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Observational Study
. 2020 Mar 3;9(5):e014083.
doi: 10.1161/JAHA.119.014083. Epub 2020 Feb 26.

Beverage Consumption and Longitudinal Changes in Lipoprotein Concentrations and Incident Dyslipidemia in US Adults: The Framingham Heart Study

Danielle E Haslam  1 , Gina M Peloso  2 , Mark A Herman  3 , Josée Dupuis  2   4 , Alice H Lichtenstein  5 , Caren E Smith  6 , Nicola M McKeown  1
Affiliations
Observational Study

Beverage Consumption and Longitudinal Changes in Lipoprotein Concentrations and Incident Dyslipidemia in US Adults: The Framingham Heart Study

Danielle E Haslam et al. J Am Heart Assoc. .

Abstract

Background Limited data are available on the prospective relationship between beverage consumption and plasma lipid and lipoprotein concentrations. Two major sources of sugar in the US diet are sugar-sweetened beverages (SSBs) and 100% fruit juices. Low-calorie sweetened beverages are common replacements. Methods and Results Fasting plasma lipoprotein concentrations were measured in the FOS (Framingham Offspring Study) (1991-2014; N=3146) and Generation Three (2002-2001; N=3584) cohorts. Beverage intakes were estimated from food frequency questionnaires and grouped into 5 intake categories. Mixed-effect linear regression models were used to examine 4-year changes in lipoprotein measures, and Cox proportional hazard models were used to estimate hazard ratios for incident dyslipidemia, adjusting for potential confounding factors. We found that regular (>1 serving per day) versus low (<1 serving per month) SSB consumption was associated with a greater mean decrease in high-density lipoprotein cholesterol (β±standard error -1.6±0.4 mg/dL; Ptrend<0.0001) and increase in triglyceride (β±standard error: 4.4±2.2 mg/dL; Ptrend=0.003) concentrations. Long-term regular SSB consumers also had a higher incidence of high triglyceride (hazard ratio, 1.52; 95% CI, 1.03-2.25) compared with low consumers. Although recent regular low-calorie sweetened beverage consumers had a higher incidence of high non-high-density lipoprotein cholesterol (hazard ratio, 1.40; 95% CI, 1.17-1.69) and low-density lipoprotein cholesterol (hazard ratio, 1.27; 95% CI, 1.05-1.53) concentrations compared with low consumers, cumulative average intakes of low-calorie sweetened beverages were not associated with changes in non-high-density lipoprotein cholesterol, low-density lipoprotein cholesterol concentrations, or incident dyslipidemias. Conclusions SSB intake was associated with adverse changes in high-density lipoprotein cholesterol and triglyceride concentrations, along with a higher risk of incident dyslipidemia, suggesting that increased SSB consumption may contribute to the development of dyslipidemia.

Keywords: carbohydrates; dyslipidemia; fruit juice; low‐calorie sweetened beverages; nutrition; observational study; sugar‐sweetened beverages.

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Figures

Figure 1
Figure 1
Relationship between cross‐stratified sugar‐sweetened beverage (SSB) and low‐calorie sweetened beverage (LCSB) intakes for mean 4‐year changes in high‐density lipoprotein cholesterol (HDL‐C) and triglyceride concentrations among Framingham cohorts (pooled data). Participants in the highest categories of both SSB and LCSB intakes had mean 4‐year increases in triglyceride concentrations 4.3 mg/dL greater (β±standard error: 4.3±2.4 mg/dL; P=0.07) and mean 4‐year decreases in HDL‐C concentrations 1.6 mg/dL greater (β±SE: −1.6±0.4 mg/dL; P<0.0001) compared with those in the lowest categories of both SSB and LCSB intakes. There was little evidence of a significant interaction between SSB and LCSB intake (P>0.01 for the interaction). All changes in lipoprotein concentrations were adjusted for age, cohort, sex, total energy, baseline lipoprotein concentration, education, current smoking status, current diabetes mellitus status, physical activity index, alcohol intake, percent energy from saturated fat, change in waist circumference, and servings per day of vegetables, whole fruits, 100% fruit juice, whole grains, nuts/seeds, and seafood. Multivariable‐adjusted β estimates for additional comparisons are presented in Table S2. Vertical error bars indicate standard errors for regression coefficients.
Figure 2
Figure 2
Hazard ratios for development of dyslipidemia among the highest beverage consumers (>1 serving per day) compared with the lowest beverage consumers (<1 serving per month) indicated by recent beverage consumption vs cumulative average of beverage consumption among the Framingham Offspring Study cohort. Participants were followed for a mean of 12.5 years and were free of dyslipidemia at baseline (according to each definition). Thus, maximum sample sizes and case numbers were as follows: low‐density lipoprotein cholesterol (LDL‐C) (n=2161; 961 cases), high‐density lipoprotein cholesterol (HDL‐C) (n=1703; 319 cases), triglyceride (TG) (n=2116; 457 cases), and non–HDL‐C (n=2205; 975 cases). We defined “recent” beverage intake as intake one examination before development of dyslipidemia and “cumulative” beverage intake as the average beverage intake during the period before development of dyslipidemia. All hazard ratios are adjusted for age, sex, total energy, education, current smoking status, current diabetes mellitus status, physical activity index, waist circumference, alcohol intake, percent energy from saturated fat, and servings per day of vegetables, whole fruits, 100% fruit juice, whole grains, nuts/seeds, and seafood. Horizontal bars indicate 95% CIs. FJ indicates fruit juice; LCSB; low‐calorie sweetened beverage; SSB, sugar‐sweetened beverage.
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