Relation of Total Sugars and Fructose‐Containing Sugars with Risk of Cardiovascular Disease: A Systematic Review and Meta‐Analysis of Prospective Cohort Studies

Objective Intake of sugars‐sweetened beverages has been associated with weight gain and risk of cardiovascular disease in adults, though, it is not known if the intake of total sugars and particularly fructose‐containing sugars is associated with cardiovascular disease (CVD). We undertook a systematic review and meta‐analysis of cohort studies to quantify the relation of total sugars, sucrose, and fructose with incident CVD. Methods MEDLINE, EMBASE and Cochrane Library (through October 31, 2015) were searched for relevant studies. We included prospective cohort studies in humans investigating the association between total and individual fructose‐containing sugars and incident CVD. Two independent reviewers reviewed and extracted the relevant data and assessed study quality (Newcastle‐Ottawa Scale). Risk estimates of extreme comparisons (lowest versus highest quantile) were pooled using inverse variance random effects models and expressed as risk ratios (RR) with 95% confidence intervals (CIs). Inter‐study heterogeneity was assessed with Cochran Q statistic and quantified with the I 2 statistic. Results Eight prospective cohort comparisons (n = 512,343) involving 14,035 cases of CVD observed over an average of 11.9 years of follow‐up were eligible. Median total sugar intake was 55 g and 115 g in the lowest and highest quantile respectively. Total sugars intake was weakly associated with increased CVD risk (RR, 1.08 [95% CIs, 1.01 to 1.14]) with no evidence of heterogeneity (I 2 = 0%, p= 0.99). There was a weak positive association with total fructose intake (RR, 1.08 [95% CIs, 1.00 to 1.15]) but not total sucrose intake (RR, 0.95 [95% CIs, 0.87 to 1.04]) with no evidence of significant heterogeneity (I 2 <29%, P>0.24). Effect estimates were similar when stratified by sex. Limitations As the observed associations were weak and the 95% CIs for sucrose included potentially important benefit, measured and unmeasured residual confounding cannot be excluded. Conclusions Total sugars and fructose were weakly associated with increased CVD risk in eight large prospective cohort comparisons. Additional studies looking at important food sources of sugars other than sugars‐sweetened beverages may be helpful in better explaining the relationship between dietary sugars and CVD risk. Support or Funding Information Canadian Diabetes Association and PSI Foundation. https://clinicaltrials.gov/ct2/show/NCT01608620