Sugary beverage intake and preclinical Alzheimer's disease in the community

Authors: PASE, MATTHEW - Boston University; HIMALI, JAYANDRA - Boston University; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; DECARLI, CHARLES - University Of California; SATIZABAL, CLAUDIA - Boston University; APARICIO, HUGO - Boston University; VASAN, RAMACHANDRAN - Boston University; BEISER, ALEXA - Boston University; SESHADRI, SUDHA - Boston University

Submitted to: Alzheimer's & Dementia
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/26/2017
Publication Date: 3/6/2017
Citation: Pase, M.P., Himali, J.J., Jacques, P.F., DeCarli, C., Satizabal, C.L., Aparicio, H., Vasan, R.S., Beiser, A.S., Seshadri, S. 2017. Sugary beverage intake and preclinical Alzheimer's disease in the community. Alzheimer's & Dementia. 13(9):955-964. https://doi.org/10.1016/j.jalz.2017.01.024.
DOI: https://doi.org/10.1016/j.jalz.2017.01.024

Interpretive Summary: Consumption of sugary beverages, including sugar sweetened soft drinks, fruit drinks with added sugar and 100% fruit juice, are major contributors to excess sugar intake. Studies in animal models suggest that excess sugar intake, including from sugary beverages, leads to the development of Alzheimer’s disease (AD) pathology. However, little is known about the long term effect of sugary beverage intake on the human brain. Using detailed neuropsychological tests and magnetic resonance imaging (MRI) of the brain, we examined the association between usual sugary beverage consumption and preclinical AD and vascular brain injury (VBI) in participants from the Framingham Heart Study, a large, community based, prospective cohort study. We studied 4276 participants who completed neuropsychological testing and 3846 participants with brain MRI and were free from overt stroke and dementia. The mean age of the study sample was 54years. Intakes of sugar sweetened soft drinks, fruit juice, and diet soft drinks were measured using a food frequency questionnaire, a mean of 2 years before the measurement of the neuropsychological testing and brain MRIs. Markers of preclinical AD included neuropsychological tests of episodic memory and total brain volume and hippocampal volume based on MRI. Markers of VBI included neuropsychological tests of executive function, abstract reasoning and visual memory and white matter hyperintensities and silent brain infarcts based on the MRI. After accounting for the potential influences of age, sex and total energy intake, higher intake of sugary beverages was associated with evidence of increased preclinical AD (including lower total brain volume and poorer episodic memory). Relative to no intake, the difference in total brain volume and episodic memory associated with consuming greater than 2 sugary beverages per day was equivalent to 2 and 11 years of brain aging, respectively. Daily fruit juice intake was associated with poorer outcomes for all preclinical AD markers. Sugary beverage intake was not associated with VBI. Additional studies are needed to elucidate the clinical significance of, and biological basis underlying, these observed associations.

Technical Abstract: IMPORTANCE: Sugary beverages are a key component of the Western diet, yet the long-term effects of these beverages on the brain are poorly understood. OBJECTIVE: To determine whether habitual sugary beverage consumption is associated with markers of preclinical Alzheimers disease (AD) and/or vascular brain injury (VBI). DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of participants from the Framingham Heart Study, a large, community- based, prospective cohort study. We studied 4276 participants with neuropsychological outcomes and 3846 participants with brain magnetic resonance imaging (MRI), all free from overt stroke and dementia (mean age 54 [SD, 11] years; 46% men for larger sample). EXPOSURES: Intake of total sugary beverages, fruit juice, sugar sweetened soft drink, and diet soft drink were quantified using a food frequency questionnaire, a mean of 2 (SD, 1) years before the measurement of the study outcomes. MAIN OUTCOMES AND MEASURES: Markers of preclinical AD included total brain volume, hippocampal volume and tests of episodic memory. Markers of VBI included white matter hyperintensities, silent brain infarcts and tests of executive function, abstract reasoning and visual memory. RESULTS: In multivariable models adjusted for at least age, sex and total caloric intake, higher intake of total sugary beverages was associated with lower total brain volume (<1/day, reference; 1-2/day, beta +/- standard error [SE]= 0.55 +/- 0.14 mean percent change, p=0.0002; >2/day, beta +/- SE= 0.68 +/- 0.18, p<0.0001), and poorer episodic memory, both for immediate (<1/day, reference; 1-2/day, beta +/- SE = 0.41 +/- 0.12 mean score change, p=0.001; and >2/day, beta +/-SE= 0.67 +/- 0.16, p<0.0001) and delayed recall (<1/day, reference; 1-2/day, beta +/- SE= 0.37 +/- 0.12 mean score change, p=0.003; and >2/day, beta +/- SE = 0.69 +/- 0.16, p<0.0001). Relative to no intake, the difference in total brain volume and episodic memory associated with consuming greater than 2 sugary beverages per day was equivalent to 2 and 11 years of brain aging, respectively. Daily fruit juice intake was associated with poorer outcomes across all AD markers (all p<0.05). Sugary beverage intake was not associated with vascular brain injury in a consistent manner across statistical models or outcomes. CONCLUSIONS: Higher intake of sugary beverages was associated cross sectionally with markers of preclinical AD. Additional studies are needed to elucidate the clinical significance of and biological basis underlying the observed associations.