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Added Sugar Adds Up to Heart Risk

y Michael Smith, North American Correspondent, MedPage Today

pril 20, 2010

MedPage Today Action Points

Explain to interested patients that extra sugar in many processed foods can addup to a significant heart health risk.

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On average, Americans get nearly 16% of their total dietary calories from sugarsadded to processed foods during manufacturing, researchers found.

And a high intake of such sugars -- mainly sucrose from beets and cane and high

ructose corn syrup -- is correlated with some key measures of dyslipidemia,according to Miriam Vos, MD, of Emory University in Atlanta, and colleagues.

Because dyslipidemia is a risk factor for cardiovascular disease, the findings supportietary guidelines aimed at reducing consumption of added sugars, Vos andolleagues said in the April 21 issue of the Journal of the American Medical

Association.

The findings are not a surprise, according to Rachel Johnson, PhD, of the Universityof Vermont in Burlington. Johnson, a nutritionist, was the primary author of atatement on added sugars issued in August 2009 by the American Heart

Association. (See Cut Back on Added Sugar, AHA Recommends)

Among the nutrition science community, we're certainly not shocked by thesendings," she told MedPage Today.

But the study "certainly adds strength to the evidence base around this issue," sheadded.

ndeed, Vos and colleagues noted in their paper, increased carbohydrate intake hasbeen linked with dyslipidemia, but there has been no research on the links betweenadded sugars and the condition.

To help fill the gap, they turned to the long-running National Health and NutritionExamination Survey (NHANES) from 1999 through 2006. NHANES is a continuousurvey of the US civilian, noninstitutionalized population that is designed to obtainationally representative estimates on diet and health indicators.

The 6,113 respondents were divided into five groups based on the proportion of totalenergy intake from added sugars: less than 5% (serving as the reference group); 5%o less than 10%; 10% to less than 17.5%; 17.5% to less than 25%; and 25% ormore.

The outcome measures were lipid markers -- average high-density lipoprotein

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holesterol (HDL-C), geometric mean triglycerides, and average low-densitypoprotein cholesterol (LDL-C), all adjusted for range of covariates.

The researchers also calculated adjusted odds ratios for dyslipidemia, including lowHDL-C levels, high triglyceride levels, high LDL-C levels, and a high ratio ofriglycerides to HDL-C.

The results were weighted to be representative of the U.S. population as a whole.

Analysis showed that, on average, participants obtained 15.8% of their energy intakerom added sugars -- 21.4 teaspoons a day containing 359 kilocalories.

The difference among the groups was striking: those in the lowest group consumedabout three teaspoons of added sugar a day, compared with 46 teaspoons for theighest-consuming group, the researchers said.

As the intake of added sugars rose, participants were more likely to be younger,poorer, and non-Hispanic black; the linear trend was significant at P

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greater than 3.8), the researchers found.

ohnson said Americans have been focusing on removing fat from their diets, butaven't realized that added sugars can have the same ill effects for health.

We've always thought of saturated fat in the diet as the culprit in terms of the dietarysk factors for heart disease," Johnson said. "Just lowering your fat and not thinking

about what you replace it with is not putting you in a good place."

f people want to have sugar as part of their diet, Johnson said, one way is to make itpart of a meal that is basically healthy -- brown sugar on oatmeal, for instance. "Thereare plenty of very delicious choices people can make," she said.

Primary source: Journal of the American Medical AssociationSource reference:Welsh JA, et al "Caloric sweetener consumption and dyslipidemia among US adults"JAMA 2010; 303(15): 1490-97.

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The researchers did not report external support for the study.

Vos reported that she is the author of and receives royalties from a book about childhood obesity. She issupported in part by a career award from the National Institute of Diabetes and Digestive and Kidney Diseasesand from the Children's Digestive Health and Nutrition Foundation.

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