Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Dietary sugar intake was associated with increased body fatness but decreased cardiovascular mortality in Chinese elderly: an 11-year prospective study of Mr and Ms OS of Hong Kong

Abstract

Background/Objectives:

Epidemiological studies suggest that sugar intake contributes to weight gain and increased risk of cardiovascular diseases (CVDs). However, this association is largely undefined in the elderly population. Our aim was to investigate the effect of sugar consumption on the subsequent changes in body fatness and CVD mortality in Chinese elderly.

Methods:

A total of 2000 men and 2000 women aged 65 years were recruited from 2001 to 2003. Dietary sugar intake was estimated based on a validated 329-item food frequency questionnaire and a local sugar database. Adiposity was measured using dual-energy X-ray absorptiometry at baseline and follow-up after 4 years. Mortality was ascertained by local death registry until March 2014. Multivariable linear and Cox regression were conducted to evaluate the association of sugar consumption on the changes in body fatness and CVD mortality.

Results:

A total of 174 CVD deaths were documented within the total 37 999 person-years’ follow-up. Significant positive association between sugar intake and increase in body fatness at follow-up after 4 years was found in men but not in women. After adjustment for potential confounders, men who consumed 1% increase in added sugar had an increase in whole body fat by 0.043 kg (P=0.006), central fat by 0.029 kg (P=0.016) and peripheral fat by 0.026 kg (P=0.006). However, in both genders, after an average of 11.1-year follow-up, compared with the lowest quintile, the highest intakes of added sugar were associated with significantly lowered CVD mortality by 74.9% (hazard ratio (HR) (95% confidence interval (CI)): 0.251(0.070, 0.899)) in a dose–response manner (Ptrend=0.011). This association was attenuated to non-significance by further adjustment of the change in body fatness (Ptrend=0.055).

Conclusions:

Thus higher sugar intake of the Chinese elderly was associated with increased adiposity in men but decreased CVD mortality. The current World Health Organization recommendation for the elderly should be reviewed.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. 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 2013; 346: e7492.

    Article  Google Scholar 

  2. Malik VS, Willett WC, Hu FB . Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. Am J Clin Nutr 2009; 89: 438–439 author reply 9–40.

    CAS  Article  Google Scholar 

  3. Qi Q, Chu AY, Kang JH, Jensen MK, Curhan GC, Pasquale LR et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012; 367: 1387–1396.

    CAS  Article  Google Scholar 

  4. Bray GA, Popkin BM . Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care 2014; 37: 950–956.

    CAS  Article  Google Scholar 

  5. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB . Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 2014; 174: 516–524.

    CAS  Article  Google Scholar 

  6. Mattes RD, Shikany JM, Kaiser KA, Allison DB . Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments. Obes Rev 2011; 12: 346–365.

    CAS  Article  Google Scholar 

  7. Forshee RA, Anderson PA, Storey ML . Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis. Am J Clin Nutr 2008; 87: 1662–1671.

    CAS  Article  Google Scholar 

  8. Trumbo P, Schlicker S, Yates AA, Poos M . Food, Nutrition Board of the Institute of Medicine TNA. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002; 102: 1621–1630.

    Article  Google Scholar 

  9. WHO. Guideline: Sugars Intake for Adults and Children, 2015. WHO: Geneva, Switzerland, 1–49 pp (accessed on 13 October 2015). Available from http://www.who.int/nutrition/publications/guidelines/sugar_intake_information_note_en.pdf?ua=1.

  10. Moynihan PJ, Kelly SAM . Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res 2014; 93: 8–18.

    CAS  Article  Google Scholar 

  11. Kaeberlein M, Rabinovitch PS, Martin GM . Healthy aging: the ultimate preventative medicine. Science 2015; 350: 1191–1193.

    CAS  Article  Google Scholar 

  12. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L et al. Defining and setting National goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation 2010; 121: 586–613.

    Article  Google Scholar 

  13. Louie JC, Moshtaghian H, Rangan AM, Flood VM, Gill TP . Intake and sources of added sugars among Australian children and adolescents. Eur J Nutr 2015; 55: 2347–2355.

    Article  Google Scholar 

  14. Lei L, Rangan A, Flood VM, Louie JC . Dietary intake and food sources of added sugar in the Australian population. Br J Nutr 2016; 115: 868–877.

    CAS  Article  Google Scholar 

  15. Li D, Yu D, Zhao L . [Trend of sugar-sweetened beverage consumption and intake of added sugar in China nine provinces among adults]. Wei Sheng Yan Jiu 2014; 43: 70–72.

    PubMed  Google Scholar 

  16. Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL . Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010. Am J Clin Nutr 2013; 98: 180–188.

