Skip to main content

Advertisement

Log in

Cardiovascular risk and dietary sugar intake: is the link so sweet?

  • IM - REVIEW
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Soft drinks and sugar-sweetened beverages have been targeted as one of the primary culprits in the escalating rates of obesity and diabetes and reduction of added sugars is considered between the goals to achieve in order to promote cardiovascular health and to reduce deaths from cardiovascular causes. Many reliable mechanisms, such as dislypidemia, inflammation and enhanced oxidative stress, have been proposed to support a causal link between sugar sweetened beverages intake and cardiovascular risk, but the ultimate underlying pathways remain to be determined in adequately designed studies. Furthermore, while epidemiological evidence strongly supports an association between sugar sweetened beverages consumption and obesity, type 2 diabetes mellitus or cardiovascular risk, incongruous findings yielded by clinical trials, or formal meta-analyses make difficult to draw firm conclusions in this regard. Further and rigorous studies are needed to better understand the role of sugar sweetened beverages in the etiology of cardiovascular diseases and to better address the warnings and decisions of regulatory authorities on public health worldwide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pincock S (2006) Paul Zimmet: fighting the “diabesity” pandemic. Lancet 368:1643

    Article  PubMed  Google Scholar 

  2. Sowers JR (2003) Obesity as a cardiovascular risk factor. Am J Med 115 (Suppl) 8A:37S–41S

    Google Scholar 

  3. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LM, Wylie-Rosett J, on behalf of the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism and the Council on Epidemiology and Prevention (2009) Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 120:1011–1020

    Google Scholar 

  4. Davì G, Patrono C (2007) Platelet activation and atherothrombosis. N Engl J Med 357:2482–2494

    Article  PubMed  Google Scholar 

  5. Ferroni P, Basili S, Falco A, Davì G (2004) Inflammation, insulin resistance and obesity. Curr Atheroscler Rep 6:424–431

    Article  PubMed  Google Scholar 

  6. Kato H, Kashiwagi H, Shiraga M, Tadokoro S, Kamae T, Ujiie H, Honda S, Miyata S, Ijiri Y, Yamamoto J, Maeda N, Funahashi T, Kurata Y, Shimomura I, Tomiyama Y, Kanakura Y (2006) Adiponectin acts as an endogenous antithrombotic factor. Arterioscler Thromb Vasc Biol 26:224–230

    Article  PubMed  CAS  Google Scholar 

  7. Meerarani P, Badimon JJ, Zias E, Fuster V, Moreno PR (2006) Metabolic syndrome and diabetic atherothrombosis: implications in vascular complications. Curr Mol Med 6:501–514

    Article  PubMed  CAS  Google Scholar 

  8. Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, Hatcher B, Cox CL, Dyachenko A, Zhang W, McGahan JP, Seibert A, Krauss RM, Chiu S, Schaefer EJ, Ai M, Otokozawa S, Nakajima K, Nakano T, Beysen C, Hellerstein MK, Berglund L, Havel PJ (2009) Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 119:1322–1334

    Article  PubMed  CAS  Google Scholar 

  9. Anfossi G, Trovati M (2006) Pathophysiology of platelet resistance to anti-aggregating agents in insulin resistance and type 2 diabetes: implications for anti-aggregating therapy. Cardiovasc Hematol Agents Med Chem 4:111–128

    Article  PubMed  CAS  Google Scholar 

  10. Romano M, Guagnano MT, Pacini G, Vigneri S, Falco A, Marinopiccoli M, Manigrasso MR, Basili S, Davì G (2003) Association of inflammation markers with impaired insulin sensitivity and coagulative activation in obese healthy women. J Clin Endocrinol Metab 88:5321–5326

    Article  PubMed  CAS  Google Scholar 

  11. Davì G, Guagnano MT, Ciabattoni G, Basili S, Falco A, Marinopiccoli M, Nutini M, Sensi S, Patrono C (2002) Platelet activation in obese women: role of inflammation and oxidant stress. JAMA 288:2008–2014

    Article  PubMed  Google Scholar 

  12. Basili S, Pacini G, Guagnano MT, Manigrasso MR, Santilli F, Pettinella C, Ciabattoni G, Patrono C, Davì G (2006) Insulin resistance as a determinant of platelet activation in obese women. J Am Coll Cardiol 48:2531–2538

