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CME Released: 7/12/2010
Valid for credit through: 7/12/2011, 11:59 PM EST
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July 12, 2010 — High fructose intake in the form of added sugar is independently associated with higher blood pressure (BP), according to the results of a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES 2003 to 2006), reported online ahead of print July 1 in the Journal of the American Society of Nephrology.
"The recent increase in fructose consumption in industrialized nations mirrors the rise in the prevalence of hypertension, but epidemiologic studies have inconsistently linked these observations," write Diana I. Jalal, from University of Colorado Denver Health Sciences Center in Aurora, and colleagues. "We investigated whether increased fructose intake from added sugars associates with an increased risk for higher BP levels in US adults without a history of hypertension."
In the study sample of 4528 adults without a history of hypertension, median fructose intake was 74 g/day, which is approximately equivalent to 2.5 sugary soft drinks each day. Increased fructose intake of at least 74 g/day was independently and significantly associated with higher odds of elevated BP levels, after adjustment for demographics; comorbid conditions; physical activity; total kilocalorie intake; and dietary confounders including total carbohydrate, alcohol, salt, and vitamin C intake. Increased risk associated with fructose intake of 74 g/day or more was 26% for a BP cutoff point of 135/85 mm Hg or higher, 30% for a BP cutoff point of 140/90 mm Hg or higher, and 77% for a BP cutoff point of 160/100 mm Hg or higher.
"These results suggest that high fructose intake, in the form of added sugar, independently associates with higher BP levels among US adults without a history of hypertension," the study authors write.
Limitations of this study include cross-sectional analysis, precluding determination of causality; reliance on self-report for fructose intake; and inability to rule out the possibility that the high glucose content of the included foods may have contributed to the findings.
"These findings support the hypothesis that increased intake of fructose may result in hypertension through a variety of mechanisms," the study authors conclude. "Limiting fructose intake is readily feasible, and, in light of our results, prospective studies are needed to assess whether decreased intake of fructose from added sugars will reduce the incidence of hypertension and the burden of cardiovascular disease in the US adult population."
The National Institutes of Health supported this study. One of the study authors (Richard J. Johnson) is listed as an inventor on several patent applications on lowering uric acid levels as it relates to BP and metabolic syndrome. He is also author of The Sugar Fix (2008, Rodale Inc; 2009, Simon and Schuster).
J Am Soc Nephrol. Published online July 1, 2010.
In developed countries, hypertension is the most common chronic disease, and US prevalence has steadily risen to nearly one third of the adult population and an increasing proportion of adolescents. Because of associated risks for coronary artery disease, congestive heart failure, stroke, and chronic kidney disease, hypertension is thought to be responsible for 7.1 million deaths per year worldwide.
Approximately two thirds of patients with hypertension are untreated or are treated ineffectively, highlighting the need to identify and correct potentially modifiable risk factors. Dietary fructose intake has risen dramatically in developed nations since the 1900s, primarily because of greater consumption of added sugars in processed drinks and foods including sugary soft drinks and bakery products. Animal studies suggest that fructose can raise BP, but epidemiologic studies have been few and have yielded conflicting results.
