In a recent study published in the European Journal of Clinical Nutrition, researchers used Mendelian randomization (MR) to explore the associations between the intake of pure fruit juices (PFJ) and sugar-sweetened beverages (SSBs) with cardiovascular disease (CVD).
Study: Association between sugar-sweetened beverages and pure fruit juice with risk of six cardiovascular diseases: a Mendelian randomization study. Image Credit: Andrii Zastrozhnov/Shutterstock.com
Background
Cardiovascular illnesses are a major worldwide health problem, with risk factors including high body mass index (BMI), alcohol use, and smoking habits.
SSBs and PFJ are associated with CVD; however, the causative relationship is uncertain. SSBs may be an elastic dietary target for lowering the CVD risk among females; however, PFJ may be a primary predictor.
However, several investigations have found no direct link between SSBs and CVD. PFJ use can increase important nutrient intake; however, one should limit intake due to the high free sugar and energy content.
The health consequences of PFJ consumption are inconsistent, and dietary advice differs among nations. The link between PFJ use and CVD mortality is unclear.
About the study
The present study researchers investigated whether SSB and PFJ consumption increased CVD risk.
The researchers assessed genetically estimated causal relationships between sugar-sweetened beverages, pure fruit juices [obtained from genome-wide association studies (GWAS) of European individuals], and six CVDs [hypertension, angina pectoris, atrial fibrillation (AF), coronary atherosclerosis (CA), acute myocardial infarction (AMI), and heart failure (HF)] using mendelian randomization.
The team obtained dietary intake data from the United Kingdom Biobank based on the Oxford WebQ 24-hour diet recall questionnaires filled out by 85,852 individuals. GWAS data on atrial fibrillation included 3,818 cases, with 333,381 control individuals. Angina data included 10,083 patients and 452,927 disease-free individuals.
AMI data included 3,927 patients and 333,272 control individuals. Coronary atherosclerosis data included 14,334 patients with 346,860 controls. Heart failure GWAS data included 1,405 patients with 359,789 control individuals. GWAS data on hypertension included 54,358 patients with 408,652 controls.
The researchers used the inverse variance weighted (IVW) approach for analysis, supplemented by the Cochran Q test, weighted median, MR Egger regressions, MR pleiotropy, Bonferroni corrections, and funnel plots.
To ensure that the primary analysis findings were robust, they calculated F-values as complementary tests to establish looser cut-offs for exposing the instrumental variables (IVs) and selected IVs by detecting single nucleotide polymorphisms (SNPs) strongly associated with PFJ and SSBs.
They determined odds ratios (OR) for the associations between SSB, PFJ intake, and CVD.
Results and discussion
The MR analysis showed genetically causal positive associations between sugar-sweetened beverages and atrial fibrillation (OR, 1.02) and negative associations between pure fruit juice and angina pectoris (OR, 0.97).
However, there were no causal relationships between SSB and PFJ intake and other cardiovascular disease risks. Supplementary MR methods yielded similar results.
The leave-one-out analysis showed that individual SNP removal did not alter the causal associations, indicating that the primary findings were reliable and robust.
SSB and PFJ intakes have distinct substance compositions, which can raise the chance of developing AF while decreasing the risk of angina. SSBs contain dietary additives such as sodium citrate, which may increase the risk of AF over time.
Excessive intake of SSBs can activate an inflammatory response, resulting in higher levels of circulating inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor receptors 1 and 2 (TNF-r1, r2). Higher IL-6 levels are associated with an increase in AF burden and mortality.
PFJ, on the other hand, has high levels of polyphenols, some of which have anti-inflammatory properties. Pomegranate juice can lower inflammatory indicators such as vascular cell adhesion molecule-1 (VCAM-1), E-selectin, and IL-6 due to its high concentration of hydrolyzable tannins.
PFJ’s anti-inflammatory properties may lower angina incidence by blocking platelet aggregation and preventing coronary plaque development.
Conclusions
The study findings revealed a positive relationship between sugar-sweetened beverages and atrial fibrillation, whereas pure fruit juice had a negative link with angina.
The findings should help us better understand the impact of long-term SSB/PFJ intake on cardiovascular disease (CVD) and recommend dietary choices for people who are at risk. Patients with AF should limit their SSB consumption to prevent potential pathogenic hazards, whereas individuals may incorporate PFJ into their diet as a protective factor against angina.
However, further clinical and fundamental research is required to confirm these findings. Future research should concentrate on non-European ancestry groups and study data on various types of SSBs/PFJ and consumption rates to better understand their impact on CVD.
Further research is needed to improve the understanding of their protective and pathogenic characteristics and assess their potential utility in clinical CVD prevention and therapy.