    Article  PubMed  CAS  Google Scholar 

  13. Russo I, Traversa M, Bonomo K, De Salve A, Mattiello L, Del Mese P, Doronzo G, Cavalot F, Trovati M, Anfossi G (2010) In central obesity, weight loss restores platelet sensitivity to nitric oxide and prostacyclin. Obesity 18:788–797

    Article  PubMed  CAS  Google Scholar 

  14. Christiansen T, Paulsen SK, Bruun JM, Ploug T, Pedersen SB, Richelsen B (2010) Diet-induced weight loss and exercise alone and in combination enhance the expression of adiponectin receptors in adipose tissue and skeletal muscle but only diet-induced weight loss enhanced circulating adiponectin. J Clin Endocrinol Metab 95:911–919

    Article  PubMed  CAS  Google Scholar 

  15. Klempel MC, Varady KA (2011) Reliability of leptin, but not adiponectin, as a biomarker for diet-induced weight loss in humans. Nutr Rev 69:145–154

    Article  PubMed  Google Scholar 

  16. Vazzana N, Santilli F, Cuccurullo C, Davì G (2009) Soluble forms of RAGE in internal medicine. Intern Emerg Med 4:389–401

    Article  PubMed  Google Scholar 

  17. Devangelio E, Santilli F, Formoso G, Ferroni P, Bucciarelli L, Michetti N, Clissa C, Ciabattoni G, Consoli A, Davì G (2007) Soluble RAGE in type 2 diabetes: association with oxidative stress. Free Radic Biol Med 43:511–518

    Article  PubMed  CAS  Google Scholar 

  18. Davì G, Ciabattoni G, Consoli A, Mezzetti A, Falco A, Santarone S, Pennese E, Vitacolonna E, Bucciarelli T, Costantini F, Capani F, Patrono C (1999) In vivo formation of 8-iso-prostaglandin F2alpha and platelet activation in diabetes mellitus: effects of improved metabolic control and vitamin E supplementation. Circulation 99:224–229

    Article  PubMed  Google Scholar 

  19. Davì G, Catalano I, Averna M, Notarbartolo A, Strano A, Ciabattoni G, Patrono C (1990) Thromboxane biosynthesis and platelet function in type II diabetes mellitus. N Engl J Med 322:1769–1774

    Article  PubMed  Google Scholar 

  20. Santilli F, Davì G, Consoli A, Cipollone F, Mezzetti A, Falco A, Taraborelli T, Devangelio E, Ciabattoni G, Basili S, Patrono C (2006) Thromboxane-dependent CD40 ligand release in type 2 diabetes mellitus. J Am Coll Cardiol 47:391–397

    Article  PubMed  CAS  Google Scholar 

  21. Tappy L, Le KM (2010) Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev 90:23–46

    Article  PubMed  CAS  Google Scholar 

  22. Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, Ludwig DS (2009) The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med 361:1599–1605

    Article  PubMed  CAS  Google Scholar 

  23. Reedy J, Krebs-Smith SM (2010) Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc 110:1477–1484

    Article  PubMed  CAS  Google Scholar 

  24. Marriott BP, Cole N, Lee E (2009) National estimates of dietary fructose intake increased from 1977 to 2004 in the United States. J Nutr 139:1228–1235

    Article  Google Scholar 

  25. Stanhope KL, Griffen SC, Bair BR, Swarbrick MM, Keim NL, Havel PJ (2008) Twenty-four-hour endocrine and metabolic profiles following consumption of high-fructose corn syrup-, sucrose-, fructose-, and glucose sweetened beverages with meals. Am J Clin Nutr 87:1194–1203

    PubMed  CAS  Google Scholar 

  26. Ranjit N, Evans MH, Byrd-Williams C, Evans AE, Hoelscher DM (2010) Dietary and activity correlates of sugar-sweetened beverage consumption among adolescents. Pediatrics 126:e754–e761

    Article  PubMed  Google Scholar 

  27. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD et al (2020) on behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee(2010) Defining, Setting National Goals for Cardiovascular Health Promotion, Disease Reduction The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation 121:586–613

    Article  Google Scholar 

  28. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB (2004) Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 292:927–934

    Article  PubMed  CAS  Google Scholar 

  29. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB (2010) Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 33:2477–2483

    Article  PubMed  Google Scholar 

  30. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, D’Agostino RB, Gaziano JM, Vasan RS (2007) Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 116:480–488

    Article  PubMed  Google Scholar 

  31. Welsh JA, Sharma A, Cunningham SA, Vos MB (2011) Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation 1233:249–257