    CAS  Article  Google Scholar 

  17. Woo J, Leung SSF, Ho SC, Lam TH, Janus ED . A food frequency questionnaire for use in the Chinese population in Hong Kong: description and examination of validity. Nutr Res 1997; 17: 1633–1641.

    CAS  Article  Google Scholar 

  18. Johnson DB, Bruemmer B, Lund AE, Evens CC, Mar CM . Impact of school district sugar-sweetened beverage policies on student beverage exposure and consumption in middle schools. J Adolesc Health 2009; 45 (3 Suppl): S30–S37.

    Article  Google Scholar 

  19. Agriculture. USDo. USDA Database for the Added Sugars Content of Selected Foods, Release 1, 2009 last accessed 18 February 2013. Available from: http://www.ars.usda.gov/services/docs.htm?docid=12107.

  20. Food Nutrient Finder [database on the Internet]. The Government of Hong Kong Special Administrative Region. 2009 [cited 26 October 2015]. Available from: http://www.cfs.gov.hk/english/nutrient/search1.php.

  21. Millen AE, Midthune D, Thompson FE, Kipnis V, Subar AF . The National Cancer Institute diet history questionnaire: validation of pyramid food servings. Am J Epidemiol 2006; 163: 279–288.

    Article  Google Scholar 

  22. Louie JC, Moshtaghian H, Boylan S, Flood VM, Rangan AM, Barclay AW et al. A systematic methodology to estimate added sugar content of foods. Eur J Clin Nutr 2015; 69: 154–161.

    CAS  Article  Google Scholar 

  23. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB . Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364: 2392–2404.

    CAS  Article  Google Scholar 

  24. Washburn RA, Smith KW, Jette AM, Janney CA . The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 1993; 46: 153–162.

    CAS  Article  Google Scholar 

  25. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009; 120: 1011–1020.

    CAS  Article  Google Scholar 

  26. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 2007; 116: 480–488.

    Article  Google Scholar 

  27. Price GM, Uauy R, Breeze E, Bulpitt CJ, Fletcher AE . Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 2006; 84: 449–460.

    CAS  Article  Google Scholar 

  28. Chen L, Appel LJ, Loria C, Lin PH, Champagne CM, Elmer PJ et al. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J Clin Nutr 2009; 89: 1299–1306.

    CAS  Article  Google Scholar 

  29. Malik VS, Schulze MB, Hu FB . Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84: 274–288.

    CAS  Article  Google Scholar 

  30. Vartanian LR, Schwartz MB, Brownell KD . Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 2007; 97: 667–675.

    Article  Google Scholar 

  31. Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA . Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol 2010; 171: 701–708.

    Article  Google Scholar 

  32. Lowndes J, Sinnett S, Pardo S, Nguyen VT, Melanson KJ, Yu Z et al. The effect of normally consumed amounts of sucrose or high fructose corn syrup on lipid profiles, body composition and related parameters in overweight/obese subjects. Nutrients 2014; 6: 1128–1144.

    Article  Google Scholar 

  33. Lowndes J, Sinnett S, Yu Z, Rippe J . The effects of fructose-containing sugars on weight, body composition and cardiometabolic risk factors when consumed at up to the 90th percentile population consumption level for fructose. Nutrients 2014; 6: 3153–3168.

    Article  Google Scholar 

  34. Valente H, Teixeira V, Padrao P, Bessa M, Cordeiro T, Moreira A et al. Sugar-sweetened beverage intake and overweight in children from a Mediterranean country. Public Health Nut 2011; 14: 127–132.

    Article  Google Scholar 

  35. Nicklas TA, O'Neil CE, Liu Y . Intake of added sugars is not associated with weight measures in children 6 to 18 years: National Health and Nutrition Examination Surveys 2003-2006. Nutr Res 2011; 31: 338–346.

    CAS  Article  Google Scholar 

  36. Malik VS, Pan A, Willett WC, Hu FB . Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 2013; 98: 1084–1102.

    CAS  Article  Google Scholar 

  37. Bachman CM, Baranowski T, Nicklas TA . Is there an association between sweetened beverages and adiposity? Nutr Rev 2006; 64: 153–174.

    Article  Google Scholar 

  38. Gibson S . Dietary sugars and micronutrient dilution in normal adults aged 65 years and over. Public Health Nutr 2001; 4: 1235–1244.

    CAS  Article  Google Scholar 

  39. Bueno MB, Marchioni DM, Cesar CL, Fisberg RM . Added sugars: consumption and associated factors among adults and the elderly. Sao Paulo, Brazil. Rev Bras Epidemiol 2012; 15: 256–264.

