Among older adults, higher consumption of sugary beverages — including sugar-sweetened sodas, soft drinks, fruit drinks, and 100% fruit juices — is associated with an increased risk for death from any cause, according to study results published in JAMA Network Open.
The investigators of this cohort study sought to examine the association between sugar-sweetened beverages (SSBs) and 100% fruit juices (both alone and in combination) with cardiovascular health and mortality risk.
The study included 13,440 participants who were randomly recruited from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Participants with a self-reported baseline history of coronary heart disease (CHD), type 2 diabetes, stroke, or with missing dietary data were excluded. The investigators estimated the consumption of SSBs and 100% fruit juices using the validated Block 98 food-frequency questionnaire. Consumption was then calculated as the contribution to total energy for each participant and was grouped according to cutoffs that aligned with the upper limits for added sugar intake recommended by US Dietary Guidelines: low (<5%), medium (5% to <10%), and high (≥10%). Primary outcomes were all-cause and CHD-specific mortality. Using multivariable adjusted Cox proportional hazard regression, the investigators estimated the risk for mortality outcomes associated with the consumption of sugary beverages by the level of sugar intake and individually by each additional 12 oz consumed daily.
The participants had a mean age of 63.6 ± 9.1 years at baseline; 59.3% were men, 68.9% were white, and 70.8% were overweight or obese. Among the total cohort, 1000 participants died from any cause and 168 died from CHD-related causes during a mean follow-up period of 6 ± 1.8 years. Mean consumption of sugary beverages was 317 ± 334 g or 8.4 ± 8.3% of total energy, in which 4.4 ± 6.8% was from SSBs and 4 ± 6.8% was from fruit juice. The investigators compared risk-adjusted hazard ratios (HRs) between high and low sugary beverage consumers, which for CHD-related mortality was 1.44 (95% CI, 0.97-2.15) and for all-cause mortality was 1.14 (95% CI, 0.97-1.33). In individual associations, the HR of CHD-related mortality was 1.11 (95% CI, 0.9-1.39) for each additional 12 oz of SSBs consumed daily and 1.28 (95% CI, 0.95-1.74) for each additional 12 oz of fruit juice consumed daily. The HR of all-cause mortality for each additional 12 oz of SSBs was 1.06 (95% CI, 0.96-1.16) and for fruit juice was 1.24 (95% CI, 1.09-142).
Limitations to the study included the relatively short follow-up period, in which the number of mortalities was small, potentially risking a type 2 error in stratified analyses. Consumption of sugary beverages was self-reported by participants, which may result in an underreporting bias, as well as beverage exposure estimates that were only collected at baseline and did not measure consumption throughout the follow-up period. Missing income data and incomplete food-frequency questionnaires from the REGARDS cohort may have contributed to potential selection bias.
The investigators suggested that higher consumption of sugary beverages, including fruit juices, is associated with an increased risk for all-cause mortality among older adults in the US.
Collin LJ, Judd S, Safford M, Vaccarino V, Welsh JA. Association of sugary beverage consumption with mortality risk in US adults: a secondary analysis of data from the REGARDS study. JAMA Netw Open. 2019;2(5):e193121.