Background and Purpose: Sugar- and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. We examined whether sugar- or artificially sweetened beverage consumption was associated with the prospective risks of incident stroke or dementia in the community-based Framingham Heart Study Offspring cohort.
Methods: 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).
Results: 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.
Conclusions: Artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia.
Using prospective data from the Framingham Offspring Cohort, the findings in Pase et al. cannot provide evidence or a plausible mechanism for a causal link between diet drinks’ consumption and stroke and dementia. Importantly, the suggested association with stroke and dementia attenuated or disappeared after adjusting for diabetes and vascular risk factors such as high blood pressure in this analysis.
Indeed, when prevalent hypertension, the single most important stroke risk factor, was taken into account in the statistical analysis, the association between diet drinks and incident all-stroke was attenuated. Similarly, the magnitude of the association of diet drinks with dementia decreased significantly when the authors considered the influence of diabetes as a potential confounding factor.
Notably, the findings of this observational study are based only on a small group of 97 cases of incident stroke and 81 cases of dementia out of a total of 2888 participants aged over 45 and 1484 participants over 60 who were included in the analysis for incident stroke and dementia, respectively. In addition, there was no convincing trend in risk, i.e. the hazard ratio of ischemic stroke was already about 2-fold elevated among occasional low-calorie sweetened beverage users.
Therefore, there is no evidence that low calorie sweetened drinks cause stroke or dementia on the basis of this analysis. For more information please read the ISA statement by clicking here.