweetened beverages (SSBs) is associated with an increased risk of hypertension in cross-sectional studies. However, prospective data are limited. OBJECTIVE: To examine the associations between SSBs and artificially sweetened beverages (ASBs) with incident hypertension. DESIGN AND SETTING: Prospective analysis using Cox proportional hazards regression to examine the association between SSBs and ASBs with incident hypertension in three large, prospective cohorts, the Nurses' Health Studies I (n=88,540 women) and II (n=97,991 women) and the Health Professionals' Follow-Up Study (n=37,360 men). MEASUREMENTS: Adjusted hazard ratios for incident clinically diagnosed hypertension. RESULTS: Higher SSB and ASB intake was associated with an increased risk of developing hypertension in all three cohorts. In a pooled analysis, participants who consumed at least one SSB daily had an adjusted HR for incident hypertension of 1.13 (95 % CI, 1.09-1.17) compared with those who did not consume SSBs; for persons who drank at least one ASB daily, the adjusted HR was 1.14 (95 % CI, 1.09-1.18). The association between sweetened beverage intake and hypertension was stronger for carbonated beverages versus noncarbonated beverages, and for cola-containing versus non-cola beverages in the NHS I and NHS II cohorts only. Higher fructose intake from SSBs as a percentage of daily calories was associated with increased hypertension risk in NHS I and NHS II (p-trend=0.001 in both groups), while higher fructose intake from sources other than SSBs was associated with a decrease in hypertension risk in NHS II participants (p-trend=0.006). LIMITATIONS: Residual confounding factors may interfere with the interpretation of results. CONCLUSIONS: SSBs and ASBs are independently associated with an increased risk of incident hypertension after controlling for multiple potential confounders. These associations may be mediated by factors common to both SSBs and ASBs (e.g., carbonation or cola), but are unlikely to be due to fructose.

Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies

“…[53][54][55] Another possibility is that sugar-sweetened beverages are a marker of an unhealthy lifestyle. [56][57][58][59] High consumers of sugar-sweetened beverages consume more energy, take less physical activity and smoke more, [60][61][62] all of which may be difficult to measure and adjust for in observational studies.…”

Dairy Food Intake Is Inversely Associated with Risk of Hypertension: The Singapore Chinese Health Study

“…However, this should be interpreted with caution because dietary assessment tools, such as FFQs, often underestimate sodium intake because of underreporting and inherent difficulties in capturing information about recipes and discretionary salt (28). Milk consumption may also serve as a replacement for a sweetened beverage, which was shown to be adversely associated with hypertension risk (13,29). Epidemiological evidence has shown that light-to-moderate coffee consumption may elevate hypertension risk (30), whereas drinking green tea may have a favorable effect on blood pressure (31).…”

Sugar-sweetened beverages, vascular risk factors and events: a systematic literature review

“…In that study, the consumption of one SSB daily was associated with an adjusted HR of newonset hypertension of 1·13 (95 % CI 1·09, 1·17), when compared with non-drinkers. When analysed separately, the association between SSB intake and incident hypertension was stronger for women than men (women: agedadjusted HR = 1·22; 95 % CI 1·18, 1·27, men: aged-adjusted HR = 1·39; 95 % CI 1·34, 1·46) (21) . Two other studies found a direct association between SSB intake and hypertension (24) RCT N/A, Denmark SSB, sugar-sweetened beverages; RR, relative risk; HR, hazard ratio; BP, blood pressure; RCT, randomised controlled trial; CARDIA, Coronary Artery Risk Development in Young Adults; NHS, Nurses' Health Study; HPFS, Health Professionals Follow-up Study; SUN, Seguimiento Universidad de Navarra (University of Navarra Follow-up); N/A, not applicable; M, male; F, female; ASB, artificially sweetened beverages; DH, diet history; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; FBG, fasting blood glucose; SDP, systolic blood pressure; DBP, diastolic blood pressure.…”

“…Four studies examined baseline (or cumulative average) SSB intake and vascular risk factors (20)(21)(22)24) and two others further examined change in SSB intake and vascular risk factors (23,25) .…”