Sugar-Sweetened Beverage Consumption and Incident Cardiovascular Risk Factors: The Multi-Ethnic...
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![Page 1: Sugar-Sweetened Beverage Consumption and Incident Cardiovascular Risk Factors: The Multi-Ethnic Study of Atherosclerosis (MESA) Christina Shay PhD MA 1.](https://reader035.fdocuments.net/reader035/viewer/2022062421/56649d2f5503460f94a06c05/html5/thumbnails/1.jpg)
Sugar-Sweetened Beverage Consumption and Incident Cardiovascular Risk Factors:
The Multi-Ethnic Study of Atherosclerosis(MESA)
Christina Shay PhD MA1 Jennifer Nettleton PhD2; Pamela Lutsey PhD MPH3;
Tamar Polonsky MD4; Mercedes Carnethon PhD4; Linda Van Horn PhD RD4,
Gregory Burke MD MSc5
1Dept of Biostatistics and Epidemiology, Univ of Oklahoma Health Sciences Ctr, Oklahoma City, OK ; 2Div of Epidemiology, Human Genetics and Environmental Sciences, Univ of Texas School of Public Health, Houston, TX; 3Div of Epidemiology and Community Health, Univ of Minnesota, School of Public Health, Minneapolis 4Dept of Preventive Medicine, Feinberg School
of Medicine, Northwestern Univ, Chicago, IL; 5Div of Public Health Sciences, Wake Forest Univ Health Science, Winston-Salem, NC
Corresponding Author: [email protected]
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Background
• Sugar-sweetened beverage (SSB) consumption has been associated with weight gain and obesity, dyslipidemia, hyperglycemia, type 2 diabetes, and increased risk for cardiovascular (CV) events
• The association between SSB consumption and development of CV risk factors has not been extensively examined in large, prospective, multi-ethnic cohorts
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Objective
• To quantify the association between SSB consumption and risk for developing individual CV risk factors in men and women in the Multi-Ethnic Study of Atherosclerosis (MESA)
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MESA Study Description6,814 participants recruited in 2000-2002
Field Centers:- Baltimore - New York
- Chicago - St. Paul
- Los Angeles - Winston-Salem
• 45-84 years, free of clinical cardiovascular disease
• 57% women • 38% Non-Hispanic White, 28% African-American,
22% Hispanic, 12% Chinese American
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Assessment of SSB Intake
• Food Frequency Questionnaire (FFQ) was used to measure SSB consumption at the first exam (2000-2002)
• The FFQ specifically asked about consumption of “regular soft drinks, soda, sweetened mineral water (not diet), and nonalcoholic beer”
• SSB intake was categorized into the following groups: 0-<1, 1-<2, and 2+ servings per day
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CV Risk Factors Definitions (1)
• Weight Gain: Weight on any follow-up exam or average of all exam weight measurements >3% higher than baseline
• Increased Waist Circumference (WC): WC from any follow-up exam or average of all exam WC measurements >3% higher than baseline
• High Triglycerides: HDL >40 mg/dL (men), > 50mg/dL (women), LDL <160mg/dL, and triglycerides >150mg/dL
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• Low HDL cholesterol: HDL <40mg/dL (men), <50 mg/dL (women), LDL <160mg/dL, and triglycerides <150mg/dL
• Impaired Fasting Glucose: Fasting plasma glucose 100-125 mg/dL
• Type 2 Diabetes (T2D): Fasting glucose ≥126 mg/dL, medication use for T2D or self-reported T2D
CV Risk Factors Definitions (2)
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Selection of Study Participants for the Current Study
8
