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Esther González-Padilla

Doctoral student

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Association between added sugar intake and mortality is nonlinear and dependent on sugar source in 2 Swedish population-based prospective cohorts

Author

  • Stina Ramne
  • Joana Alves Dias
  • Esther González-Padilla
  • Kjell Olsson
  • Bernt Lindahl
  • Gunnar Engström
  • Ulrika Ericson
  • Ingegerd Johansson
  • Emily Sonestedt

Summary, in English

Background:

Although sugar consumption has been associated with several risk factors for cardiometabolic diseases, evidence for harmful long-term effects is lacking. In addition, most studies have focused on sugar-sweetened beverages (SSBs), not sugar per se.
Objective:

The aim of this study was to examine the associations between added and free sugar intake, intake of different sugar sources, and mortality risk.
Methods:

Two prospective population-based cohorts were examined: the Malmö Diet and Cancer Study (MDCS; n = 24,272), which collected dietary data by combining a food diary, interview, and food-frequency questionnaire (FFQ), and the Northern Swedish Health and Disease Study (NSHDS; n = 24,475), which assessed diet with an FFQ. Sugar intakes defined as both added and free sugar and different sugar sources were examined. The associations with mortality were examined using a multivariable Cox proportional hazards regression.
Results:

Higher sugar consumption was associated with a less favorable lifestyle in general. The lowest mortality risk was found with added sugar intakes between 7.5% and 10% of energy (E%) intake in both cohorts. Intakes >20E% were associated with a 30% increased mortality risk, but increased risks were also found at intakes <5E% [23% in the MDCS and 9% (nonsignificant) in the NSHDS]. Similar U-shaped associations were found for both cardiovascular and cancer mortality in the MDCS. By separately analyzing the different sugar sources, the intake of SSBs was positively associated with mortality, whereas the intake of treats was inversely associated.
Conclusions:

Our findings indicate that a high sugar intake is associated with an increased mortality risk. However, the risk is also increased among low sugar consumers, although they have a more favorable lifestyle in general. In addition, the associations are dependent on the type of sugar source.

Department/s

  • Nutrition Epidemiology
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence in Diabetes Research in Sweden
  • Cardiovascular Research - Epidemiology
  • Diabetes - Cardiovascular Disease

Publishing year

2019

Language

English

Pages

411-423

Publication/Series

The American journal of clinical nutrition

Volume

109

Issue

2

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Nutrition and Dietetics

Keywords

  • added sugar
  • free sugar
  • sugar-sweetened beverages
  • mortality
  • cardiometabolic risk marker
  • nutritional epidemiology

Status

Published

Research group

  • Nutrition Epidemiology
  • Cardiovascular Research - Epidemiology
  • Diabetes - Cardiovascular Disease

ISBN/ISSN/Other

  • ISSN: 1938-3207