Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review - PubMed (original) (raw)

Meta-Analysis

Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review

Jiawei Yin et al. Adv Nutr. 2021.

Abstract

The long-term associations between the consumption of sugar-sweetened beverages (SSBs) and low-calorie sweetened beverages (LCSBs) with cardiovascular diseases (CVDs) remains inconsistent. To synthesize the evidence, we conducted a meta-analysis of prospective cohort studies published up to 1 December, 2019 on the associations between SSB and LCSB intake and the risk of CVD incidence and mortality. Out of 5301 articles retrieved from our literature search, 11 articles evaluating the consumption of SSBs (16,915 incident CVD cases, 18,042 CVD deaths) and 8 articles evaluating the consumption of LCSBs (18,077 incident CVD cases, 14,114 CVD deaths) were included in the meta-analysis. A 1 serving/d increment of SSBs was associated with an 8% (RR: 1.08; 95% CI: 1.02, 1.14, I2 = 43.0%) and 8% (RR: 1.08; 95% CI: 1.04, 1.13, I2 = 40.6%) higher risk of CVD incidence and CVD mortality, respectively. A 1 serving/d increment of LCSBs was associated with a 7% (RR: 1.07; 95% CI: 1.05, 1.10, I2 = 0.0%) higher risk of CVD incidence. The association between LCSBs and CVD mortality appeared to be nonlinear (P = 0.003 for nonlinearity) with significant associations observed at high intake levels (>2 servings/d). Under an assumption of causality, the consumption of SSBs may be linked to 9.3% (95% CI: 6.6%, 11.9%) of predicted CVD incidence in the USA from 2015 to 2025, among men and nonpregnant women, who were aged 40-79 y in 2015-2016. The habitual consumption of SSBs was associated with a higher risk of CVD morbidity and mortality in a dose-response manner. LCSBs were also associated with a higher risk of these outcomes, however, the interpretation of these findings may be complicated by reverse causation and residual confounding.

Keywords: cardiovascular disease; dose-response analysis; low-calorie sweetened beverages; meta-analysis; population attributable fraction; sugar-sweetened beverages; systematic review.

Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.

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Figures

FIGURE 1

FIGURE 1

Flow chart of article selection. CVD, cardiovascular disease.

FIGURE 2

FIGURE 2

Forest plot showing the study-specific estimates and meta-analysis results of SSB intake (per 1 serving/d) and risk of CVD incidence in a random-effects model. CHD, coronary heart disease; CVD, cardiovascular disease; HPFS, Health Professionals Follow-up Study; IHD, ischemic heart disease; MI, myocardial infarction; NHS, Nurses’ Health Study; SSB, sugar-sweetened beverage.

FIGURE 3

FIGURE 3

Dose-response relations of SSB (A, B) and LCSB (C, D) intake with CVD incidence (A, C) and mortality (B, D) in random-effects models. Modeling was performed using restricted cubic splines with knots fixed at the 10th, 50th, and 90th percentiles of the distribution. The solid line represents point estimates of the association between beverage intake and RRs; dashed lines are 95% CIs. Circles are RRs corresponding to the comparison categories. Sizes of circles are in proportion to the follow-up person-years for each comparison group. CVD, cardiovascular disease; LCSB, low-calorie sweetened beverage; SSB, sugar-sweetened beverage.

FIGURE 4

FIGURE 4

Forest plot showing the study-specific estimates and meta-analysis results of SSB intake (per 1 serving/d) and risk of CVD mortality in a random-effects model. CVD, cardiovascular disease; HPFS, Health Professionals Follow-up Study; NHS, Nurses’ Health Study; SSB, sugar-sweetened beverage.

FIGURE 5

FIGURE 5

Forest plot showing the study-specific estimates and meta-analysis results of LCSB intake (per 1 serving/d) and risk of CVD incidence in a random-effects model. CHD, coronary heart disease; CVD, cardiovascular disease; HPFS, Health Professionals Follow-up Study; LCSB, low-calorie sweetened beverage; MI, myocardial infarction; NHS, Nurses’ Health Study.

FIGURE 6

FIGURE 6

Forest plot showing the study-specific estimates and meta-analysis results of LCSB intake (per 1 serving/d) and risk of CVD mortality in a random-effects model. CVD, cardiovascular disease; HPFS, Health Professionals Follow-up Study; NHS, Nurses’ Health Study; LCSB, low-calorie sweetened beverage.

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