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Title: Beverage consumption and longitudinal changes in lipoprotein concentrations and incident dyslipidemia in U.S. adults: the Framingham Heart Study

Author
item HASLAM, DANIELLE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item PELOSO, GINA - Boston University
item HERMAN, MARK - Duke University
item DUPUIS, JOSEE - Boston University
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item SMITH, CAREN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item MCKEOWN, NICOLA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of the American Heart Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/18/2020
Publication Date: 2/26/2020
Citation: Haslam, D.E., Peloso, G.M., Herman, M.A., Dupuis, J., Lichtenstein, A.H., Smith, C.E., McKeown, N.M. 2020. Beverage consumption and longitudinal changes in lipoprotein concentrations and incident dyslipidemia in U.S. adults: the Framingham Heart Study. Journal of the American Heart Association. 9(5). https://doi.org/10.1161/JAHA.119.014083.
DOI: https://doi.org/10.1161/JAHA.119.014083

Interpretive Summary: Dietary modification offers a promising strategy to both prevent and treat dyslipidemia, a risk factor for cardiovascular disease. Dyslipidemia is characterized by unfavorable blood cholesterol measures that include elevated low-density lipoprotein cholesterol (LDL-C = "bad" cholesterol) and triglyceride concentrations, along with decreased high-density lipoprotein cholesterol (HDL-C = "good" cholesterol) concentrations. Dyslipidemia affects an estimated 40-50% of adults. Excess sugar consumption, particularly in the form of sugar-sweetened beverages (SSBs), is one aspect of diet that may contribute to development of dyslipidemia. Two major sources of sugar in the diet are sugar-sweetened beverages (SSB; sodas and fruit drinks) and 100% fruit juices (FJ). Low-calorie sweetened beverages (LCSB) are common replacements for these sugary drinks. Few studies have looked at how consumption of these beverages may influence clinical blood cholesterol measures over time. In our study of over 6,000 U.S. adults from the Framingham Heart Study, we found that greater SSB consumption was adversely associated with changes in clinical blood cholesterol measures over time and development of dyslipidemia. LCSB and FJ consumption were not associated with changes in clinical blood cholesterol measures, but LCSB consumption was associated with higher risk for dyslipidemia. Thus, our study indicates that increased SSB consumption may contribute to the development of dyslipidemia and highlights that more studies are necessary to understand whether LCSB consumption may contribute to development of dyslipidemia.

Technical Abstract: Background: Limited data are available on the prospective relationship between beverage consumption and plasma lipid and lipoprotein concentrations in population-based studies. Two major sources of sugar in the US diet are sugar-sweetened beverages (SSB; sodas and fruit drinks) and 100% fruit juices (FJ). Low-calorie sweetened beverages (LCSB) are common replacements. Methods: Fasting plasma concentrations of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at up to 5 exams in Framingham Heart Study Offspring (1991-2014; N=3,146) and up to 2 exams in the Generation Three (2002-2011; N=3,584) cohorts. Intake was estimated from food frequency questionnaires. 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 (HR) for incident dyslipidemia, adjusting for potential confounding factors. Results: We found that SSB intake was associated with smaller mean 4-year changes in HDL-C [highest (>1 serving/day) vs. lowest intake category (<1 serving/month) (H vs. L): beta +/- SE: -1.0 +/- 0.3 mg/dl, p for trend = 0.0001] and greater mean 4-year changes in TG (H vs. L: beta +/- SE: 5.6 +/- 2.1 mg/dl, p for trend = 0.0004), along with a higher incidence of low HDL-C [H vs. L HR (95% CI): 1.98 (1.20-3.28); p = 0.007; p for trend = 0.01)], and high TG [HR (95% CI): 1.53 (1.01-2.31); p=0.05; p for trend = 0.004)]. LCSB intake was associated with a higher incidence of high non-HDL-C [H vs. L HR (95% CI): 1.40 (1.17-1.69); p = 0.007; p for trend = 0.0002)] and LDL-C [H vs. L HR (95% CI): 1.27 (1.05-1.53); p = 0.01; p for trend = 0.01)]. No other significant associations between beverage consumption and lipids were observed. Conclusions: SSB intake was associated with adverse changes in HDL-C and TG concentrations, along with a higher risk of incident dyslipidemia, indicating that increased SSB consumption may contribute to the development of dyslipidemia.