title: Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure.
abstract: The obesity epidemic has focused attention on relationships of sugars and sugar-sweetened beverages (SSBs) to cardiovascular risk factors. Here we report cross-sectional associations of SSBs, diet beverages, and sugars with blood pressure (BP) for United Kingdom and US participants of the International Study of Macro/Micronutrients and Blood Pressure. Data collected include four 24-hour dietary recalls, two 24-hour urine collections, 8 BP readings, and questionnaire data for 2696 people ages 40 to 59 years of age from 10 US/United Kingdom population samples. Associations of SSBs, diet beverages, and sugars (fructose, glucose, and sucrose) with BP were assessed by multiple linear regression. SSB intake related directly to BP, with P values of 0.005 to <0.001 (systolic BP) and 0.14 to <0.001 (diastolic BP). SSB intake higher by 1 serving per day (355 mL/24 hours) was associated with systolic/diastolic BP differences of +1.6/+0.8 mm Hg (both P<0.001) and +1.1/+0.4 mm Hg (P<0.001/<0.05) with adjustment for weight and height. Diet beverage intake was inversely associated with BP (P 0.41 to 0.003). Fructose- and glucose-BP associations were direct, with significant sugar-sodium interactions: for individuals with above-median 24-hour urinary sodium excretion, fructose intake higher by 2 SD (5.6% kcal) was associated with systolic/diastolic BP differences of +3.4/+2.2 mm Hg (both P<0.001) and +2.5/+1.7 mm Hg (both P=0.002) with adjustment for weight and height. Observed independent, direct associations of SSB intake and BP are consistent with recent trial data. These findings, plus adverse nutrient intakes among SSB consumers, and greater sugar-BP differences for persons with higher sodium excretion lend support to recommendations that intake of SSBs, sugars, and salt be substantially reduced.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom. ian.j.brown@imperial.ac.uk
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Brown
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Stamler
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: Claire E
authors.initials: CE
authors.lastname: Robertson
authors.forename: Queenie
authors.initials: Q
authors.lastname: Chan
authors.forename: Alan R
authors.initials: AR
authors.lastname: Dyer
authors.forename: Chiang-Ching
authors.initials: CC
authors.lastname: Huang
authors.forename: Beatriz L
authors.initials: BL
authors.lastname: Rodriguez
authors.forename: Liancheng
authors.initials: L
authors.lastname: Zhao
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000328:Adult; D001628:Beverages / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D004032:Diet; D004034:Diet Surveys; D019422:Dietary Sucrose / Q000009:adverse effects*; D005260:Female; D005632:Fructose / Q000009:adverse effects*; D005947:Glucose / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000652:urine; D013549:Sweetening Agents / Q000009:adverse effects*
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents; D005632:Fructose; D012964:Sodium; D005947:Glucose