Advanced

Association between added sugar intake and mortality is nonlinear and dependent on sugar source in 2 Swedish population-based prospective cohorts

Ramne, Stina LU ; Alves Dias, Joana LU ; González-Padilla, Esther LU ; Olsson, Kjell LU ; Lindahl, Bernt; Engström, Gunnar LU ; Ericson, Ulrika LU ; Johansson, Ingegerd and Sonestedt, Emily LU (2018) In The American journal of clinical nutrition p.1-13
Abstract
Background:

Although sugar consumption has been associated with several risk factors for cardiometabolic diseases, evidence for harmful long-term effects is lacking. In addition, most studies have focused on sugar-sweetened beverages (SSBs), not sugar per se.
Objective:

The aim of this study was to examine the associations between added and free sugar intake, intake of different sugar sources, and mortality risk.
Methods:

Two prospective population-based cohorts were examined: the Malmö Diet and Cancer Study (MDCS; n = 24,272), which collected dietary data by combining a food diary, interview, and food-frequency questionnaire (FFQ), and the Northern Swedish Health and Disease Study (NSHDS; n = 24,475),... (More)
Background:

Although sugar consumption has been associated with several risk factors for cardiometabolic diseases, evidence for harmful long-term effects is lacking. In addition, most studies have focused on sugar-sweetened beverages (SSBs), not sugar per se.
Objective:

The aim of this study was to examine the associations between added and free sugar intake, intake of different sugar sources, and mortality risk.
Methods:

Two prospective population-based cohorts were examined: the Malmö Diet and Cancer Study (MDCS; n = 24,272), which collected dietary data by combining a food diary, interview, and food-frequency questionnaire (FFQ), and the Northern Swedish Health and Disease Study (NSHDS; n = 24,475), which assessed diet with an FFQ. Sugar intakes defined as both added and free sugar and different sugar sources were examined. The associations with mortality were examined using a multivariable Cox proportional hazards regression.
Results:

Higher sugar consumption was associated with a less favorable lifestyle in general. The lowest mortality risk was found with added sugar intakes between 7.5% and 10% of energy (E%) intake in both cohorts. Intakes >20E% were associated with a 30% increased mortality risk, but increased risks were also found at intakes <5E% [23% in the MDCS and 9% (nonsignificant) in the NSHDS]. Similar U-shaped associations were found for both cardiovascular and cancer mortality in the MDCS. By separately analyzing the different sugar sources, the intake of SSBs was positively associated with mortality, whereas the intake of treats was inversely associated.
Conclusions:

Our findings indicate that a high sugar intake is associated with an increased mortality risk. However, the risk is also increased among low sugar consumers, although they have a more favorable lifestyle in general. In addition, the associations are dependent on the type of sugar source. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
added sugar, free sugar, sugar-sweetened beverages, mortality, cardiometabolic risk marker, nutritional epidemiology
in
The American journal of clinical nutrition
pages
1 - 13
publisher
American Society for Clinical Nutrition
ISSN
1938-3207
DOI
10.1093/ajcn/nqy268
language
English
LU publication?
yes
id
8b994a44-c11e-47ad-8498-cdb8233e1e36
date added to LUP
2019-01-17 12:01:58
date last changed
2019-01-19 03:00:02
@article{8b994a44-c11e-47ad-8498-cdb8233e1e36,
  abstract     = {Background:<br>
<br>
Although sugar consumption has been associated with several risk factors for cardiometabolic diseases, evidence for harmful long-term effects is lacking. In addition, most studies have focused on sugar-sweetened beverages (SSBs), not sugar per se.<br>
Objective:<br>
<br>
The aim of this study was to examine the associations between added and free sugar intake, intake of different sugar sources, and mortality risk.<br>
Methods:<br>
<br>
Two prospective population-based cohorts were examined: the Malmö Diet and Cancer Study (MDCS; n = 24,272), which collected dietary data by combining a food diary, interview, and food-frequency questionnaire (FFQ), and the Northern Swedish Health and Disease Study (NSHDS; n = 24,475), which assessed diet with an FFQ. Sugar intakes defined as both added and free sugar and different sugar sources were examined. The associations with mortality were examined using a multivariable Cox proportional hazards regression.<br>
Results:<br>
<br>
Higher sugar consumption was associated with a less favorable lifestyle in general. The lowest mortality risk was found with added sugar intakes between 7.5% and 10% of energy (E%) intake in both cohorts. Intakes &gt;20E% were associated with a 30% increased mortality risk, but increased risks were also found at intakes &lt;5E% [23% in the MDCS and 9% (nonsignificant) in the NSHDS]. Similar U-shaped associations were found for both cardiovascular and cancer mortality in the MDCS. By separately analyzing the different sugar sources, the intake of SSBs was positively associated with mortality, whereas the intake of treats was inversely associated.<br>
Conclusions:<br>
<br>
Our findings indicate that a high sugar intake is associated with an increased mortality risk. However, the risk is also increased among low sugar consumers, although they have a more favorable lifestyle in general. In addition, the associations are dependent on the type of sugar source.},
  author       = {Ramne, Stina and Alves Dias, Joana and González-Padilla, Esther and Olsson, Kjell and Lindahl, Bernt and Engström, Gunnar and Ericson, Ulrika and Johansson, Ingegerd and Sonestedt, Emily},
  issn         = {1938-3207},
  keyword      = {added sugar,free sugar,sugar-sweetened beverages,mortality,cardiometabolic risk marker,nutritional epidemiology},
  language     = {eng},
  month        = {12},
  pages        = {1--13},
  publisher    = {American Society for Clinical Nutrition},
  series       = {The American journal of clinical nutrition},
  title        = {Association between added sugar intake and mortality is nonlinear and dependent on sugar source in 2 Swedish population-based prospective cohorts},
  url          = {http://dx.doi.org/10.1093/ajcn/nqy268},
  year         = {2018},
}