BMJ 2014;348:g1352 doi: 10.1136/bmj.g1352 (Published 5 February 2014)
Page 1 of 2
Research News
RESEARCH NEWS Higher sugar intake linked to raised risk of cardiovascular mortality, study finds Michael McCarthy Seattle
Higher consumption of added sugar is associated with an increased risk of cardiovascular mortality, a new US study has shown.1
The researchers evaluated data from the National Health and Nutrition Examination Survey, a series of cross sectional surveys that include physical examinations and interview of participants concerning 24 hour dietary recall and a related linked mortality cohort of a nationally representative sample of US adults. Quanhe Yang of the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia, was the lead author of the paper, which was published on 3 February by JAMA Internal Medicine. The researchers found that added sugar—such as sugar found in baked goods, processed and prepared foods, and sweetened beverages—accounted for more than 10% of the energy intake of most US adults (71.4%) and for 25% or more of intake of a 10th of adults.
After adjusting for age, sex, race and ethnicity, smoking status, family history of cardiovascular disease, body mass index, and other factors, the researchers found that, in a comparison with people who derived less than 10% of their energy from added sugars, the hazard ratios for cardiovascular mortality were 1.3 (95% confidence interval 1.09 to 1.55) among people who derived 10% to 24.9% of their energy from added sugar and 2.75 (1.40 to 5.42) among those who derived 25% or more (P=0.004).
Current dietary recommendations on added sugar vary widely, the researchers noted. The US Institute of Medicine, for example, recommends that added sugar should make up less than 25% of energy intake, while the World Health Organization and the American Heart Association recommend less than 10%. The researchers wrote, “Our analysis suggests that participants who consumed greater than or equal to 10% but less than 25% of calories from added sugar, the level below the Institute of Medicine recommendation and above the World Health Organization/American Heart Association recommendation, had a 30% higher risk of CVD [cardiovascular disease] mortality; for those who consumed 25% or more of calories from added sugar, the relative risk was nearly tripled.”
In a commentary Laura Schmidt, of the School of Medicine at the University of California at San Francisco, noted that under the “old paradigm” overconsumption of sugar had been thought of as a marker of an unhealthy diet or obesity.2 For personal use only: See rights and reprints http://www.bmj.com/permissions
“The new paradigm views sugar overconsumption as an independent risk factor in CVD as well as many other chronic diseases, including diabetes mellitus, liver cirrhosis, and dementia—all linked to metabolic perturbations involving dyslipidemia, hypertension, and insulin resistance,” she wrote. “Too much sugar does not just make us fat; it can also make us sick.” The findings by Yang and colleagues, Schmidt wrote, showed that the risk of cardiovascular mortality rose “once added sugar intake surpasses 15% of daily calories—equivalent to drinking one 20-ounce Mountain Dew soda in a 2000-calorie daily diet.” She added, “These findings provide physicians and consumers with actionable guidance. Until federal guidelines are forthcoming, physicians may want to caution patients that, to support cardiovascular health, it is safest to consume less than 15% of their daily calories as added sugar.”
Schmidt noted that the study also highlighted ethnic disparities in diet and nutrition by showing that heavy sugar consumption—greater than or equal to 25% of daily energy—was disproportionately higher among African Americans, at 16.9%, than among white people (9.1%) and Mexican Americans (11.9%). The findings, Schmidt concluded, “underscore the need for federal guidelines that help consumers set safe limits on their intake as well as evidence-based regulatory strategies that discourage excess sugar consumption at the population level.”
bmj.com Research: Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK (BMJ 2013;347:f6189, doi:10.1136/bmj.f6189); Editorial: A substantial tax on sugar sweetened drinks could help reduce obesity (BMJ 2013;347:f5947, doi:10.1136/bmj.f5947); Observations: The dietary advice on added sugar needs emergency surgery (BMJ 2013;346:f3199, doi:10.1136/ bmj.f3199); Feature: Sugar and the heart: old ideas revisited (BMJ 2013;346:e7800, doi:10.1136/bmj.e7800)
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BMJ 2014;348:g1352 doi: 10.1136/bmj.g1352 (Published 5 February 2014)
Page 2 of 2
RESEARCH NEWS
1 2
Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 3 Feb 2014, doi:10. 1001/jamainternmed.2013.13563. Schmidt LA. New unsweetened truths about sugar. JAMA Intern Med 3 Feb 2014, doi:10. 1001/jamainternmed.2013.12991.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Cite this as: BMJ 2014;348:g1352 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
Research News
RESEARCH NEWS Higher sugar intake linked to raised risk of cardiovascular mortality, study finds Michael McCarthy Seattle
Higher consumption of added sugar is associated with an increased risk of cardiovascular mortality, a new US study has shown.1
The researchers evaluated data from the National Health and Nutrition Examination Survey, a series of cross sectional surveys that include physical examinations and interview of participants concerning 24 hour dietary recall and a related linked mortality cohort of a nationally representative sample of US adults. Quanhe Yang of the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia, was the lead author of the paper, which was published on 3 February by JAMA Internal Medicine. The researchers found that added sugar—such as sugar found in baked goods, processed and prepared foods, and sweetened beverages—accounted for more than 10% of the energy intake of most US adults (71.4%) and for 25% or more of intake of a 10th of adults.
