A large-scale Swedish study suggests that the consumption of sugary drinks significantly increases the risk of serious cardiovascular diseases, while occasional enjoyment of sweets does not.
A little of what you fancy does you good… unless it’s a fizzy drink. Scientists who have investigated the effects of sugar on the risk of cardiovascular diseases have found that consuming too much added sugar increases the risk of stroke or aneurysm, while eating a few treats is associated with a lower risk of cardiovascular disease. In contrast, drinking sweetened beverages increases the risk of stroke, heart failure, and atrial fibrillation;
"The most striking finding of our study is the different association between different sources of added sugar and the risk of cardiovascular diseases," said Suzanne Janzi, a doctoral student at Lund University and corresponding author of the paper in Frontiers in Public Health. "This surprising contrast highlights the importance of considering not only the amount of sugar consumed, but also its source and context."
A spoonful of sugar
Although most public health authorities recommend limiting sugar intake to protect teeth and improve diet, there is limited evidence to date on the effects of sugar consumption on cardiovascular diseases. These diseases are the leading cause of death and illness in Europe, and changing one's diet is a relatively simple way to reduce risk;
To understand how sugar intake affects the risk of cardiovascular diseases and whether consuming different types of sugar alters this risk, scientists collected data from two large cohort studies, the Swedish Mammography Cohort and the Swedish Men Cohort. As part of these studies, dietary questionnaires were completed in 1997 and 2009, allowing scientists to track participants' dietary habits over a long period;
After exclusions were made to ensure the two cohorts had the same inclusion criteria, and to remove independent risk factors for cardiovascular diseases, a sample of 69,705 participants remained. They examined three types of sugar consumption – sweets such as honey, treats such as pastries, or sweetened beverages such as sodas – and seven cardiovascular diseases: two different types of stroke, myocardial infarction, heart failure, aortic aneurysm, atrial fibrillation, and aortic stenosis.
Participants were followed until they died, were diagnosed with one of the cardiovascular diseases, or reached the end of the follow-up period in 2019. During this period, 25,739 participants were diagnosed with a cardiovascular disease.
The scientists used this data to break down how different types of sugar consumption affect the risk of various cardiovascular diseases;
Matters of the Heart
They found that consuming sugary drinks is worse for health than any other form of sugar: consuming more sweetened beverages significantly increased the risk of ischemic stroke, heart failure, atrial fibrillation, and abdominal aortic aneurysm.
“Liquid sugar, such as that found in sweetened beverages, is generally less satiating than solid forms – you feel less full, which can lead to overconsumption,” said Janzi. “Context also plays a role: treats are often enjoyed in social settings or on special occasions, while sweetened beverages tend to be consumed more regularly”;
Different cardiovascular diseases were affected differently by increased sugar consumption, possibly because the additional sugar consumption affects participants’ individual risk profiles differently. Increased sugar consumption in general increased the risk of ischemic stroke and abdominal aortic aneurysm, as well as the risk of heart failure in participants with a normal BMI.
However, the highest risks of a negative health impact were found in the lowest consumption category for treats. Occasional consumption of sweets was associated with better outcomes than abstaining from sweets;
“This could reflect underlying dietary behaviors – individuals who consume very little sugar may be following very restrictive diets or limiting sugar intake due to existing health problems,” said Janzi. “While our observational study cannot establish causality, the findings suggest that extremely low sugar intake may not be necessary or beneficial for cardiovascular health”;
However, the scientists pointed out that further work is needed to understand the mechanisms involved in the different effects of different types of sugar consumption. They also pointed out that diet is highly demographic and culturally determined;
"Our results are based on a Swedish population whose dietary habits and lifestyle may differ from those of other populations," said Janzi. "Particularly relevant in this context is the social custom of 'Fika' – regular coffee and pastry breaks that are firmly anchored in Swedish culture. These results may not be directly transferable to other populations with different dietary cultures."
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