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Original Contribution
April 21, 2010

Caloric Sweetener Consumption and Dyslipidemia Among US Adults

Author Affiliations

Author Affiliations: Nutrition and Health Science Program, Graduate Division of Biological and Biomedical Sciences (Ms Welsh and Drs Sharma, Vaccarino, and Vos), Department of Epidemiology, Rollins School of Public Health (Drs Abramson and Vaccarino), Division of Cardiology, School of Medicine (Dr Vaccarino), Department of Pediatrics, Gastroenterology, Hepatology and Nutrition, School of Medicine (Dr Vos), Emory University; Children's Healthcare of Atlanta (Ms Welsh and Dr Vos); and Divisions of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (Dr Sharma) and Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (Dr Gillespie), Atlanta, Georgia.

JAMA. 2010;303(15):1490-1497. doi:10.1001/jama.2010.449

Context Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovascular disease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures.

Objective To assess the association between consumption of added sugars and blood lipid levels in US adults.

Design, Setting, and Participants Cross-sectional study among US adults (n = 6113) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (< 5% [reference group], 5%-<10%, 10%-<17.5%, 17.5%-<25%, and ≥25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated.

Main Outcome Measures Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (<40 mg/dL for men; <50 mg/dL for women), high triglyceride levels (≥150 mg/dL), high LDL-C levels (≥130 mg/dL), or high ratio of triglycerides to HDL-C (>3.8). Results were weighted to be representative of the US population.

Results A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 10%, 10% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P < .001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P < .001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P = .047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (≥10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (<5% added sugars).

Conclusion In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.