An analysis of over 200,000 UK Biobank participants found that drinking two liters or more of either sugar- or artificially-sweetened drinks per week was associated with a significantly higher risk of atrial fibrillation, a study in Circulation: Arrhythmia and Electrophysiology found.
 
However, drinking about one liter or less per week of pure, unsweetened juice like orange or vegetable juice was associated with a reduced risk of AFib.
 
While the study was observational in nature, and causality couldn’t be established, the researchers found that the association remained even when accounting for a person’s genetic susceptibility to the condition.
 
Atrial fibrillation (AFib) is a condition characterized by irregular heart rhythm, in which the heart’s upper chambers beat out of coordination with the heart’s lower chambers. AFib increases the risk of stroke by five-fold, and more than 12 million people are expected to have the condition by 2030, according to the American Heart Association.
 
“Our study’s findings cannot definitively conclude that one beverage poses more health risk than another due to the complexity of our diets and because some people may drink more than one type of beverage,” said lead study author Ningjian Wang, MD, PhD, a researcher at the Shanghai Ninth People’s Hospital and Shanghai Jiao Tong University School of Medicine in Shanghai, China. “However, based on these findings, we recommend that people reduce or even avoid artificially sweetened and sugar-sweetened beverages whenever possible. Do not take it for granted that drinking low-sugar and low-calorie artificially sweetened beverages is healthy, it may pose potential health risks.”
 
Study Details
 
Researchers determined the participants’ intakes of sugar- and artificially-sweetened beverages through dietary questionnaires, and reviewed genetic susceptibility to AFib, in 200,000 adults who were free of AFib at the time of enrollment in the UK Biobank, which was between 2006 and 2010. During the nearly 10-year follow-up period, there were 9,362 cases of AFib among study participants.
 
Compared to people who didn’t consume any sweetened drinks, there was a 20% increased AFib risk in those who drank more than two liters per week (67 ounces or more, roughly one 12-ounce drink six days per week) of artificially-sweetened beverages, and a 10% increased risk among participants who reported drinking the same amount of sugar-sweetened beverages.
 
Meanwhile, drinking one liter or less of pure fruit juice each week was linked to an 8% lower risk of AFib.
 
Those who consumed more artificially sweetened beverages tended to be female, younger, and have a higher BMI and prevalence of type 2 diabetes. Meanwhile, people who consumed more sugar-sweetened beverages were more likely to be male, younger, and have a higher BMI, a higher prevalence of heart disease, and a lower socioeconomic status.
 
Those who drank sugar-sweetened beverages and pure juice were more likely to have a higher intake of total sugar than those who drank artificially sweetened drinks.
 
Smoking may also have affected risk, with smokers who drank more than two liters per week of sugar-sweetened beverages having a 31% higher risk of AFib, while there was no difference between former smokers and people who never smoked.
 
“These novel findings on the relationships among atrial fibrillation risk and sugar- and artificially sweetened beverages and pure juice may prompt the development of new prevention strategies by considering decreasing sweetened drinks to help improve heart health,” Wang said, noting that insulin resistance, the body’s response to different sweeteners, are among several possible explanations for the association.
 
Prior Warning from AHA
 
In 2018, the American Heart Association issued a science advisory noting the scarcity of data on the efficacy and safety of artificial sweeteners. The group advised against the prolonged consumption of low-calorie sweetened beverages by children, though they noted that they may be a useful replacement strategy to reduce sugar-sweetened beverages in adults.
 
These findings are surprising, given that two liters of artificially sweetened beverages is about one 12-ounce diet soda per day, noted Penny M. Kris-Etherton, PhD, RD, FAHA, AHA nutrition committee member and co-author of the science advisory.
 
“This is the first study to report an association between no- and low-calorie sweeteners and also sugar-sweetened beverages and increased risk of atrial fibrillation,” she said. “While there is robust evidence about the adverse effects of sugar-sweetened beverages and cardiovascular disease risk, there is less evidence about adverse health consequences of artificial sweeteners.
 
“We still need more research on these beverages to confirm these findings and to fully understand all the health consequences on heart disease and other health conditions. In the meantime, water is the best choice, and, based on this study, no- and low-calorie sweetened beverages should be limited or avoided.”