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A daily soda habit might do more than cause weight gain -- it could eventually lead to diabetes, a heart attack, or even a stroke, according to a review published in the Journal of the American College of Cardiology.
The leading culprit involved is fructose, an added sugar with unique metabolic properties whose chief dietary source is sugar-sweetened beverages (SSBs), said co-authors Vasanti Malik, ScD, and Frank Hu, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston.
"Time trend data over the past 3 to 4 decades have shown a close parallel between the rise in added sugar intake and the obesity and diabetes epidemics in the United States," Malik and Hu wrote.
"Largely driving these trends has been the dramatic increase in the consumption of sugar-sweetened beverages, which are the single greatest source of calories and added sugars in the U.S. diet, accounting for nearly one-half of all added sugar intake," the review authors said.
The co-authors conducted a contemporary review of the evidence, not a systematic review or meta-analysis, Malik said in an interview with MedPage Today. The goal was to assess the impact of fructose from SSBs on cardiometabolic health.
"We pulled the most relevant and robust studies, focusing on recent evidence," she said. The investigation focused on three types of studies: prospective cohort studies, randomized clinical trials, and feeding studies. Key findings include the following:
Individuals who consumed the most SSBs (one or two servings daily) had a 26% greater risk of developing diabetes compared with those who consumed the least (none or less than one serving a month), according to a recent meta-analysis of eight prospective cohort studies.
Individuals who consumed two or more SSB servings per day had a 35% greater risk of coronary heart disease (CHD), including nonfatal myocardial infarction and fatal CHD, than infrequent consumers, according to the Nurses' Health Study, which followed 80,000 women for 24 years.
Drinking one or more SSBs per day was associated with a 16% increased risk for stroke compared with those who drank none, according to another analysis of data from the Nurse's Health Study.
Fructose is linked to cardiometabolic health risk not only because of the excess empty calories it contains, but also because of the way it is metabolized, the review authors said. Unlike glucose, which is absorbed in the gastrointestinal tract, fructose is metabolized in the liver, where it can lead to elevated triglycerides, fatty liver disease, and insulin resistance.
"Although reducing consumption of SSBs or added sugar alone is unlikely to solve the obesity epidemic entirely, limiting intake is one simple change that will have a measurable effect on weight control and prevention of cardiometabolic disease," the authors concluded.
"We know from three lines of evidence that sugar-sweetened beverages increase the risk of obesity, diabetes, and heart disease," Malik said. "I'd like to see more primary care physicians looking at this evidence and guiding their patients to reduce their intake of these beverages, particularly patients who are overweight or have pre-diabetes."
SSBs include not only carbonated sodas, but any beverage to which the manufacturer has added sugar, including fruit drinks, iced teas, and sports drinks, Malik said.
"At the individual level, physicians, health professionals, and educators can advise patients and students to consume fewer SSBs, on the basis of consistent evidence of increased risk of obesity, type 2 diabetes, and cardiovascular disease in various populations," said Maria Van Rompay, PhD, of Tufts University in Boston, in an email to MedPage Today.
Van Rompay recently published a study on the impact of SSBs on lipids in children.
"However, given the high prevalence of consumption of SSBs, population-level policies and interventions that discourage consumption of unhealthy foods, like SSBs, and encourage consumption of healthy foods, such as fruits and vegetables, while also improving the overall food environment, will be most effective at curbing SSB intake and thereby averting cardiometabolic burdens," Van Rompay said.
This research was supported by the National Institutes of Health.
Malik reported no financial relationships with industry.
Van Rompay reported no financial relationships with industry.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Journal of the American College of CardiologySource Reference: Malik V. S., et al "Fructose and cardiometabolic health: what the evidence from sugar-sweetened beverages tells us" JACC 2015; 66(14): 1615-1624.