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Should We Be Concerned About Dietary Sugar and CVD?

A recent article in the Journal of the American Medical Association (JAMA)1 found studies as far back as the 1960’s suggesting that sugar may contribute to the development of cardiovascular disease. Many studies were epidemiologic, suggesting that risk factors for cardiovascular disease include a diet with a high intake of added sugar. A prospective study in 2014 involving the National Health and Nutrition Examination Survey (NHANES) (1988-1994, 1999-2004, and 2005-2010) for the time trend analysis and NHANES III Linked Mortality cohort (1988-2006) showed a significant relationship between added sugar consumption and increased risk for cardiovascular disease mortality. The findings were independent of other risk factors such as blood pressure and lipid values and were consistent across age groups, sex, race, educational levels, physical activity and BMI.2 The pathophysiologic mechanism is not completely understood. Some studies have observed an association between high sugar intake and hypertension, lipogenesis, hepatic triglyceride synthesis and increased triglycerides. Other studies have shown that an elevation in inflammatory markers was associated with intake of sugar-sweetened beverages. 

The American Heart Association’s (AHA) recommendation is to limit the amount of added sugar. For most women this is no more than 100 calories or 6 teaspoons, and 150 calories or 9 teaspoons for men.3

So, how can we help our patients? 

Personal

  1. Read food labels for sugar content and choose foods with the lowest sugar grams.
  2. Incremental sugar reduction.
  3. Limit eating out at restaurants, but if patients do eat out, choose a restaurant that prepares fresh, unprocessed foods and shows nutritional information for their food.
  4. Reduce the amount of prepared, “ready to eat” foods that are purchased in the grocery store or food marts.
  5. Buy fresh or unsweetened frozen fruit or canned fruit in water.
  6. Reduce the amount of sugar called for in recipes.
  7. Avoid consumption of sugar-added beverages such as soft drinks, sports drinks, fruit drinks and juices, and ready-to-drink tea and coffee beverages.

Advocacy

  1. Encourage patients and other professionals to get involved with their local AHA to influence the state government to encourage the food industry to reduce added sugars in food and drinks.
  2. Promote the adoption of food policies that create healthier diets in schools, workplaces, sports clubs, faith centers, and community organizations. 
  3. Reduce the availability of sugar-sweetened beverages in schools.
  4. Place restrictions on marketing sugar-sweetened drinks to children.
  5. Work through the AHA locally or on the state level to adopt a tax on sugar-sweetened beverages.
  6. In addition to working with the food industry to reduce the amount of sugars in foods and drinks, further prospective studies are needed to look at pathophysiologic effects and to more closely determine an amount of dietary sugar that may be safe to consume.

References

  1. Kearns, CE, Schmidt LA, Glantz, SA.  Sugar Industry and Cornonary Heat Disease Research:  A Historical Analysis of Internal Industry Documents. JAMA Intern. Med. Published on line September 12, 2016 doi:10.1001/jamainternmed.2016.5394
  2. Yang, Q, Zhang Z, Gregg, EW, Flanders WD, Merritt, R, Hu, FB.  Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults.  JAMA Intern. Med. 2014;174(4):516-524.
  3. American Heart Association Sugar 101.  www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Sugar-101_UCM_306024_Article.jsp#.V-1sAcorkM8