A long-running U.S. study found that frequent consumption of sugar-sweetened beverages and 100% fruit juice during childhood and adolescence was associated with a greater likelihood of developing high blood pressure later in life, while whole fruit showed no such association.
By yourNEWS Media Newsroom
Children and teenagers who regularly consume sugary drinks, including 100% fruit juice, may face a higher risk of developing hypertension decades later, according to a study published in Circulation that followed more than 25,000 participants into adulthood.
Researchers analyzed data from 25,749 participants in the Growing Up Today Study, who were between ages 9 and 16 and had a mean enrollment age of 12. Participants were followed for as long as 25 years, through 2021, when their average age had reached 36.
The findings showed that consuming larger amounts of sugar-sweetened beverages during youth was associated with a higher risk of high blood pressure later in life.
The study was observational, meaning it cannot establish that the beverages caused hypertension. Researchers adjusted their analysis for other factors that could influence the results.
One of the most notable findings involved the difference between fruit juice and whole fruit.
Although both contain naturally occurring fructose, frequent juice consumption was associated with increased hypertension risk, while eating whole fruit was not.
Researchers said the results suggest that the source and physical form of sugar may play an important role in how it affects long-term health.
Participants who consumed two or more servings of sugar-sweetened beverages per day had a 52% higher risk of developing hypertension compared with those who drank them fewer than three times per week.
For sugar-sweetened beverages, one serving was defined as a 12-ounce can or glass.
Soda and sports drinks were associated with the highest risk among the sugar-sweetened beverages examined.
Fruit juice also showed an association.
Participants who consumed at least 1.5 servings of 100% fruit juice each day had a 35% higher risk of hypertension compared with those who drank less than one serving per week.
One serving of juice was defined as an 8-ounce glass.
Whole fruit, by contrast, was not associated with increased hypertension risk.
The findings add to previous research examining the relationship between sugar intake and blood pressure.
A prior meta-analysis found that consuming sugar over a two-month period could increase systolic blood pressure by an average of 6.9 mmHg and diastolic blood pressure by 5.6 mmHg.
A 2007 study also associated soft-drink consumption with cardiometabolic risk factors and metabolic syndrome among middle-aged adults.
Researchers in the new study found that overall fructose consumption was not independently associated with hypertension when all sources were considered together.
The relationship became more apparent when researchers examined where the fructose came from.
Vasanti Malik, senior author of the study and an associate professor at the Temerty Faculty of Medicine at the University of Toronto, said the way fructose is consumed may be more important than the nutrient alone.
“The source and matrix — how fructose is consumed — are more important than the nutrient — fructose — itself,” Malik said.
The distinction may help explain why an apple and a glass of fruit juice can affect the body differently despite both containing fructose.
Registered dietitian nutritionist Kara Siedman said the physical structure of whole fruit changes the way its sugars are consumed and digested.
“Juice delivers the sugars without the same fiber or chewing, making it much easier to consume a larger dose quickly,” Siedman said.
Whole fruit contains fiber, water, polyphenols, vitamins, minerals and intact cellular structures that slow digestion.
Sugar occurs naturally in foods, including fructose in fruit, but is also added to processed foods and beverages in numerous forms.
Malik said excessive quantities of fructose arriving rapidly in the liver, as can occur when large amounts are consumed in liquid form, may promote fat accumulation and contribute to metabolic problems.
Fructose is found in foods and sweeteners ranging from fruit juice and honey to agave syrup and high-fructose corn syrup, and prior research has raised concerns about its effects when consumed in excessive amounts.
The study also examined what might happen when sugary beverages are replaced with other foods or drinks.
Replacing one daily serving of a sugary beverage with whole fruit was associated with a 22% lower risk of hypertension.
Replacing the same serving with milk was associated with a 13% reduction in risk, while replacing it with water was associated with a 9% lower risk.
The findings were statistical associations rather than evidence that making a particular substitution will directly produce those reductions in an individual.
Water intake may also have relevance to blood pressure for reasons beyond sugar replacement. Chronic dehydration has been associated with hypertension, and greater water intake has been cited as a possible factor in stabilizing blood pressure.
Physical activity appeared to influence the relationship between fructose and hypertension as well.
Researchers found that higher fructose consumption was associated with increased hypertension risk only among participants who were less physically active.
Malik said establishing healthier habits early in life is important because cardiometabolic risk can begin during childhood and continue into adulthood.
Earlier onset of high blood pressure may carry particularly serious consequences.
A 2020 study found that adults who developed hypertension at younger ages were more likely to later develop cardiovascular disease and die than people whose high blood pressure began later in life.
Children at greatest risk of future heart disease have also been characterized as those who are sedentary and obese and who have elevated blood pressure and cholesterol levels.
The findings arrive amid growing concern about hypertension among younger people.
About one in seven U.S. children and adolescents show signs of high blood pressure, according to the report.
Globally, childhood hypertension nearly doubled between 2000 and 2020, increasing from 3.2% to 6.2% and affecting an estimated 114 million young people worldwide, according to a separate review.
Researchers emphasized that the new findings demonstrate an association rather than proving that sugary beverages directly cause hypertension.
Diet, activity levels and other lifestyle and health factors may influence both beverage choices and cardiovascular risk, even after statistical adjustments are made.
The results also do not suggest that children should avoid whole fruit simply because it contains fructose.
Instead, researchers said the findings highlight how the same type of sugar can be delivered to the body in substantially different ways depending on whether it is consumed as intact fruit, juice or a sweetened beverage.
An apple, a glass of orange juice and a soda may all contain sugars, but their effects on digestion and metabolism may differ because of their composition and structure.
Long-term health concerns associated with obesity and poor cardiometabolic health can include cardiovascular disease, type 2 diabetes, hypertension, cancer and osteoarthritis, with some complications emerging during adulthood and others appearing earlier.
Researchers said the study adds to evidence that beverage choices made during childhood and adolescence may be associated with cardiovascular health many years later.
Replacing sugary drinks with water, milk or whole fruit was associated with lower hypertension risk in the study, although the authors and outside commentators did not use the findings to prescribe specific dietary guidelines.
Excessive consumption of sugary beverages and fruit juices has also previously been associated with increased risks involving kidney health.
The authors concluded that the long-term findings reinforce an important distinction in nutrition: the amount of sugar consumed matters, but so may the form in which that sugar reaches the body.
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