Sugar-Sweetened and Artificially Sweetened Beverages in Relation to Stroke and Dementia: Are Soft Drinks Hard on the Brain?

See related article, p 1139. Although the consumption of sodas has been decreasing in most Western countries during the past 2 decades, sugar-sweetened beverages (SSBs) are the leading sources of added sugars in the US diet and are increasing on a global level.1–3 As measured by the recommendation of the 2015 World Health Organization Guideline on the intake of free sugars, a single can of sugar-sweetened soda contains about the upper limit of the recommended 25 to 50 g per day.4 Moreover, the American Heart Association/American Stroke Association has defined 1 component of an ideal cardiovascular diet as consisting of ≤450 kcal/wk of SSBs. The harmful effects of regular SSB consumption, including weight gain, the metabolic syndrome, and type 2 diabetes mellitus, have been demonstrated in numerous large observational studies.5–9 Furthermore, a higher intake of SSBs has been repeatedly associated with increased risks of hypertension, coronary heart disease, and stroke, as well as with adverse changes in lipid levels and inflammatory markers.10,11 A recent estimation based on nationally representative data calculated that >50 000 cardiometabolic deaths in US adults in 2012 can be attributed to high SSB consumption, making SSBs the leading factor associated with cardiometabolic mortality in young and middle-aged adults.12 Artificially sweetened beverages (ASBs) are marketed as healthier alternatives to SSBs. Their consumption is rising in the United States, particularly among children.13 The American Heart Association and American Diabetes Association have given a cautious nod to the use of artificial sweeteners in place of sugar to combat obesity, metabolic syndrome, and diabetes mellitus,14,15 but there is still uncertainty about the benefits and even healthfulness of ASBs.16 Several large observational studies, including the Atherosclerosis Risk in Communities Study,17 …