TABLE 2.
Pooled Risk1 of cardiovascular events according to sugar-sweetened or artificially sweetened beverage intake categories and physical activity2 quintiles in 2 large United States cohorts
| Sugar-sweetened beverages | HR (95% CI) |
P-trend | HR (95% CI) per serving increment of SSB3 intake per day | |||||
|---|---|---|---|---|---|---|---|---|
| Never or <1 serving/mo | 1–4 servings/mo | 2–6 servings/wk | 1 to <2 servings/d | ≥2 servings/d | ||||
| Total cardiovascular disease | ||||||||
| HPFS (cases/person-years) | 1354/187,404 | 1906/266,714 | 2195/338,803 | 276/41,556 | 425/74,663 | |||
| NHS (cases/person-years) | 991/392,997 | 2669/727,712 | 2789/735,164 | 238/85,332 | 426/150,868 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 1.00 (0.95, 1.05) | 1.10 (1.05, 1.16) | 1.26 (1.15, 1.39) | 1.34 (1.24, 1.45) | <0.0001 | 1.26 (1.20, 1.32) | |
| Multivariable model | 1.00 | 1.04 (0.99, 1.10) | 1.13 (1.07, 1.19) | 1.23 (1.12, 1.36) | 1.25 (1.16, 1.36) | <0.0001 | 1.17 (1.12, 1.23) | |
| Multivariable model + AHEI | 1.00 | 1.04 (0.98, 1.09) | 1.11 (1.05, 1.17) | 1.20 (1.08, 1.32) | 1.21 (1.12, 1.32) | <0.0001 | 1.15 (1.09, 1.20) | |
| coronary artery disease | ||||||||
| HPFS (cases/person-years) | 1001/187,692 | 1435/267,136 | 1649/339,278 | 220/41,622 | 336/74,765 | |||
| NHS (cases/person-years) | 548/393,295 | 1389/728,575 | 1477/736,011 | 138/85,404 | 245/151,000 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 1.01 (0.94, 1.07) | 1.11 (1.04, 1.18) | 1.34 (1.19, 1.51) | 1.41 (1.28, 1.55) | <0.0001 | 1.30 (1.23, 1.38) | |
| Multivariable model | 1.00 | 1.06 (1.00, 1.13) | 1.14 (1.07, 1.22) | 1.30 (1.16, 1.46) | 1.31 (1.19, 1.45) | <0.0001 | 1.21 (1.14, 1.28) | |
| Multivariable model + AHEI | 1.00 | 1.05 (0.99, 1.12) | 1.12 (1.05, 1.19) | 1.25 (1.11, 1.41) | 1.25 (1.13, 1.39) | <0.0001 | 1.17 (1.10, 1.24) | |
| Stroke | ||||||||
| HPFS (cases/person-years) | 353/187,871 | 471/267,471 | 546/339,696 | 56/41,678 | 89/74,850 | |||
| NHS (cases/person-years) | 476/393,327 | 1326/728,488 | 1381/735,934 | 107/85,423 | 192/151,020 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.97 (0.89, 1.06) | 1.09 (1.00, 1.19) | 1.14 (0.96, 1.34) | 1.21 (1.05, 1.39) | <0.0001 | 1.18 (1.09, 1.28) | |
| Multivariable model | 1.00 | 0.99 (0.91, 1.08) | 1.10 (1.01, 1.20) | 1.11 (0.93, 1.31) | 1.13 (0.98, 1.31) | 0.01 | 1.11 (1.02, 1.21) | |
| Multivariable model + AHEI | 1.00 | 0.99 (0.91, 1.08) | 1.09 (1.00, 1.19) | 1.10 (0.92, 1.30) | 1.12 (0.97, 1.29) | 0.02 | 1.11 (1.02, 1.20) | |
| Artificially sweetened beverages | HR (95% CI) |
|||||||
|---|---|---|---|---|---|---|---|---|
| Never or <1 serving/mo | 1–4 servings/mo | 2–6 servings/wk | 1 to <2 servings/d | ≥2 servings/d | P-trend | HR (95% CI) per serving increment of ASB3 intake per day | ||
| Total cardiovascular disease | ||||||||
| HPFS (cases/person-years) | 1906/266,941 | 1378/188,107 | 1774/266,083 | 296/50,244 | 802/137,764 | |||
| NHS (cases/person-years) | 2692/774,993 | 1199/344,166 | 1585/487,216 | 632/184,325 | 1005/301,373 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.91 (0.87, 0.96) | 0.93 (0.89, 0.97) | 1.04 (0.97, 1.12) | 1.09 (1.04, 1.16) | <0.0001 | 1.07 (1.04, 1.10) | |
| Multivariable model | 1.00 | 0.94 (0.90, 0.99) | 0.94 (0.90, 0.98) | 1.02 (0.95, 1.10) | 1.02 (0.96, 1.08) | 0.11 | 1.02 (0.99, 1.05) | |
| Multivariable model + AHEI | 1.00 | 0.95 (0.90, 1.00) | 0.95 (0.91, 0.99) | 1.03 (0.96, 1.10) | 1.03 (0.97, 1.09) | 0.06 | 1.03 (1.00, 1.06) | |
| coronary artery disease | ||||||||
| HPFS (cases/person-years) | 1448/267,352 | 1059/188,387 | 1308/266,499 | 219/50,313 | 607/137,939 | |||
| NHS (cases/person-years) | 1452/775,826 | 629/344,545 | 849/487,721 | 329/184,504 | 538/301,689 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.91 (0.86, 0.97) | 0.92 (0.87, 0.97) | 1.01 (0.92, 1.11) | 1.10 (1.03, 1.18) | 0.0003 | 1.07 (1.03, 1.11) | |
