Cross-sectional association between sugar-sweetened beverage intake and cardiometabolic biomarkers in US women

Abstract

Few studies have evaluated the relationships between intake of sugar-sweetened beverages (SSB) and intermediate biomarkers of cardiometabolic risk. Associations between artificially sweetened beverages (ASB) and fruit juice with cardiometabolic biomarkers are also unclear. We investigated habitual SSB, ASB and fruit juice intake in relation to biomarkers of hepatic function, lipid metabolism, inflammation and glucose metabolism. We analysed cross-sectional data from 8492 participants in the Nurses' Health Study who were free of diabetes and CVD. Multivariate linear regression was used to assess the associations of SSB, ASB and fruit juice intake with concentrations of fetuin-A, alanine transaminase, γ-glutamyl transferase, TAG, HDL-cholesterol, LDL-cholesterol, total cholesterol, C-reactive protein (CRP), intracellular adhesion molecule 1 (ICAM-1), vascular cell adhesion protein 1, adiponectin, insulin and HbA1c as well as total cholesterol:HDL-cholesterol ratio. More frequent intake of SSB was significantly associated with higher concentrations of fetuin-A, TAG, CRP, ICAM-1, adiponectin and insulin, a higher total cholesterol:HDL-cholesterol ratio, and a lower concentration of HDL-cholesterol (P trend ranges from <0·0001 to 0·04) after adjusting for demographic, medical, dietary and lifestyle variables. ASB intake was marginally associated with increased concentrations of CRP (P trend=0·04) and adiponectin (P trend=0·01). Fruit juice intake was associated with increased concentrations of TAG and HbA1c and a lower concentration of adiponectin (P trend ranges from <0·0001 to 0·01). In conclusion, habitual intake of SSB was associated with adverse levels of multiple cardiometabolic biomarkers. Associations between ASB and fruit juice with cardiometabolic risk markers warrant further exploration.

Keywords: AHEI Alternative Healthy Eating Index; ASB artificially sweetened beverages; CRP C-reactive protein; SSB sugar-sweetened beverages; Artificially sweetened beverages; Cardiometabolic biomarkers; Fruit juices; Sugar-sweetened beverages.

Fig. 1.

Relative concentrations (or relative ratio) with 95 % CI of biomarkers according to sugar-sweetened beverage (SSB) intake. ALT, alanine transaminase; GGT, γ-glutamyl transferase. Relative concentrations (or relative ratio) with 95 % CI of biomarkers predicted in highest SSB intake category (once per day or more) to the lowest category as reference (never or almost never). Models were adjusted for age at blood draw, fasting status (yes/no) and time of blood draw (blood collection cycle 1/2), smoking status (current/former/never), alcohol intake (continuous), physical activity (tertile), total energy intake (tertile), Alternate Healthy Eating Index score excluding sugar-sweetened beverages (tertile), postmenopausal hormone use (yes/no) and BMI (continuous).