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. 2010 Apr 21;303(15):1490-7.
doi: 10.1001/jama.2010.449.

Caloric sweetener consumption and dyslipidemia among US adults

Jean A Welsh  1 , Andrea Sharma, Jerome L Abramson, Viola Vaccarino, Cathleen Gillespie, Miriam B Vos
Affiliations

Caloric sweetener consumption and dyslipidemia among US adults

Jean A Welsh et al. JAMA. .

Abstract

Context: Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovascular disease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures.

Objective: To assess the association between consumption of added sugars and blood lipid levels in US adults.

Design, setting, and participants: Cross-sectional study among US adults (n = 6113) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (< 5% [reference group], 5%-<10%, 10%-<17.5%, 17.5%-<25%, and > or = 25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated.

Main outcome measures: Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (< 40 mg/dL for men; < 50 mg/dL for women), high triglyceride levels (> or = 150 mg/dL), high LDL-C levels (> or = 130 mg/dL), or high ratio of triglycerides to HDL-C (> 3.8). Results were weighted to be representative of the US population.

Results: A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P < .001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P < .001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P = .047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (> or = 10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (< 5% added sugars).

Conclusion: In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.

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Figures

Figure 1
Figure 1. Multivariable-Adjusted Mean HDL-C Levels by Level of Added Sugar Intake Among US Adults, NHANES 1999–2006
Participants grouped by percentage of total energy intake from added sugar; <5% comprises the reference group. P<.001 for linear trend. Error bars indicate 95% confidence intervals. HDL-C indicates high-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey. To convert values to mmol/L, multiply by 0.0259. The 3 highest categories (10–<17.5, 17.5–<25, and ≥25) were significantly lower than the referent group (P<.001).
Figure 2
Figure 2. Multivariable-Adjusted Geometric Mean Triglyceride Levels by Level of Added Sugar Intake Among US Adults, NHANES 1999–2006
Participants grouped by percentage of total energy intake from added sugar; <5% comprises the reference group. P=.02 for linear trend. Error bars indicate 95% confidence intervals. NHANES indicates National Health and Nutrition Examination Survey. To convert values to mmol/L, multiply by 0.0113. The categories 10–<17.5 and 17.5–<25 were significantly higher than the referent group at P<.05, and the category ≥25 was significantly higher at P<.01.
Figure 3
Figure 3. Multivariable-Adjusted Mean LDL-C Levels by Level of Added Sugar Intake Among US Men and Women, NHANES 1999–2006
Participants grouped by percentage of total energy intake from added sugar; <5% comprises the reference group. Linear trend: P=.047 (women) and P=.17 (men). Error bars indicate 95% confidence intervals. LDL-C indicates low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey. To convert values to mmol/L, multiply by 0.0259.
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