Artificially Sweetened Beverages and Risk of Stroke and Dementia

This week from Dr. Cerami and Utah Sports and Wellness

From: Stroke, April 2017

Quick Summary:

Sugar and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. This study examined whether sugar or artificially sweetened beverage consumption was associated with the prospective risks of incident stroke or dementia. The authors looked at three combinations: intake of total sugary beverages (soft drinks, fruit juice), intake of sugar sweetened soft drinks (high sugar carbonated) and intake of artificially sweetened soft drinks (sugar free carbonated). They found that greater recent consumption of artificially sweetened soft drinks was associated with an increased risk of stroke, with the strongest associations observed for ischemic stroke.  While higher cumulative intake of artificially sweetened soft drinks was also associated with an increased risk of ischemic stroke.

Abstract:

We studied 2888 participants aged >45 years for incident stroke (mean age 62 [SD, 9] years; 45% men) and 1484 participants aged >60 years for incident dementia (mean age 69 [SD, 6] years; 46% men). Beverage intake was quantified using a food-frequency questionnaire at cohort examinations 5 (1991-1995), 6 (1995-1998), and 7 (1998-2001). We quantified recent consumption at examination 7 and cumulative consumption by averaging across examinations. Surveillance for incident events commenced at examination 7 and continued for 10 years. We observed 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer’s disease). After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia. When comparing daily cumulative intake to 0 per week (reference), the hazard ratios were 2.96 (95% confidence interval, 1.26-6.97) for ischemic stroke and 2.89 (95% confidence interval, 1.18-7.07) for Alzheimer’s disease. Sugar-sweetened beverages were not associated with stroke or dementia. Artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia.

These authors also note:

• “Sugar- and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia.”
• Artificially sweetened beverages are typically sweetened with non-nutritive sweeteners, such as saccharin, acesulfame, aspartame, neotame, or sucralose.
• “When comparing daily cumulative intake [of artificial sweeteners] to 0 per week (reference), the hazard ratios were 2.96 for ischemic stroke and 2.89 for Alzheimer’s disease.” [This means that drinking intake of artificially sweetened soft drinks essentially tripled the risk of suffering both ischemic stroke and Alzheimer’s]. [The upper end of the risk range was an approximate 700% increased risk].
• “When examining cumulative beverage consumption, daily intake of artificially sweetened soft drink was associated with an increased risk of both all-cause dementia and AD dementia.”
• “To our knowledge, our study is the first to report an association between daily intake of artificially sweetened soft drink and an increased risk of both all cause dementia and dementia because of Alzheimer’s disease.”
• Diabetes is an important risk factor for both stroke and dementia; importantly, both sugar intake (including sweetened drinks) intake and artificially sweetened drinks intake increase the risk of diabetes. “Diabetes mellitus status was identified as a potential mediator of the association between artificially sweetened beverage intake and the risk of both incident all-cause dementia and AD dementia.”
• Artificial sweeteners cause glucose intolerance by altering gut microbiota and are associated with dysbiosis and glucose intolerance.
• “After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.”
•  “Sugar-sweetened beverages were not associated with stroke or dementia.”