    Article  Google Scholar 

  40. Woo J, Ho SC, Sham A . Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatr Soc 2001; 49: 737–746.

    CAS  Article  Google Scholar 

  41. Takata Y, Ansai T, Soh I, Akifusa S, Sonoki K, Fujisawa K et al. Association between body mass index and mortality in an 80-year-old population. J Am Geriatr Soc 2007; 55: 913–917.

    Article  Google Scholar 

  42. Veronese N, Cereda E, Solmi M, Fowler SA, Manzato E, Maggi S et al. Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects. Obes Rev 2015; 16: 1001–1015.

    CAS  Article  Google Scholar 

  43. Lee JS, Auyeung TW, Chau PP, Hui E, Chan F, Chi I et al. Obesity can benefit survival-a 9-year prospective study in 1614 Chinese nursing home residents. J Am Med Dir Assoc 2014; 15: 342–348.

    Article  Google Scholar 

  44. Auyeung TW, Lee JS, Leung J, Kwok T, Leung PC, Woo J . Survival in older men may benefit from being slightly overweight and centrally obese—a 5-year follow-up study in 4,000 older adults using DXA. J Gerontol Ser A Biol Sci Med Sci 2010; 65: 99–104.

    Article  Google Scholar 

  45. Flicker L, McCaul KA, Hankey GJ, Jamrozik K, Brown WJ, Byles JE et al. Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc 2010; 58: 234–241.

    Article  Google Scholar 

  46. de Ruijter W, Westendorp RG, Assendelft WJ, den Elzen WP, de Craen AJ, le Cessie S et al. Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ 2009; 338: a3083.

    Article  Google Scholar 

  47. Motta M, Bennati E, Cardillo E, Passamonte M, Ferlito L, Malaguarnera M . The metabolic syndrome (MS) in the elderly: considerations on the diagnostic criteria of the International Diabetes Federation (IDF) and some proposed modifications. Arch Gerontol Geriatr 2009; 48: 380–384.

    Article  Google Scholar 

  48. Lindqvist P, Andersson K, Sundh V, Lissner L, Bjorkelund C, Bengtsson C . Concurrent and separate effects of body mass index and waist-to-hip ratio on 24-year mortality in the Population Study of Women in Gothenburg: evidence of age-dependency. Eur J Epidemiol 2006; 21: 789–794.

    Article  Google Scholar 

  49. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105–2120.

    CAS  Article  Google Scholar 

  50. Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML, Campbell PT et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med 2010; 170: 1293–1301.

    Article  Google Scholar 

  51. Gibson SA . Dietary sugars intake and micronutrient adequacy: a systematic review of the evidence. Nutr Res Rev 2007; 20: 121–131.

    CAS  Article  Google Scholar 

  52. Westerbacka J, Corner A, Tiikkainen M, Tamminen M, Vehkavaara S, Hakkinen AM et al. Women and men have similar amounts of liver and intra-abdominal fat, despite more subcutaneous fat in women: implications for sex differences in markers of cardiovascular risk. Diabetologia 2004; 47: 1360–1369.

    CAS  Article  Google Scholar 

  53. Lafay L, Mennen L, Basdevant A, Charles MA, Borys JM, Eschwege E et al. Does energy intake underreporting involve all kinds of food or only specific food items? Results from the Fleurbaix Laventie Ville Sante (FLVS) study. Int J Obes Relat Metab Disord 2000; 24: 1500–1506.

    CAS  Article  Google Scholar 

  54. Scagliusi FB, Polacow VO, Artioli GG, Benatti FB, Lancha AH Jr . Selective underreporting of energy intake in women: magnitude, determinants, and effect of training. J Am Diet Assoc 2003; 103: 1306–1313.

    Article  Google Scholar 

Download references

Acknowledgements

The study was supported by the National Institutes of Health R01 grant AR049439-01A1 and the Research Grants Council Earmarked Grant CUHK4101/02 M. The funders had no role in the study design, data collection and analysis, interpretation of the data, as well as in writing the manuscript.We thank all participants for their participation and Dr Edith Lau for her contribution in setting up the cohort.

Author contributions

Z-mL conceptualized the study, analyzed the data, interpreted the results and drafted the manuscript. All the coauthors critically commented and revised the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Z-m Liu or S Y S Wong.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on International Journal of Obesity website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, Zm., Tse, L., Chan, D. et al. Dietary sugar intake was associated with increased body fatness but decreased cardiovascular mortality in Chinese elderly: an 11-year prospective study of Mr and Ms OS of Hong Kong. Int J Obes 42, 808–816 (2018). https://doi.org/10.1038/ijo.2017.292

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2017.292

Further reading

Search

Quick links