Sugars and risk of mortality in the NIH-AARP Diet and Health Study

Abstract

Background: Although previous studies have linked intake of sugars with incidence of cancer and other chronic diseases, its association with mortality remains unknown.

Objective: We investigated the association of total sugars, added sugars, total fructose, added fructose, sucrose, and added sucrose with the risk of all-cause, cardiovascular disease, cancer, and other-cause mortality in the NIH-AARP Diet and Health Study.

Design: The participants (n = 353,751), aged 50-71 y, were followed for up to 13 y. Intake of individual sugars over the previous 12 mo was assessed at baseline by using a 124-item NIH Diet History Questionnaire.

Results: In fully adjusted models (fifth quartile compared with first quartile), all-cause mortality was positively associated with the intake of total sugars [HR (95% CI): 1.13 (1.06, 1.20); P-trend < 0.0001], total fructose [1.10 (1.04, 1.17); P-trend < 0.0001], and added fructose [1.07 (1.01, 1.13); P-trend = 0.005) in women and total fructose [1.06 (1.01, 1.10); P-trend = 0.002] in men. In men, a weak inverse association was found between other-cause mortality and dietary added sugars (P-trend = 0.04), sucrose (P-trend = 0.03), and added sucrose (P-trend = 0.006). Investigation of consumption of sugars by source showed that the positive association with mortality risk was confined only to sugars from beverages, whereas the inverse association was confined to sugars from solid foods.

Conclusions: In this large prospective study, total fructose intake was weakly positively associated with all-cause mortality in both women and men, whereas added sugar, sucrose, and added sucrose intakes were inversely associated with other-cause mortality in men. In our analyses, intake of added sugars was not associated with an increased risk of mortality. The NIH-AARP Diet and Health Study was registered at clinicaltrials.gov as NCT00340015.

Figures

FIGURE 1.

HRs and 95% CIs for all-cause mortality for quintile 5 compared with quintile 1 of sugar intake by smoking status in women (A) and men (B) in the NIH-AARP Diet and Health Study in fully adjusted models. A: Women (never smokers: n = 65,593, n = 4488 deaths; ever smokers: n = 76,308, n = 9868 deaths). B: Men (never smokers: n = 64,443, n = 5698 deaths; ever smokers: n = 133,553, n = 21,551 deaths). The dots indicate HRs, and the horizontal lines indicate 95% CIs. 1Cox proportional hazards regression model adjusted for age, BMI (in kg/m2; <18.5, ≥18.5 to <25, ≥25 to <30, ≥30 to <35, ≥35, or missing), marital status (married/living as married or widowed/divorced/separated/never married/unknown), family history of cancer (yes or no/unknown), smoking (only in ever smokers: quit ≥10 y ago, quit 5–9 y ago, quit 1–4 y ago, quit <1 y ago ≤20 cigarettes/d, quit <1 y ago >20 cigarettes/d, current ≤20 cigarettes/d, current 20–40 cigarettes/d, current >40 cigarettes /d, or missing), race (white, black, Hispanic/Asian/Pacific Islander/American Indian/Alaskan native, or unknown/missing), education (less than high school, high school graduate, some college, college graduate, or unknown/missing), physical activity (never/rarely, 1–3 times/mo, 1–2 times/wk, 3–4 times/wk, ≥5 times/wk, or unknown/missing), history of hypertension (no, yes, or unknown/missing), hypercholesterolemia (no, yes, or unknown/missing), use of aspirin (no, monthly, weekly, daily, or missing), and intake of energy (continuous), saturated fat (quintiles), polyunsaturated fat (quintiles), red meat (quintiles), vegetables (quintiles), and alcohol (quintiles). 2P-trend ≤ 0.05. 3P-trend < 0.01.