Effects of Sugar-sweetened (SSBs) and Artificially Sweetened Beverages (ASBs) in Cardiovascular Events A Narrative review

High fructose corn syrup (HFCS) has been widely used as sweetener for SSBs because of its economical and efficient qualities; however, it was linked to early onset of cardiovascular diseases (CVDs). One of the most important approaches to limit sugar intake is the substitution of artificial sugar in diet bottled beverages or also knowns as ASBs. Despite of the global acceptance on the use of artificial sweeteners in ASBs, different investigations postulated that chronic consumption of these products take a substantial role in the development of CVD. Thus, this review paper intends to provide synthesis of the literature on the effect of SSBs and ASBs on cardiovascular risks. An online search from different electronic databases such as PubMed, MEDLINE, BMJ Open Access and Science Direct was used to retrieve original articles which were published from January 2010 to August 2019. Extraction of data includes the title, authors, duration, characteristics of the sample used, exposure and outcome variables, limitations, and result of the study. Eleven (11) original articles were included in this study, six (6) SSBs and five (5) ASBs. Based on the reviewed articles, SSBs particularly those which use HFCS have direct link to CVD risks because of the metabolic pathway of fructose. Main rate-limiting steps of glycolysis is bypassed by fructose which can result to its efficient released to the circulation for extrahepatic metabolism or converted to fat or liver glycogen. The increase hepatic uptake of fructose can result to a large degradation of uric acid, adenosine triphosphate, and adenosine monophosphate which can amplify the CVD risks. Meanwhile, research studies have also shown that consumption of ASBs can also increase the risk of developing CVDs by alteration of gut microbiota. Related mechanisms involved in the development of CVD and its risk factors with consumption of SSBs and ASBs are gut dysbiosis resulting from altered gut microbiota and the neurobiological changes like increase in hunger sensation thus leading to higher food intake and body weight. Taken collectively, both SSBs and ASBs consumption are linked with the development and progression of CVD and its risk factors primarily caused by the biochemical alterations in carbohydrate metabolism leading to higher weight gain, blood sugar and atherogenic lipid levels. The consumption of any artificially sweetened beverages daily remains not a healthy option for the whole population. Intake of sweetened beverages including both with added natural and artificial sweeteners must be within the recommended levels.

Keywords – artificially sweetened beverages, cardiovascular outcomes, sugar-sweetened beverages