After adjusting for age, sex, race and ethnicity, smoking status, family history of cardiovascular disease, body mass index, and other factors, the researchers found that, in a comparison with people who derived less than 10% of their energy from added sugars, the hazard ratios for cardiovascular mortality were 1.3 (95% confidence interval 1.09 to 1.55) among people who derived 10% to 24.9% of their energy from added sugar and 2.75 (1.40 to 5.42) among those who derived 25% or more (P=0.004).
Current dietary recommendations on added sugar vary widely, the researchers noted. The US Institute of Medicine, for example, recommends that added sugar should make up less than 25% of energy intake, while the World Health Organization and the American Heart Association recommend less than 10%. The researchers wrote, “Our analysis suggests that participants who consumed greater than or equal to 10% but less than 25% of calories from added sugar, the level below the Institute of Medicine recommendation and above the World Health Organization/American Heart Association recommendation, had a 30% higher risk of CVD [cardiovascular disease] mortality; for those who consumed 25% or more of calories from added sugar, the relative risk was nearly tripled.”
In a commentary Laura Schmidt, of the School of Medicine at the University of California at San Francisco, noted that under the “old paradigm” overconsumption of sugar had been thought of as a marker of an unhealthy diet or obesity.2 For personal use only: See rights and reprints http://www.bmj.com/permissions
“The new paradigm views sugar overconsumption as an independent risk factor in CVD as well as many other chronic diseases, including diabetes mellitus, liver cirrhosis, and dementia—all linked to metabolic perturbations involving dyslipidemia, hypertension, and insulin resistance,” she wrote. “Too much sugar does not just make us fat; it can also make us sick.” The findings by Yang and colleagues, Schmidt wrote, showed that the risk of cardiovascular mortality rose “once added sugar intake surpasses 15% of daily calories—equivalent to drinking one 20-ounce Mountain Dew soda in a 2000-calorie daily diet.” She added, “These findings provide physicians and consumers with actionable guidance. Until federal guidelines are forthcoming, physicians may want to caution patients that, to support cardiovascular health, it is safest to consume less than 15% of their daily calories as added sugar.”
Schmidt noted that the study also highlighted ethnic disparities in diet and nutrition by showing that heavy sugar consumption—greater than or equal to 25% of daily energy—was disproportionately higher among African Americans, at 16.9%, than among white people (9.1%) and Mexican Americans (11.9%). The findings, Schmidt concluded, “underscore the need for federal guidelines that help consumers set safe limits on their intake as well as evidence-based regulatory strategies that discourage excess sugar consumption at the population level.”
bmj.com Research: Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK (BMJ 2013;347:f6189, doi:10.1136/bmj.f6189); Editorial: A substantial tax on sugar sweetened drinks could help reduce obesity (BMJ 2013;347:f5947, doi:10.1136/bmj.f5947); Observations: The dietary advice on added sugar needs emergency surgery (BMJ 2013;346:f3199, doi:10.1136/ bmj.f3199); Feature: Sugar and the heart: old ideas revisited (BMJ 2013;346:e7800, doi:10.1136/bmj.e7800)
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g1352 doi: 10.1136/bmj.g1352 (Published 5 February 2014)
Page 2 of 2
RESEARCH NEWS
1 2
Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 3 Feb 2014, doi:10. 1001/jamainternmed.2013.13563. Schmidt LA. New unsweetened truths about sugar. JAMA Intern Med 3 Feb 2014, doi:10. 1001/jamainternmed.2013.12991.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Cite this as: BMJ 2014;348:g1352 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
