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Association of Sweetened Beverage Intake with Incident Hypertension

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Abstract

BACKGROUND

Consumption of sugar-sweetened beverages (SSBs) is associated with an increased risk of hypertension in cross-sectional studies. However, prospective data are limited.

OBJECTIVE

To examine the associations between SSBs and artificially sweetened beverages (ASBs) with incident hypertension.

DESIGN AND SETTING

Prospective analysis using Cox proportional hazards regression to examine the association between SSBs and ASBs with incident hypertension in three large, prospective cohorts, the Nurses' Health Studies I (n = 88,540 women) and II (n = 97,991 women) and the Health Professionals' Follow-Up Study (n = 37,360 men).

MEASUREMENTS

Adjusted hazard ratios for incident clinically diagnosed hypertension.

RESULTS

Higher SSB and ASB intake was associated with an increased risk of developing hypertension in all three cohorts. In a pooled analysis, participants who consumed at least one SSB daily had an adjusted HR for incident hypertension of 1.13 (95 % CI, 1.09–1.17) compared with those who did not consume SSBs; for persons who drank at least one ASB daily, the adjusted HR was 1.14 (95 % CI, 1.09–1.18). The association between sweetened beverage intake and hypertension was stronger for carbonated beverages versus non-carbonated beverages, and for cola-containing versus non-cola beverages in the NHS I and NHS II cohorts only. Higher fructose intake from SSBs as a percentage of daily calories was associated with increased hypertension risk in NHS I and NHS II (p-trend = 0.001 in both groups), while higher fructose intake from sources other than SSBs was associated with a decrease in hypertension risk in NHS II participants (p-trend = 0.006).

LIMITATIONS

Residual confounding factors may interfere with the interpretation of results.

CONCLUSIONS

SSBs and ASBs are independently associated with an increased risk of incident hypertension after controlling for multiple potential confounders. These associations may be mediated by factors common to both SSBs and ASBs (e.g., carbonation or cola), but are unlikely to be due to fructose.

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Acknowledgements

The authors wish to thank Elaine Coughlin-Gifford for her help with the statistical programming in this manuscript. This work was funded by AHA Grant-in-Aid #2009A050171 (JF). The funding source did not influence the study design, conduct, or reporting. This work was presented as a poster at the 2011 American Society of Nephrology (ASN) meeting on November 4, 2011 in Philadelphia, PA.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of Nephrology, University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD, 21201, USA

    Lisa Cohen MD

  2. Division of Nephrology, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Gary Curhan MD, ScD & John Forman MD, MsC

Authors
  1. Lisa Cohen MD
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  2. Gary Curhan MD, ScD
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  3. John Forman MD, MsC
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Corresponding author

Correspondence to Lisa Cohen MD.

APPENDIX 1

APPENDIX 1

We ascertained fructose intake from sugar-sweetened beverages by multiplying the frequency of consumption of a particular SSB by the sugar content (in grams) per beverage serving, derived from US Department of Agriculture Research Service nutritional data (http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR23/reports/sr23fg14.pdf). The fructose derived from each type of SSB was then computed as 55 % of the sugar total obtained from that beverage, since the high-fructose corn syrup used to sweeten all sugary beverages contains 55 % fructose. The fructose intakes from each individual type of SSB were then summed to determine the fructose intake from all SSBs for each participant (in grams). Next, fructose intake obtained from sugar-sweetened beverages was subtracted from their total fructose intake to obtain the fructose intake from other sources (such as apples, bananas, raisins, etc.). Grams of fructose from SSBs and fructose from other sources were then multiplied by 4 calories/gram to obtain energy derived from that source of fructose, and divided by the participant’s total daily energy intake to obtain the following variables: percent of total daily calories from fructose from SSBs; and percent of total daily calories from fructose from other sources. In the NHS I at baseline, SSBs contributed 16 % of all fructose consumed by the cohort. In NHS II at baseline, SSBs accounted for 20 % of fructose intake. In HPFS at baseline, SSBs made up approximately 17 % all fructose consumed.

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Cohen, L., Curhan, G. & Forman, J. Association of Sweetened Beverage Intake with Incident Hypertension. J GEN INTERN MED 27, 1127–1134 (2012). https://doi.org/10.1007/s11606-012-2069-6

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  • DOI: https://doi.org/10.1007/s11606-012-2069-6

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