6,814 MESA participants ages 45-84 and free of clinical CVD at first exam
General Analysis Sample (n=4,166)
Lipid Analyses (n=1,614)
IGT Analyses (n=3,437)
Excluded Participants
No follow up exams (n=761)
Type 2 diabetes at baseline(n=773)
BMI <18.5 kg/m2 at baseline (n=37)
Missing covariates of interest (n=1,077)
Additional Exclusions
Lipid Medication Use (n=2,552)
Impaired fasting glucose at baseline (n=729)
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Statistical Analyses• Cox proportional hazards regression used
estimate hazard ratios
• All risk estimates adjusted for:
• Age
• Sex
• Race/ethnicity
• Study center
• Educational attainment
• Intentional exercise
• Smoking status
• Dietary intake (i.e., total energy, fiber, saturated fat, cholesterol, fruits and vegetables, sodium)
• Family history of T2D (for T2D
incidence)
• Time-varying BMI and WC
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Results
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Table 1: MESA Baseline Characteristics According to SSB Consumption
Sugar-sweetened beverage consumption (s/day)
0 - <1 1 - <2 2+
Number of Participants 3418 490 258
Male sex (%)** 44.5 56.1 54.6
Age (years)** 61.7 (10.3) 58.8 (9.8) 56.2 (8.9)
Current smokers (%)** 11.3 17.8 19.0
Body Mass Index (kg/m2)** 27.5 (5.0) 29.3 (5.3) 30.0 (6.1)
Waist Circumference (cm)** 95.6 (13.6) 100.2 (13.2) 101.1 (14.9)
Total Intentional Exercise, MET-min/wk [median (IQR)]**
945.0 (210.0 - 2175.0)
630.0 (0.0 -1635.0) 495.0 (0.0 - 1680.0)
HDL Cholesterol (mg/dL)** 52.7 (15.5) 48.8 (13.9) 46.9 (12.9)
LDL Cholesterol (mg/dL) 120.0 (30.8) 119.4 (31.1) 122.1 (30.0)
Triglycerides [median (IQR)]* 106.0 (75.0-153.0) 108.0 (79.0-153.0) 113.0 (81.0-167.0)
Fasting Plasma Glucose (mg/dL)
88.8 (10.4) 89.6 (10.3) 90.1 (10.3)
Systolic Blood Pressure (mmHg) 124.6 (21.0) 124.7 (20.7) 123.1 (19.5)
Diastolic Blood Pressure (mmHg)** 71.5 (10.2) 73.4 (10.9) 73.6 (9.9)
Follow-Up Time, years 4.7 (0.8) 4.7 (0.8) 4.6 (0.8)IQR, interquartile range; Significantly different across groups, *p-value < 0.01, **p-value < 0.001
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Hazard Ratios (95% CI) for Weight Gain According to Level of Sugar-Sweetened Beverage Consumption:
The Multi-Ethnic Study of Atherosclerosis (MESA)
Series10
1
2
3
4
5
6
7
8
9
0-<1 1-<2 2+
Servings/Day
Men Women
Haz
ard
Rat
ios
(95%
C.I
.)
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Series10
1
2
3
4
5
6
7
8
9
0-<1 1-<2 2+
Servings/Day
Hazard Ratios (95% CI) for Increased Waist Circumference According to Level of Sugar-Sweetened Beverage Consumption:
The Multi-Ethnic Study of Atherosclerosis (MESA)
Men Women
Haz
ard
Rat
ios
(95%
C.I
.)
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Series10
1
2
3
4
5
6
7
8
9
0-<1 1-<2 2+
Servings/Day
Hazard Ratios (95% CI)* for High Triglycerides According to Level of Sugar-Sweetened Beverage Consumption:
The Multi-Ethnic Study of Atherosclerosis (MESA)
Men Women
Haz
ard
Rat
ios
(95%
C.I
.)
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Series10
1
2
3
4
5
6
7
8
9
0-<1 1-<2 2+
Servings/Day
Hazard Ratios (95% CI) for Low HDL Cholesterol According to Level of Sugar-Sweetened Beverage Consumption:
The Multi-Ethnic Study of Atherosclerosis (MESA)
Men Women
Haz
ard
Rat
ios
(95%
C.I
.)
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Series10
1
2
3
4
5
6
7
8
9
0-<1 1-<2 2+
Servings/Day
Hazard Ratios (95% CI) for Impaired Fasting Glucose According to Level of Sugar-Sweetened Beverage Consumption:
The Multi-Ethnic Study of Atherosclerosis (MESA)
Men Women
Haz
ard
Rat
ios
(95%
C.I
.)
