Consumption of sugar-sweetened beverages (SSBs) is associated with adverse changes in lipid profiles, including low high-density lipoprotein cholesterol (HDL-C) and high triglyceride concentrations, whereas consumption of low-calorie sweetened beverages and limited amounts of 100% fruit juice do not have the same effect, according to study results published in the Journal of the American Heart Association.

Previous studies have reported a positive association between consumption of SSBs, including sodas, fruit-flavored drinks, sports drinks, and presweetened coffees and teas, and cardiovascular risk. One of the potential mechanisms for this association is through the effect of these added sugars on lipoprotein levels. The goal of the current study was to assess the association between SSBs, low-calorie sweetened beverages, and fruit juice consumption and changes in lipoprotein concentrations.

The researchers collected diet and lipid measures on 3146 individuals in the Framingham Offspring Study (1991-2014) and 3584 in the Generation 3 (2002-2011) cohorts, including 3182 and 2805 in the analyses, respectively, with available data from ≥2 consecutive examination periods. Beverage consumption was stratified using 5 categories of intake: <1 serving per month, 1 to 4 servings per month, 1 to 2 servings per week, 3 to 7 servings per week, or >1 serving per day. Beverage exposure was estimated as recent intake (ie, intake at the examination before developing dyslipidemia) and as cumulative average intake.

After multivariable adjustment for potential confounders and change in abdominal adiposity, individuals in the highest category for SSB intake (>1 serving per day) had a 1.6 mg/dL lower mean 4-year change in HDL-C concentrations (β±SE: -1.6±0.4 mg/dL; P <.0001 for trend) and a 4.4 mg/dL higher mean 4-year change in triglyceride concentrations (β±SE: 4.4±2.2 mg/dL; P =.003 for trend) compared with those in the lowest category for SSB intake (<1 serving per month).

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Individuals in the highest category for low-calorie sweetened beverage consumption had mean 4-year changes in HDL-C concentrations that were 0.7 mg/dL lower than those in people in the lowest intake category (β±SE: -0.7±0.2 mg/dL; P =.001 for trend).

During a mean follow-up of 12.5 years in the Offspring Study cohort, the incidence of high triglyceride levels was significantly higher among individuals in the highest compared with the lowest category of cumulative SSB consumption (adjusted hazard ratio [HR], 1.52; 95% CI, 1.03-2.25; P =.03 for trend). The highest recent low-calorie sweetened beverage consumers had a 40% higher incidence of high non-HDL-C (HR, 1.40; 95% CI, 1.17-1.69; P =.0002 for trend) and 27% higher incidence of high low-density lipoprotein cholesterol levels (HR, 1.27; 95% CI, 1.05-1.53; P =.01 for trend) compared with the lowest low-calorie sweetened beverage consumers, but these associations were attenuated using cumulative average intakes.

Consumption of fruit juice was not significantly associated with the development of dyslipidemia, but there was suggestion of a lower incidence of high non-HDL-C observed in the highest compared with the lowest fruit juice consumers (HR, 0.75; 95% CI, 0.56-1.00; P =.34 for trend).

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Over a mean follow-up of 6.1 years in the Generation 3 cohort, results for the association between recent sweetened beverage consumption were nonsignificant, suggesting a less prominent role among these younger, lower-risk individuals.

The researchers acknowledged several study limitations, including the use of self-reported dietary data, lack of data on changes in diet prescribed to patients diagnosed with dyslipidemia, and additional unmeasured confounders.

“These findings are consistent with current recommendations to limit SSB consumption and emphasize the need for further research to inform recommendations related to [low-calorie sweetened beverage] and [fruit juice] consumption,” concluded the researchers.


Haslam DE, Peloso GM, Herman MA, et al. Beverage consumption and longitudinal changes in lipoprotein concentrations and incident dyslipidemia in US adults: the Framingham Heart Study. J Am Heart Assoc. 2020;9:e014083.