1. Drinking two or more sweetened beverages per day was associated with an increased the risk of heart failure in this prospective cohort study of Swedish males in their sixties.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Routine consumption of sweetened beverages has been associated with poorer health and with chronic disease including hypertension, metabolic syndrome, diabetes, and coronary heart disease. However, while a number of retrospective studies have examined the increased risk of heart failure with sweetened beverages, the literature has lacked a large, prospective cohort study. After analyzing data from a prospective cohort of Swedish men starting at about 60 years of age, this study reports that drinking more than two sweetened beverages, defined as soft drinks or sweetened juice beverages not fruit juice, a day increased the risk of heart failure by about 20% over about 11 years of follow up. After controlling for many confounding factors, such as age, obesity, pre-morbid cardiovascular or metabolic conditions, smoking, dietary factors, and coffee and alcohol consumption, this association remained unchanged. Further, a sensitivity analysis excluding diabetic patients did not change this association. Interestingly, drinking 1 sweetened beverage a day did not increase heart failure risk, but this lack of significance may be limited by study size.
While this study provides clear evidence that extended consumption of high amounts of sweetened beverages increases the risk of heart failure in men, it is unclear if this result is generalizable to women. Further, the time course of the study was men in their sixties, and there is no evidence from this study to inform about the risk of drinking sweetened beverages throughout a person’s life. Overall, this study supports past findings regarding the independent association of sweetened beverages and heart failure but still leaves room for a broader, more generalizable, prospective study.
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In-Depth [prospective cohort]: Using data from the Cohort of Swedish Males (COSM), 42,400 men about 60 years of age were followed for an average of 11.7 years (494,772 person-years) using a self-administered questionnaire. Heart failure incidence was assessed by identification of ICD 10 codes I50 and I11.0 in the National Swedish Patient Register. By setting up the amount of sweetened beverages drunk into quintiles, Cox proportional hazards ratios were calculated with an without adjusting for age, educational attainment, smoking, alcohol consumption, physical activity, family history of myocardial infarction, history of stroke, angina, hypertension, diabetes, BMI, coffee consumption, fruit intake, vegetable intake, processed meat consumption, fish consumption, and total energy intake. Though the lowest quintiles showed no increased risk of heart failure, those at the highest quintile that drank more than 2 sweetened beverages a day had an age-adjusted increase in heart failure risk of 26% (CI95 1.15 to 1.37) and a multivariate adjusted risk of 23% (CI95 1.12 to 1.35). Non-diabetics had a similar increase in risk (1.21; CI95 1.10 to 1.34) and a sensitivity analysis excluding the first 5 years of heart failure diagnosis did not significantly change the risk profile.
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