Sugary Beverages Pose Significant Risks to Cardiovascular and Overall Health

  • Antonis S Manolis Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
  • Theodora A Manolis Red Cross Hospital, Athens
Keywords: sugary beverages, sugar-sweetened beverages, soft drinks, sodas, colas, added sugars, cardiovascular disease


Consumption of added sugar is associated with weight gain and metabolic syndrome, but most importantly with cardiovascular disease (CVD) morbidity and mortality. Sugar-sweetened beverages (SSBs) in the form of soft drinks or sodas constitute a major source of added sugar with its attendant ill effects on health. Of particular concern is the rising consumption of soft drinks among young people. The World Health Organization (WHO) recommends the reduction of free sugars to <10% of total energy intake due to their potential implications in dental caries, weight gain and CVD consequences, however, adherence to this recommendation is generally very low. Non-caloric drinks in the form of artificially sweetened beverages (ASBs) (diet sodas) are popular as alternatives to SSBs. However, these sweeteners may also have various negative, albeit at a lesser degree, health outcomes, including weight gain, obesity, metabolic syndrome, type II diabetes, and CV events. Finally, substantially lower health risks are incurred from 100% fruit juice consumption compared with SSBs. All these issues are herein reviewed and measures are discussed to lessen the consequences of such an unhealthy dietary behavior. Rhythmos 2019;14(3):45-50.


Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in U.S. between 1977 and 1996: similar shifts seen across age groups. Obes Res 2002;10:370-8.

USDHHS. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at /.2015-2020 Dietary Guidelines for Americans. US Department of Health and Human Services. 2015.

Manolis AS. You Are What You Eat, Hence Curtail Saturated and Trans Fats, Free Sugars and Salt. Rhythmos 2016;11:28-38.

Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004;79:537-43.

Elliott SS, Keim NL, Stern JS, Teff K, Havel PJ. Fructose, weight gain, and the insulin resistance syndrome. Am J Clin Nutr 2002;76:911-22.

Brown CM, Dulloo AG, Montani JP. Sugary drinks in the pathogenesis of obesity and cardiovascular diseases. Int J Obes (Lond) 2008;32 Suppl 6:S28-34.

Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274-88.

Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. Bmj 2012;346:e7492.

Malik VS, Popkin BM, Bray GA, et al. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010;33:2477-83.

Yang Q, Zhang Z, Gregg EW, et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 2014;174:516-24.

Haslam D, Peloso G, Herman M, et al. Beverage Consumption and Longitudinal Changes in Lipid Concentrations and Incident Dyslipidemia in U.S. Adults: The Framingham Heart Study (P18-017-19). Curr Dev Nutr 2019;3.

Collin LJ, Judd S, Safford M, Vaccarino V, Welsh JA. Association of Sugary Beverage Consumption With Mortality Risk in US Adults: A Secondary Analysis of Data From the REGARDS Study. JAMA Netw Open 2019;2:e193121.

Pase MP, Himali JJ, Jacques PF, et al. Sugary beverage intake and preclinical Alzheimer's disease in the community. Alzheimers Dement 2017;13:955-64.

Chatelan A, Gaillard P, Kruseman M, Keller A. Total, Added, and Free Sugar Consumption and Adherence to Guidelines in Switzerland: Results from the First National Nutrition Survey menuCH. Nutrients 2019;11.

Graffe MIM, Pala V, De Henauw S, et al. Dietary sources of free sugars in the diet of European children: the IDEFICS Study. Eur J Nutr 2019.

Brown RJ, de Banate MA, Rother KI. Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes 2010;5:305-12.

Swithers SE. Artificial sweeteners are not the answer to childhood obesity. Appetite 2015;93:85-90.

Nettleton JA, Lutsey PL, Wang Y, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2009;32:688-94.

Swithers SE. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends Endocrinol Metab 2013;24:431-41.

Vyas A, Rubenstein L, Robinson J, et al. Diet drink consumption and the risk of cardiovascular events: a report from the Women's Health Initiative. J Gen Intern Med 2015;30:462-8.

Mossavar-Rahmani Y, Kamensky V, Manson JE, et al. Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative. Stroke 2019;50:555-62.

Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. Bmj 2013;347:f5001.

Imamura F, O'Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. Bmj 2015;351:h3576.

Scheffers FR, Boer JMA, Verschuren WMM, et al. Pure fruit juice and fruit consumption and the risk of CVD: the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study. Br J Nutr 2019;121:351-59.

Guasch-Ferre M, Hu FB. Are Fruit Juices Just as Unhealthy as Sugar-Sweetened Beverages? JAMA Netw Open 2019;2:e193109.

Auerbach BJ, Dibey S, Vallila-Buchman P, Kratz M, Krieger J. Review of 100% Fruit Juice and Chronic Health Conditions: Implications for Sugar-Sweetened Beverage Policy. Adv Nutr 2018;9:78-85.

Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. Jama 1999;282:1233-9.

Liu K, Xing A, Chen K, et al. Effect of fruit juice on cholesterol and blood pressure in adults: a meta-analysis of 19 randomized controlled trials. PLoS One 2013;8:e61420.

Wang B, Liu K, Mi M, Wang J. Effect of fruit juice on glucose control and insulin sensitivity in adults: a meta-analysis of 12 randomized controlled trials. PLoS One 2014;9:e95323.

Yuan C, Fondell E, Bhushan A, et al. Long-term intake of vegetables and fruits and subjective cognitive function in US men. Neurology 2019;92:e63-e75.

Fardet A, Richonnet C, Mazur A. Association between consumption of fruit or processed fruit and chronic diseases and their risk factors: a systematic review of meta-analyses. Nutr Rev 2019;77:376-87.

Heyman MB, Abrams SA. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics 2017;139.

Fidler Mis N, Braegger C, Bronsky J, et al. Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017;65:681-96.

Huang Y, Kypridemos C, Liu J, et al. Cost-Effectiveness of the US Food and Drug Administration Added Sugar Labeling Policy for Improving Diet and Health. Circulation 2019;139:2613-24.

Vos MB, Kaar JL, Welsh JA, et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. Circulation 2017;135:e1017-e34.

Anderson CAM, Thorndike AN, Lichtenstein AH, et al. Innovation to Create a Healthy and Sustainable Food System: A Science Advisory From the American Heart Association. Circulation 2019;139:e1025-e32.