| Multivariable model | 1.00 | 0.95 (0.89, 1.01) | 0.92 (0.87, 0.98) | 0.97 (0.88, 1.07) | 1.00 (0.93, 1.08) | 0.61 | 1.01 (0.97, 1.05) | |
| Multivariable model + AHEI | 1.00 | 0.95 (0.90, 1.02) | 0.94 (0.88, 0.99) | 0.98 (0.89, 1.08) | 1.01 (0.94, 1.09) | 0.42 | 1.02 (0.98, 1.05) | |
| Stroke | ||||||||
| HPFS (cases/person-years) | 458/267,729 | 319/188,627 | 466/266,738 | 77/50,370 | 195/138,102 | |||
| NHS (cases/person-years) | 1292/775,823 | 596/344,501 | 781/487,702 | 321/184,495 | 492/301,670 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.92 (0.85, 1.00) | 0.96 (0.89, 1.03) | 1.11 (1.00, 1.24) | 1.09 (1.00, 1.20) | 0.002 | 1.07 (1.03, 1.12) | |
| Multivariable model | 1.00 | 0.95 (0.87, 1.03) | 0.98 (0.91, 1.06) | 1.11 (1.00, 1.24) | 1.06 (0.97, 1.17) | 0.03 | 1.05 (1.00, 1.10) | |
| Multivariable model + AHEI |
1.00 |
0.95 (0.88, 1.03) |
0.98 (0.91, 1.06) |
1.12 (1.00, 1.25) |
1.07 (0.97, 1.17) |
0.03 |
1.05 (1.01, 1.10) |
|
| Physical activity |
HR (95% CI) | |||||||
| Quintile 1 (0 to ≤3.0) |
Quintile 2 (>3.0 to ≤8.4) |
Quintile 3 (>8.4 to ≤17.8) |
Quintile 4 (>17.8 to ≤35.1) |
Quintile 5 (>35.1) |
P-trend |
|||
| Total cardiovascular disease | ||||||||
| HPFS (cases/person-years) | 1924/178,321 | 1239/181,529 | 1105/182,492 | 990/183,382 | 898/183,415 | |||
| NHS (cases/person-years) | 2205/413,395 | 1520/418,327 | 1262/417,294 | 1163/421,176 | 963/421,881 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.72 (0.69, 0.76) | 0.66 (0.62, 0.69) | 0.61 (0.58, 0.64) | 0.54 (0.51, 0.57) | <0.0001 | ||
| Multivariable model | 1.00 | 0.78 (0.74, 0.82) | 0.74 (0.70, 0.78) | 0.71 (0.67, 0.75) | 0.65 (0.61, 0.69) | <0.0001 | ||
| Multivariable model + AHEI | 1.00 | 0.78 (0.74, 0.82) | 0.74 (0.71, 0.78) | 0.72 (0.68, 0.76) | 0.66 (0.63, 0.70) | <0.0001 | ||
| coronary artery disease | ||||||||
| HPFS (cases/person-years) | 1524/178,645 | 916/181,811 | 847/182,731 | 697/183,661 | 657/183,644 | |||
| NHS (cases/person-years) | 1221/414,038 | 806/418,789 | 657/417,706 | 589/421,559 | 524/422,193 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.68 (0.64, 0.73) | 0.63 (0.59, 0.67) | 0.55 (0.52, 0.59) | 0.52 (0.49, 0.56) | <0.0001 | ||
| Multivariable model | 1.00 | 0.75 (0.71, 0.80) | 0.73 (0.68, 0.78) | 0.67 (0.62, 0.71) | 0.65 (0.61, 0.70) | <0.0001 | ||
| Multivariable model + AHEI | 1.00 | 0.76 (0.71, 0.80) | 0.74 (0.70, 0.79) | 0.68 (0.64, 0.73) | 0.67 (0.63, 0.72) | <0.0001 | ||
| Stroke | ||||||||
| HPFS (cases/person-years) | 400/178,905 | 323/182,010 | 258/182,987 | 293/183,828 | 241/183,837 | |||
| NHS (cases/person-years) | 1033/413,964 | 746/418,790 | 634/417,681 | 608/421,538 | 461/422,220 | |||
| Pooled risk | ||||||||
| Age-adjusted model | 1.00 | 0.79 (0.73, 0.86) | 0.70 (0.64, 0.76) | 0.72 (0.66, 0.78) | 0.58 (0.53, 0.63) | <0.0001 | ||
| Multivariable model | 1.00 | 0.83 (0.76, 0.90) | 0.75 (0.69, 0.82) | 0.79 (0.73, 0.86) | 0.64 (0.59, 0.71) | <0.0001 | ||
| Multivariable model + AHEI | 1.00 | 0.83 (0.77, 0.90) | 0.75 (0.69, 0.82) | 0.80 (0.73, 0.87) | 0.64 (0.59, 0.71) | <0.0001 | ||
Total sample size, n = 105,148 (HPFS, n = 39,418; NHS, n = 65,730). Sugar-sweetened beverages and alcohol intake were removed from the AHEI calculation.
Abbreviations: AHEI, Alternative Healthy Eating Index; HPFS, Health Professionals Follow-up Study; MET, metabolic equivalent task; NHS, Nurses’ Health Study.
1
HRs and 95% CIs derived from the age-adjusted and multivariable model adjusted for age; race; ethnicity; physical activity (excluded in the physical activity as main exposure models); smoking status; alcohol intake; multivitamin use; in women, postmenopausal status and menopausal hormone use; family history of myocardial infarction; baseline hypertension; baseline hypercholesterolemia; calorie intake; and body mass index.
2
Physical activity was measured in MET h/wk.
3
One serving increment of sugar-sweetened or artificially sweetened beverage intake per day, where appropriate.