Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohorts.
BACKGROUND
The role of sugar-sweetened beverages (SSBs) that contain free or bound fructose in the pathogenesis of hypertension remains unclear.


OBJECTIVE
We conducted a systematic review and meta-analysis of prospective cohort studies to quantify the association between fructose-containing SSBs and risk of hypertension.


METHODS
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane registry were searched from conception through 11 November 2014. Two independent reviewers extracted data and assessed the quality of studies (with the use of the Newcastle-Ottawa Scale). Risk estimates of extreme quantiles of SSB intake (lowest compared with highest) for hypertension incidence were generated with the use of generic inverse-variance methods with random-effects models and expressed as risk ratios with 95% CIs. Heterogeneity was assessed with the Cochran Q statistic and quantified with the I(2) statistic.


RESULTS
Six prospective cohort studies (n = 240,508) with 79,251 cases of hypertension observed over ≥3,197,528 person-years of follow-up were included. SSB consumption significantly increased the risk of developing hypertension by 12% (risk ratio: 1.12; 95% CI: 1.06, 1.17) with evidence of significant heterogeneity (I(2) = 62%, P = 0.02) when highest [≥1 serving (6.7, 8, or 12 oz)/d] and lowest (none) quantiles of intake were compared. With the use of a dose-response analysis, a significant 8.2% increase in risk of every additional SSB per day from none to ≥1 SSB/d (β = 0.0027, P < 0.001) was identified. Limitations include unexplained heterogeneity and residual confounding. The results may also have been subject to collinearity effects from aspects of a Western dietary pattern.


CONCLUSIONS
SSBs were associated with a modest risk of developing hypertension in 6 cohorts. There is a need for high-quality randomized trials to assess the role of SSBs in the development of hypertension and its complications. This study was registered at clinicaltrials.gov as NCT01608620.
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Departments of Nutritional Sciences and.
Viranda H
VH
Jayalath
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Departments of Clinical Epidemiology & Biostatistics and.
Russell J
RJ
de Souza
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Departments of Clinical Epidemiology & Biostatistics and.
Vanessa
V
Ha
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Departments of Nutritional Sciences and.
Arash
A
Mirrahimi
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Departments of Nutritional Sciences and.
Sonia
S
Blanco-Mejia
Departments of Nutritional Sciences and Heart and Stroke Foundation of Ontario, Toronto, Canada; and American Heart Association, Dallas, TX.
Marco
M
Di Buono
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center.
Alexandra L
AL
Jenkins
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Division of Endocrinology and Metabolism, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Departments of Nutritional Sciences and Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada;
Lawrence A
LA
Leiter
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Division of Endocrinology and Metabolism, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Departments of Nutritional Sciences and Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada;
Thomas Ms
TM
Wolever
Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada;
Joseph
J
Beyene
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Departments of Nutritional Sciences and Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada;
Cyril Wc
CW
Kendall
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Division of Endocrinology and Metabolism, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Departments of Nutritional Sciences and Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada;
David Ja
DJ
Jenkins
Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, Division of Endocrinology and Metabolism, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Departments of Nutritional Sciences and Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; john.sievenpiper@utoronto.ca.
John L
JL
Sievenpiper
D001628:Beverages; D016208:Databases, Factual; D005632:Fructose / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D064427:Nutritive Sweeteners / Q000008:administration & dosage* / Q000009:adverse effects*; D012307:Risk Factors
D064427:Nutritive Sweeteners; D005632:Fructose
hypertension; meta-analysis; prospective cohort; sugar-sweetened beverage; sugars