Objective
To investigate the association between sugar consumption and risk of cardiovascular disease.
Methods
1988-94 National
Health and Nutrition Examination Survey (NHANES) data was used for this
investigation. NHANES is a nationally representative sample of the U.S. population.
Each participant completed a household interview and a physical examination at
a mobile examination center. Diet was measured by means of a 24 hour dietary
recall that was conducted through a personal interview. Sugar consumption was
measured, and subjects were followed for 14 years for incidence of
cardiovascular disease.
Results
In this cohort,
71.4 percent of subjects consumed more than 10% of their calories as sugar. The
average sugar consumption was 15.7% of calories. When compared to subjects
consuming the lowest amount of sugar (7.4% of calories), subjects consuming the
most sugar (25.2% of calories) had more than double the risk of cardiovascular
disease. This was after controlling for all known risk factors for cardiovascular
disease, and even after controlling for overall diet quality.
Comment
Studies showing
the risk of a high sugar diet are really starting to mount. There have been
reported associations between sugar and risk of obesity, type 2 diabetes,
hypertension, dyslipidemia, and now even stronger evidence that sugar
consumption is associated with cardiovascular disease.
What makes this
study interesting is that it controlled for the Healthy Eating Index score in
the statistical modelling. This score measures overall diet quality. It is easy
to argue in an epidemiological study such as this, that sugar is simply a
marker for an unhealthy diet, so of course it will be associated with
cardiovascular disease. Since this study controlled for overall diet quality,
it focuses in a bit more on sugar as the culprit.
As for the
mechanisms, the authors propose several possibilities:
1) Sugar has
been shown in animal studies to increase hypertension.
2) Excess sugar
has been shown to increase triglycerides and LDL cholesterol while lowering HDL
cholesterol.
3) Sugar has
been shown to increase inflammation, which is a big part of developing
cardiovascular disease.
Take Home Message
If you work with
me or have read any of my books you already know I am an anti-sugar guy. Sugar
is everywhere and the percentages can creep up on you quickly. One soda has 35
grams of sugar, and at 140 calories, makes up 7% of total calories on a 2000
calorie diet.
Strictly
limiting sugar, or better yet completely avoided it, should be a high priority
for anyone who is looking to manage their weight or reduce their risk of
chronic disease. The most common sources of sugar in this cohort were sugar
sweetened beverages, grain based desserts (like cookies and cakes), fruit
drinks, dairy based desserts (like ice cream), and candy. Limiting these foods is an awesome place to
start.
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