NEW YORK, Dec 12: The Centers for Disease Control and Prevention (CDC) defines added sugar as the sugar added to foods and beverages during processing or preparation. While researchers continue to explore the specific risks associated with excess added sugar, a study published in Frontiers in Public Health explored the link between added sugar consumption and cardiovascular disease (CVD) risk.

The research revealed an interesting finding: avoiding sugar altogether may actually be worse for cardiovascular health than consuming small to moderate amounts. It also highlighted that the type of sugar consumed plays a significant role in the associated risk.

The study focused on understanding the relationship between various sources of added sugar and different cardiovascular conditions. Data from two Swedish cohorts—the Swedish Mammography Cohort and the Cohort of Swedish Men—were analyzed, totaling 69,705 participants. Individuals with pre-existing conditions like cancer, diabetes, or cardiovascular disease were excluded from the study, as were those with extreme dietary intakes, to avoid inaccuracies.

Dietary data collected in 1997 and 2009 helped estimate the amount of added sugar consumed by participants and its contribution to overall energy intake. The researchers categorized the sources of added sugar into three groups:

Toppings, like table sugar and honey

Sweetened beverages, including sodas and fruit drinks (excluding pure fruit juice)

The 2009 dietary survey also differentiated between beverages containing sugar and those sweetened with artificial sweeteners. The researchers tracked several cardiovascular health outcomes, including stroke, heart attack, heart failure, atrial fibrillation, aortic stenosis, and abdominal aortic aneurysm. Participants were followed until they either developed cardiovascular disease, passed away, or until the study concluded in 2019.

Throughout the follow-up period, 25,739 participants were diagnosed with at least one cardiovascular condition. Various models were used to analyze the data, adjusting for factors such as age, sex, smoking, exercise, and body mass index.

The study found that increased added sugar intake was linked to a higher risk of ischemic stroke and abdominal aortic aneurysm. However, those with the lowest intake of added sugar actually had the highest cardiovascular disease risk. Participants who consumed 5% to 7.5% of their energy from added sugar had a lower risk for ischemic stroke, heart attack, heart failure, aortic stenosis, and atrial fibrillation compared to those with the lowest intake.

Among the different sources of added sugar, sweetened beverages were found to pose the greatest cardiovascular risk. Increased consumption of sweetened beverages correlated with higher risks of ischemic stroke, heart failure, atrial fibrillation, and abdominal aortic aneurysm. Interestingly, artificially sweetened beverages were linked to increased risk for ischemic stroke and heart failure, while sugar-sweetened beverages did not show a direct association with cardiovascular disease.

On the other hand, the consumption of sweet treats was associated with a lower cardiovascular risk. The lowest level of sweet treat consumption was tied to the highest risk, suggesting that moderate intake of such treats may be beneficial. The results for toppings varied; higher consumption was linked to a reduced risk of heart failure and aortic stenosis, but a linear relationship was found with abdominal aortic aneurysm, with the highest intake group showing a 34% increased risk.

Suzzane Janzi, a research student in nutrition epidemiology at Lund University and lead author, highlighted these key findings: "The research revealed that different sources of added sugar have varying impacts on cardiovascular diseases. For instance, sweetened beverages were associated with a higher risk of cardiovascular disease, while treats like pastries and sweets were linked to a lower risk."

The study has several limitations, primarily due to its observational nature. Data were collected only from Swedish participants, limiting the study's generalizability. Additionally, participants self-reported their dietary intake, which can lead to inaccuracies. Only 42,327 participants completed the 2009 dietary assessment, and the study's observational design means it cannot establish cause-and-effect relationships.

The study's methods and assumptions may also introduce potential errors. For example, missing data was assumed to represent non-consumption of certain foods, and estimations of total added sugar intake may not be entirely accurate. Furthermore, factors like social relationships and preexisting health concerns, particularly in Swedish cultural contexts such as the tradition of "fika," could also influence the results.

Dr. Robert L. Salazar, an interventional cardiologist at Memorial Hermann, who was not involved in the study, stated that the research can inform healthcare providers on advising patients about healthy eating habits. "This study highlights the importance of minimizing sweetened beverage consumption to improve cardiovascular health and avoid serious outcomes like ischemic stroke and heart failure," he noted.

Despite its limitations, the study points to the complexity of sugar's effects on health. Janzi emphasized the need for further research to understand the underlying mechanisms behind the associations observed, particularly in regard to the unexpected link between sweet treats and a lower cardiovascular risk.

Overall, while higher consumption of sweetened beverages appears to be harmful, the study suggests that moderate sugar intake, particularly from sweet treats, may not be as detrimental to cardiovascular health as previously thought. Future research is needed to better understand the nuances of added sugar consumption and its long-term impacts on health.