Cross-sectional association between sugar-sweetened beverage intake and cardiometabolic biomarkers in US women

Br J Nutr. 2018 Mar;119(5):570-580. doi: 10.1017/S0007114517003841.


Few studies have evaluated the relationships between intake of sugar-sweetened beverages (SSB) and intermediate biomarkers of cardiometabolic risk. Associations between artificially sweetened beverages (ASB) and fruit juice with cardiometabolic biomarkers are also unclear. We investigated habitual SSB, ASB and fruit juice intake in relation to biomarkers of hepatic function, lipid metabolism, inflammation and glucose metabolism. We analysed cross-sectional data from 8492 participants in the Nurses' Health Study who were free of diabetes and CVD. Multivariate linear regression was used to assess the associations of SSB, ASB and fruit juice intake with concentrations of fetuin-A, alanine transaminase, γ-glutamyl transferase, TAG, HDL-cholesterol, LDL-cholesterol, total cholesterol, C-reactive protein (CRP), intracellular adhesion molecule 1 (ICAM-1), vascular cell adhesion protein 1, adiponectin, insulin and HbA1c as well as total cholesterol:HDL-cholesterol ratio. More frequent intake of SSB was significantly associated with higher concentrations of fetuin-A, TAG, CRP, ICAM-1, adiponectin and insulin, a higher total cholesterol:HDL-cholesterol ratio, and a lower concentration of HDL-cholesterol (P trend ranges from <0·0001 to 0·04) after adjusting for demographic, medical, dietary and lifestyle variables. ASB intake was marginally associated with increased concentrations of CRP (P trend=0·04) and adiponectin (P trend=0·01). Fruit juice intake was associated with increased concentrations of TAG and HbA1c and a lower concentration of adiponectin (P trend ranges from <0·0001 to 0·01). In conclusion, habitual intake of SSB was associated with adverse levels of multiple cardiometabolic biomarkers. Associations between ASB and fruit juice with cardiometabolic risk markers warrant further exploration.

Keywords: AHEI Alternative Healthy Eating Index; ASB artificially sweetened beverages; CRP C-reactive protein; SSB sugar-sweetened beverages; Artificially sweetened beverages; Cardiometabolic biomarkers; Fruit juices; Sugar-sweetened beverages.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adiponectin / blood
  • Aged
  • Beverages / adverse effects*
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • C-Reactive Protein / metabolism
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology*
  • Cross-Sectional Studies
  • Diet*
  • Dietary Sugars / administration & dosage
  • Dietary Sugars / adverse effects*
  • Feeding Behavior*
  • Female
  • Fruit
  • Fruit and Vegetable Juices / adverse effects
  • Glycated Hemoglobin / metabolism
  • Humans
  • Inflammation / etiology
  • Linear Models
  • Liver / drug effects
  • Middle Aged
  • Non-Nutritive Sweeteners / administration & dosage
  • Non-Nutritive Sweeteners / adverse effects
  • Sweetening Agents / administration & dosage
  • Sweetening Agents / adverse effects*
  • Triglycerides / blood
  • United States


  • Adiponectin
  • Biomarkers
  • Blood Glucose
  • Dietary Sugars
  • Glycated Hemoglobin A
  • Non-Nutritive Sweeteners
  • Sweetening Agents
  • Triglycerides
  • C-Reactive Protein