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Series10
1
2
3
4
5
6
7
8
9
0-<1 1-<2 2+
Servings/Day
Hazard Ratios (95% CI) for Type 2 Diabetes According to Level of Sugar-Sweetened Beverage Consumption:
The Multi-Ethnic Study of Atherosclerosis (MESA)
Men Women
Haz
ard
Rat
ios
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Summary• Women who consumed 2+ SSBs per day
exhibited higher risk for developing:
– high triglycerides
– impaired glucose tolerance
– increased waist circumference
compared to women who consumed <1 SSB per day
• These associations remained even after accounting for baseline and time varying BMI and WC
18
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Strengths and LimitationsStrengths• The MESA study is a large, population-based
cohort designed to examine the development of
CVD risk factorsLimitations• Food frequency item used likely to not have
captured all types of SSBs consumed
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American Beverage Association
"This type of study cannot show that drinking sugar-sweetened beverages
causes increased risk for cardiovascular disease. It simply looks at associations
between the two, which could be the result of numerous other confounding factors.”
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Conclusions
• The influence of SSBs consumption on cardiovascular risk is complex and may not be the same between middle- and older-aged men and women
• Women exhibit lower energy requirements compared to men and may therefore experience higher CV risk when a greater proportion of calories is consumed in the form of SSBs
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Acknowledgements
• Co-Authors: Jennifer Nettleton, Pamela Lutsey, Tamar Polonsky, Linda Van Horn, Gregory Burke
• MESA’s Funding Agency:
National, Heart, Lung, and Blood Institute (NHLBI)
THANK YOU
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Table 1: Characteristics According to SSB Consumption at First Exam
Sugar-sweetened beverage consumption (s/day)
0 - <1 1 - <2 2+
Number of Participants 3418 490 258
Sugar-sweetened beverage consumption (s/day) [median]**
0.0 1.0 2.5
Male sex (%)** 44.5 56.1 54.6
Age (years)** 61.7 (10.3) 58.8 (9.8) 56.2 (8.9)
Education > high school (%) 68.0 65.1 63.6
Current smokers (%)** 11.3 17.8 19.0
Body Mass Index (kg/m2)** 27.5 (5.0) 29.3 (5.3) 30.0 (6.1)
Waist Circumference (cm)** 95.6 (13.6) 100.2 (13.2) 101.1 (14.9)
Total Intentional Exercise, MET-min/wk [median (IQR)]*
945.0 (210.0 - 2175.0) 630.0 (0.0 -1635.0) 495.0 (0.0 - 1680.0)
HDL Cholesterol (mg/dL)** 52.7 (15.5) 48.8 (13.9) 46.9 (12.9)
LDL Cholesterol (mg/dL) 120.0 (30.8) 119.4 (31.1) 122.1 (30.0)
Triglycerides [median (IQR)]* 106.0 (75.0-153.0) 108.0 (79.0-153.0) 113.0 (81.0-167.0)
Fasting Plasma Glucose (mg/dL) 88.8 (10.4) 89.6 (10.3) 90.1 (10.3)
Systolic Blood Pressure (mmHg) 124.6 (21.0) 124.7 (20.7) 123.1 (19.5)
Diastolic Blood Pressure (mmHg)** 71.5 (10.2) 73.4 (10.9) 73.6 (9.9)
Anti-Hypertensive Medication use (%) 29.9 28.8 29.1
Follow-Up Time, years 4.7 (0.8) 4.7 (0.8) 4.6 (0.8)IQR, interquartile range; Significantly different across groups, *p-value < 0.01, **p-value < 0.001
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CV Risk Factors
Sugar-Sweetened Beverage Consumption
Women Men
0 - <1 1 - <2 2+ 0 - <1 1 - <2 2+Weight gain >3% N 1759 195 102 1412 253 129 # Cases 694 89 47 508 78 51WC gain >3% N 1759 195 102 1412 253 129 # Cases 953 108 65 586 94 57Hypertriglyceridemia1
N 790 83 37 576 81 47 # Cases 79 11 9 79 10 5Low HDL1 N 790 83 37 576 81 47 # Cases 116 19 6 73 13 10Type 2 diabetes N 1897 215 117 1521 275 141 # Cases 138 20 15 109 22 12Impaired Fasting Glucose N 1621 179 93 1215 217 112 # Cases 331 39 25 324 51 24
Sample Sizes
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