Sugar and your risk of death!

Bottom Line:

The study showed that participants who consumed 10%-24.9% of their calories from added sugar had a 30% higher risk of death from heart disease while those that consumed more than 25% of their calories had a 175% increased risk of death from heart disease. The bottom line is that you should stick with the World Health Organization recommendations of limiting intake of added sugar to less than 10%.
In addition, the study showed that people who drank 7 or more servings (360ml or 12 ounces per serving) of sugar sweetened beverages had a 29% high risk of cardiovascular death than those consuming 1 serving per week or less.

Why this matters:

Lots of studies have shown that high sugar intake is linked to weight gain, type 2 diabetes, high blood pressure, elevated cholesterol and heart disease.  The institute of medicine recommends that added sugar should be less than 25% of total daily calories.  However, the World Health Organization recommends limiting added sugar to less than 10% of calories.  This study helps to show where the ideal limit should be.

Study Design:

This is a prospective study looking at data from the National Health and Nutrition Examination Survey (NHANES, 1988-1994, 1999-2004 and 2005-2010).  The time trend analysis included 31,147 people and the mortality cohort included 11,733 people.

Key findings:

  • Added sugar in diet increased from 15.7% in 1988-1994 to 16.8% in 1999-2004. However, it decreased in 2005-2010 to 14.9%.
  • Examining the data from 2005-2010 showed that 71.4% of the people consumed 10% or more calories from added sugars and about 10% of the people consumed 25% or more calories from added sugars.
  • Out of the 11,733 people who were studied for cardiovascular deaths, there were 831 cardiovascular deaths during a follow-up of roughly 14.6 years.
  • Hazard Ratio (HR) 1.30 (95% CI, 1.09-1.55) for participants consuming 10% to 24.9% calories from added sugars vs control of less than 10% calories from sugar
  • HR 2.75 (95% CI, 1.40-5.42) for participants consuming 25% or more calories from added sugars vs control of less than 10% calories from sugar.
  • People consuming 7 or more servings (360ml per serving) of sugar-sweetened beverages had HR 1.29 (95% CI, 1.05-1.60) versus those only consumed 1 serving per week or less.


  • Like most population based studies, the data on sugar consumption is based on 24-hour dietary recall. This allows for recall bias
  • The study doesn’t show how changes in sugar intake might affect cardiovascular mortality.
  • Lastly, the study shows only an association but not causation.


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 Apr;174(4):516-24. doi: 10.1001/jamainternmed.2013.13563.

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Sean Hashmi MD
Articles: 56

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