Dyslipidemia and Added Sugar Consumption

A review of an important, recently published scientific article selected by The North American Menopause Society (NAMS) and published in their newsletter.

 

Welsh JA, Sharma A, Abramson JL, Vaccarino V, Gillespie C, Vos MB. Caloric sweetener consumption and dyslipidemia among US adults. JAMA 2010;303: 1490-1497.

Abstract copyright © American Medical Association. All rights reserved. Used with permission.

 

CONTEXT: Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovascular disease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures.

 

OBJECTIVE: To assess the association between consumption of added sugars and blood lipid levels in US adults.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study among US adults (n = 6113) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (< 5% [reference group], 5%-<10%, 10%-<17.5%, 17.5%-<25%, and > or = 25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated.

MAIN OUTCOME MEASURES: Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (< 40 mg/dL for men; < 50 mg/dL for women), high triglyceride levels (> or = 150 mg/dL), high LDL-C levels (> or = 130 mg/dL), or high ratio of triglycerides to HDL-C (> 3.8). Results were weighted to be representative of the US population.

RESULTS: A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P < .001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P < .001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P = .047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (> or = 10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (< 5% added sugars).

CONCLUSION: In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.

 

Comment.

Obesity has received much attention in recent decades owing to its concomitant comorbid conditions. Obesity is associated with dyslipidemia, hypertension, and diabetes among other cardiovascular risk factors. There is increasing awareness of the association of macronutrient intake and cardiovascular risk as it appears that not only food quantity affects heart health but so does food quality, ie, macronutrient content. Dietary guidelines have long promoted limits on saturated fat given its association with dyslipidemia and cardiovascular disease (CVD).¹ More recently, trans fat has been implicated in its potential to promote heart disease, including acute myocardial infarction and possibly sudden cardiac death.² Attention is now increasingly given to added sugars and caloric sweeteners as their consumption has been on the rise in the United States. Caloric sweeteners are associated with negative health consequences including obesity and cardiac risk factors. ³

In this study, Welsh et al demonstrated an association between consumption of added sugars and blood lipid levels using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Greater intake of dietary sugars was associated with lower high-density lipoprotein cholesterol, higher triglycerides in both men and women, and higher low-density lipoprotein cholesterol in women. Interestingly but maybe not surprisingly, intake of dietary sugars was also associated with other unhealthy behaviors such as cigarette use, reduced physical activity, and weight gain. Collectively, these behaviors contribute to higher incidence of CVD risk as demonstrated in previous studies.

Given these results, it is appropriate that healthcare professionals recommend limitations on consumption of added sugars as recently recommended by the American Heart Association.³ Also notable, consumption of caloric sweeteners was positively correlated with low-income status in this study. These findings implicate the need for multifaceted intervention to effectively implement limitations on caloric sweeteners, particularly in populations who may have limited access to nutritious foods. While further study is necessary to determine the clinical impact of these restrictions (ie, reduction in cardiac events), this study suggests that limitations in caloric sweeteners may mitigate dyslipidemia in at-risk populations with additional cardiovascular risk factors.

Adrienne Youdim, MD
Medical Director
Center for Weight Loss
Cedars-Sinai Medical Center
Assistant Clinical Professor,
UCLA David Geffen School of Medicine
Los Angeles, CA

 

References:

  1. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, Brands M, et al. Diet and Lifestyle Recommendations Revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation 2006;114:82-96.
  2. Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354:1601-1613.
  3. Johnson RK, Appel LJ, Brands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009;120:1011-1020.
Author
Dr. Adrienne Youdim

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