{"id":1296,"date":"2017-05-04T11:31:09","date_gmt":"2017-05-04T11:31:09","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1296"},"modified":"2017-08-21T10:18:09","modified_gmt":"2017-08-21T10:18:09","slug":"primary-care-corner-with-geoffrey-modest-md-sugary-beverages-and-alzheimers","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2017\/05\/04\/primary-care-corner-with-geoffrey-modest-md-sugary-beverages-and-alzheimers\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Sugary beverages and Alzheimer’s"},"content":{"rendered":"

\u200b\u200b\u200bThe second study from the Framingham Study Offspring cohort database found that increased intake of sugary sweet beverages was associated with lower total brain volume by MRI and poorer performance on neuropsychological testing (see doi.org\/10.1016\/j.jalz.2017.01.024 ). For first study, see here<\/a><\/p>\n

Details:<\/strong><\/p>\n

–4276 participants had neuropsychological testing and 3846 had brain MRI imaging<\/p>\n

–mean age 54, 46% male, 21% high school degree\/31% some college\/46% college grads, systolic BP 121 mmHg\/17% on BP treatment, total chol 194\/HDL 57, 8% diabetes, 2% atrial fibrillation, 10% current smoker, waist-to-hip ratio 0.9 (the WHO defines abdominal obesity as >0.90 for men and >0.85 for women)<\/p>\n

–total consumption of sugary beverages:<\/p>\n

–< 1x\/d in 56%<\/p>\n

–1-2 x\/d in 29%<\/p>\n

–>\u00a02x\/d in 15%<\/p>\n

–31%\u00a0consumed\u00a0fruit juice \u2265\u200b\u200b\u00a01x\/d<\/p>\n

–diet soft drinks were\u00a0consumed more regularly\u00a0than sugar-sweetened ones:\u00a0 49% no diet soft drinks, 35% up to 6\/wk, 16% \u2265\u200b\u200b\u00a01\/d<\/p>\n

–total calorie intake 1942 cal\/d, but increased from 1782 in those consuming <1 sugary beverage\/d, to 2007 if 1-2\/d, to 2413 if >2\/d; similarly, saturated fat increased from 22 to 24 to 27 g\/d<\/p>\n

Results:<\/strong><\/p>\n

–as compared to consuming <1 sugary beverage\/day, higher intake was associated with:<\/p>\n

–lower brain volume (more so if >2\/d than1-2\/d)<\/p>\n

–poorer performance on memory tests: both immediate and delayed recall<\/p>\n

–lower hippocampal volume,\u00a0borderline significant [the hippocampus is the part of the brain that consolidates short-term information into long-term memory]<\/p>\n

–daily fruit juice intake was associated with:<\/p>\n

–lower total brain volume, hippocampal volume, and poorer immediate and delayed recall<\/p>\n

— however, none of these associations reached statistical significance in the most highly adjusted model, which included not just age, sex, caloric intake, education, blood pressure, smoking, cardiovascular disease, or cholesterol, but also included saturated fat, trans fat, dietary fiber, and physical activity.<\/p>\n

— Diet soft drinks had only a small effect on total brain volume and on\u00a0poor performance on the test of similarities but not other memory tests.<\/p>\n

— Essentially no difference in subclinical markers of vascular brain injury (silent brain infarcts and white-matter hyperintensity volume)<\/p>\n

Commentary:<\/strong><\/p>\n

–11 million metric tons of sugar were consumed by Americans in 2016 (per the US Dept of Agriculture)<\/p>\n

–a recent blog<\/a> \u00a0highlighted the remarkable statistic that “on average 26.3% of US adults consume at least one sugar-sweetened beverage daily, up to 41.4% in Mississippi, the highest of states, and that soda by itself was consumed by 24.5% of those 18-34 yo, and 47.4% in Mississippi). And a NHANES study (Welsh JA. JAMA 2010; 303(15): 1490) found that on average, 15.8% of calories came from added sugars, and that >25% of the patients got >25% of their total energy from added sugar.”<\/p>\n

— Interestingly, there was not much of an association\u00a0between sugar intake\u00a0and\u00a0vascular brain injury, despite studies showing that sugar consumption\u00a0is associated with cardiovascular disease. Instead the current study found a more profound association with several markers of preclinical Alzheimer’s disease. This is also found in mice, where sucrose intake is associated with increased tau phosphorylation, amyloid-beta aggregation, hippocampal atrophy, and reduced brain-derived neurotrophic factor, BDNF. In the Framingham study cohort, these researchers have found that one standard deviation increase in\u00a0BDNF was associated with a 33% lower risk of Alzheimer’s disease, suggesting that BDNF\u00a0might be a factor in mediating the\u00a0association between dietary sugar and Alzheimer’s. Other studies have found that impaired glucose tolerance and chronically elevated blood glucose are associated with poor memory,\u00a0perhaps related to\u00a0changes in the hippocampal volume and microstructure<\/p>\n

— as a clinical perspective, daily fruit juice intake was equivalent to 1.5 years of brain aging in terms of\u00a0\u00a0total brain volume and 3.5 years of brain aging for the delayed memory scores.\u00a0And, relative to no\u00a0intake, consuming more than 3 sugar-sweetened soft\u00a0drinks per week was associated with lower brain volume equivalent to 2.6 years of brain aging,\u00a0and lower immediate memory recall equivalent to 13.0 years!!!<\/p>\n

— this trial also highlights the potentially bad effects of fruit juice, noting that the general public underestimates the sugar content of fruit juice by an average of 48%, even though\u00a0100%\u00a0fruit juice, without added sugar,\u00a0contains lots of\u00a0fructose\u00a0with negligible fiber content<\/p>\n

— see here <\/a>which reviews the sordid (ie not so sweet)\u00a0history of the\u00a0sugar industry in promoting sugar and shifting the blame away from sugar in increasing heart disease, dental caries, etc, since the 1950s,\u00a0despite lots of scientific evidence to the contrary
\n–and, a couple of more references on lifestyle and cognitive function:<\/p>\n

—\u00a0lower adherence to a Mediterranean diet has been\u00a0associated with increased brain volume loss, supplementing other studies finding higher incidence of clinical dementia related to lifestyle issues, especially diet and exercise (see review<\/a>)<\/p>\n

\u200b– a just published systematic review\/meta-analysis of exercise interventions for cognitive function in adults older than 50, found that physical exercise improved cognitive function regardless of the cognitive status of the participants. This was true for both aerobic and resistance exercise of at least moderate intensity with the duration of 45 to 60 minutes per session, done on as many days of the week as feasible (see\u00a0doi.10.1136\/bjsports-2016-096587.)<\/p>\n

so, these 2 articles (including the earlier one)\u00a0confirm and extend the bad health effects of excess sugar and artificial sweeteners to include adverse effects on\u00a0cognition and stroke. These\u00a0studies are observational ones from the Framingham Heart Study, and therefore do not definitively confirm causality, but they do add to the growing literature on their adverse effects on the brain. And, in terms of lifestyle interventions, over the years I have found that it\u00a0is much\u00a0easier to help people stop sodas and juices, substituting water, than other dietary interventions.\u200b The low-hanging fructose….<\/p>\n","protected":false},"excerpt":{"rendered":"

Sugary beverages and Alzheimer’s […]<\/p>\n

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