    Article  Google Scholar 

  32. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB (2009) Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 89:1037–1042

    Article  PubMed  CAS  Google Scholar 

  33. Vartanian LR, Schwartz MB, Brownell KD (2007) Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 97:667–675

    Article  PubMed  Google Scholar 

  34. Nissinen K, Mikkila V, Mannisto S, Lahti-Koski M, Rasanen L, Viikari J, Raitakari OT (2009) Sweets and sugar-sweetened soft drink intake in childhood in relation to adult BMI and overweight: the Cardiovascular Risk in Young Finns Study. Public Health Nutr 12:2018–2026

    Article  PubMed  Google Scholar 

  35. Mattes RD, Shikany JM, Kaiser KA, Allison DB (2010) Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments. Obes Rev. doi: 10.1111/j.1467-789X.2010.00755.x [Epub ahead of print]

  36. Perichart-Pereira O, Balas-Nakash M, Rodríguez-Cano A, Muñoz-Manrique C, Monge-Urrea A, Vadillo-Ortega F (2010) Correlates of dietary energy sources with cardiovascular disease risk markers in Mexican school-age children. J Am Diet Assoc 110:253–260

    Article  Google Scholar 

  37. Chen L, Caballero B, Mitchell DC, Loria C, Lin PH, Champagne CM, Elmer PJ, Ard JD, Batch BC, Anderson CA, Appel LJ (2010) Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults. Circulation 121:2398–2406

    Article  PubMed  CAS  Google Scholar 

  38. Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB (2010) Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121:1356–1364

    Article  PubMed  Google Scholar 

  39. Raben A, Vasilaras TH, Moller AC, Astrup A (2002) Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr 76:721–729

    PubMed  CAS  Google Scholar 

  40. DiMeglio DP, Mattes RD (2000) Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord 24:794–800

    Article  PubMed  CAS  Google Scholar 

  41. Kavey RE (2010) How sweet it is: sugar-sweetened beverage consumption, obesity, and cardiovascular risk in childhood. J Am Diet Assoc 110:1456–1460

    Article  PubMed  Google Scholar 

  42. Tappy L, Le KA, Tran C, Paquot N (2010) Fructose and metabolic diseases: new findings, new questions. Nutrition 26:1044–1049

    Article  PubMed  CAS  Google Scholar 

  43. Feig DI, Kang DH, Johnson RJ (2008) Uric acid and cardiovascular risk. N Engl J Med 359:1811–1821

    Article  PubMed  CAS  Google Scholar 

  44. Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM (2002) Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr 75:492–498

    PubMed  CAS  Google Scholar 

  45. Uribarri J, Cai W, Sandu O, Peppa M, Goldberg T, Vlassara H (2005) Diet-derived advanced glycation end products are major contributors to the body’s AGE pool and induce inflammation in healthy subjects. Ann N Y Acad Sci 1043:461–466

    Article  PubMed  CAS  Google Scholar 

  46. Allison DB, Mattes RD (2009) Nutritively sweetened beverage consumption and obesity: the need for solid evidence on a fluid issue. JAMA 301:318–320

    Article  PubMed  CAS  Google Scholar 

  47. Wang YC, Bleich SN, Gortmaker SL (2008) Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004. Pediatrics 121:e1604–e1614

    Article  PubMed  Google Scholar 

  48. Haerens L, Craeynest M, Deforche B, Maes L, Cardon G, De Bourdeaudhuij I (2008) The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents. Eur J Clin Nutr 62:51–59

    Article  PubMed  CAS  Google Scholar 

  49. Chen L, Appel LJ, Loria C, Lin PH, Champagne CM, Elmer PJ, Ard JD, Mitchell D, Batch BC, Svetkey LP, Caballero B (2009) Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J Clin Nutr 89:1299–1306

    Article  PubMed  CAS  Google Scholar 

  50. Ochoa MC, Moreno-Aliaga MJ, Martínez-González MA, Martínez JA, Marti A et al (2007) GENOI Members. Predictor factors for childhood obesity in a Spanish case-control study. Nutrition 23:379–384

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni Davì.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mucci, L., Santilli, F., Cuccurullo, C. et al. Cardiovascular risk and dietary sugar intake: is the link so sweet?. Intern Emerg Med 7, 313–322 (2012). https://doi.org/10.1007/s11739-011-0606-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-011-0606-7

Keywords

Navigation