Intake of high fructose corn syrup sweetened soft drinks, fruit drinks and apple juice is associated with prevalent coronary heart disease, in U.S. adults, ages 45-59 y

Abstract

Background: Intake of high excess free fructose (EFF) beverages, including high fructose corn syrup (HFCS), sweetened soft drinks, fruit drinks, and apple juice, may be associated with childhood asthma, adult idiopathic chronic bronchitis/ COPD, and autoimmune arthritis, possibly due to underlying fructose malabsorption. Fructose malabsorption may contribute to the intestinal in situ formation of advanced glycation end-products (enFruAGEs) that travel to other tissues and promote inflammation. Chronic respiratory conditions and arthritis are comorbidities of coronary heart disease (CHD). The objective of this study was to investigate the association between intake of high EFF beverages and CHD. Methods: In this cross sectional study (NHANES 2003-2006) of adults, aged 45-59 y, n = 1230, the exposure variables were non-diet soft drinks, and any combination of high EFF beverages including non-diet soft drinks, fruit drinks, and apple juice. Analyses of diet soft drinks, diet fruit drinks, and orange juice (non/low EFF beverages) were included for comparison. The outcome was self-reported history of coronary heart disease and/or angina (CHD). Rao Scott O2 was used for prevalence differences and logistic regression for associations, adjusted for age, sex, race-ethnicity, BMI, socio-economic status, health insurance coverage, smoking, physical activity level, hypertension, energy intake, fruit and vegetable intake, glycated hemoglobin, pre-diabetes, and diabetes. Results: Intake of any combination of HFCS sweetened soft drinks, fruit drinks, and apple juice (tEFF) was significantly associated with CHD in adults aged 45-59 y. Adults consuming tEFF ≥5 times/wk. were 2.8 times more likely to report CHD than ≤3 times/mo consumers (OR 2.82; 95% CI 1.16-6.84; P = 0.023), independent of all covariates. Conclusion: HFCS sweetened soft drinks, fruit drinks, and apple juice may contribute to CHD, a common comorbidity of chronic respiratory conditions and autoimmune arthritis, possibly due to the high ratio of fructose to glucose in these beverages. Underlying fructose malabsorption may contribute to the intestinal in situ formation of pro-inflammatory enFruAGEs, that are eventually absorbed and induce inflammation of the coronary arteries. Additional research is needed.