Sugar- or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in US adults

Abstract

Background: The extent to which physical activity attenuates the detrimental effects of sugar (SSBs)- or artificially-sweetened beverages (ASBs) on the risk of cardiovascular disease is unknown.

Methods: We used Cox proportional-hazards models to calculate hazard ratios and 95% confidence interval [HR (CI)] between SSB or ASB intake and physical activity with cardiovascular disease risk among 65,730 women in the Nurses' Health Study (1980-2016) and 39,418 men in the Health Professional's Follow-up Study (1986-2016), who were free from chronic diseases at baseline. SSBs and ASBs were assessed every 4-years and physical activity biannually.

Results: A total of 13,269 cardiovascular events were ascertained during 3,001,213 person-years of follow-up. Compared with those that never/rarely consumed SSBs or ASBs, HR and 95% CI for cardiovascular disease for participants consuming ≥2 servings/day were 1.21 (95% CI,1.12 to 1.32; P-trend<0.001) and 1.03 (95% CI, 0.97 to 1.09; P-trend=0.06), respectively. In the joint analyses, for participants meeting and not meeting physical activity guidelines (<7.5 vs ≥7.5 MET-h/week) as well as consuming ≥2 servings/day of SSBs or ASBs, the HRs for cardiovascular disease were 1.15 (95% CI, 1.08 to 1.23) and 0.96 (95% CI, 0.91 to 1.02), and 1.47 (95% CI, 1.37 to 1.57) and 1.29 (95% CI, 1.22 to 1.37) respectively, compared with participants who met physical activity guidelines and never/rarely consumed these beverages. Similar patterns were observed when coronary heart disease and stroke were analyzed.

Conclusions: Our findings suggest that among physically active participants, higher SSB intake, but not ASBs, is associated with a higher cardiovascular risk. Our results support current recommendations to limit the intake of SSB and maintain adequate physical activity levels.

Keywords: aspartame; coronary heart disease; diet drinks; joint association; stroke; sucrose; sugary beverages.

Figure 1. Pooled Risk* of Cardiovascular Events Associated with the Joint Associations of Sugar- or Artificially-Sweetened Beverages and Physical Activity^† in Two Large US Cohorts.

* Hazard ratios and 95% confidence intervals derived from the multivariable model adjusted for the following: age, ethnicity/race; smoking status; alcohol intake; multivitamin use; in women, postmenopausal status and menopausal hormone use; family history of myocardial infarction; baseline hypertension; baseline hypercholesterolemia; calorie intake; body mass index; and AHEI. ^† Physical activity was dichotomized to meet or do not meet the US Physical activity guidelines of ≥150 minutes/week of moderate-vigorous physical activity recommendations (corresponds to ≥7.5 MET hr/week or ≥450 MET min/week). AHEI = alternative healthy eating index, sugar-sweetened beverages and alcohol intake were removed from the index calculation; MET = metabolic equivalent task.