March 5, 2024

expert reaction to study looking at a link between sweetened drinks and atrial fibrillation risk

A study published in Circulation: Arrhythmia and Electrophysiology looks at sweetened beverages and risk of atrial fibrillation.

Victoria Taylor, Senior dietician at the British Heart Foundation, said:

“This new study has highlighted an association between drinking two litres or more of either sugar sweetened or artificially sweetened drinks in a week and the risk of a type of irregular heart rhythm called atrial fibrillation. The link was found to be stronger for artificially sweetened drinks than sugar sweetened drinks. The study also found that drinking one litre or less of pure juice per week, such as pure orange juice, was associated with a lower risk of atrial fibrillation.

“As this type of study is observational it can only show us associations, not causation. We’d need more research and different types of studies to have a definitive answer.

“We already know that diets high in sugar are linked to high calorie diets which can cause weight gain and obesity. In turn, this increases the chances of developing type 2 diabetes and heart and circulatory diseases.  

“It’s recommended that adults avoid consuming more than 30g of sugar a day which is the equivalent of around 7.5 teaspoons of sugar. With sugar sweetened drinks being one of our top sources of sugar in our diets, cutting back on these is a good place to start to reduce your intake. For more information on sugar and how to cut down, visit our website.”

Dr Duane Mellor, Registered Dietitian and Senior Lecturer, Aston Medical School, Aston University, said:

“This is an interesting study of the 1/2 million people in the UK Biobank study, unfortunately for this study over half had missing data so were excluded from the analysis. It considered incidence of atrial fibrillation, genetic risk of atrial fibrillation and intake of sweetened drinks, both sugar sweetened drinks, low calorie and no calorie sweetened drinks (calls artificially sweetened drinks in this study) and fruit juice. 

“This study claimed to find that individuals who drank more than 2L per week had an increased risk of atrial fibrillation (a variation in part of the heart beat linked to increased risk of other conditions like stroke). However, the data this was based upon was only 5 separate single day food intake recalls which were taken over the first three years of the study, so this data had to be extrapolated to estimate weekly intake. Although there is an increased risk, there is limited explanation of how sweeteners might increase risk of atrial fibrillation, so there is a limited biological reason to explain how sweetened drinks could be linked to heart health.

“Although this study highlights health risks linked to sweetened drinks, which includes both those containing sugar and artificial sweetener, these were already known not to be as healthy as drinking water. It is unclear if the findings in this study are a chance finding in the data and statistical anomaly as there is a lack of a clear link biologically between the exposure – the sweetened drinks and the effect – the atrial fibrillation. If there is a link it could be linked to other factors which acted to confound the data, although many were considered e.g. smoking etc, it is possible the effect reported in this study could be an effect of confounding variables.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This is interesting but as the authors say, the work is a long way from proving drinking artificial sweetened drinks ‘cause’ atrial fibrillation.  Even though the authors tried to adjust for many factors, there is a strong chance that other behavioural aspects linked to drink behaviour could be more relevant as a cause of AF rather than the drinks themselves. There is a good reason to avoid sugar sweetened beverages given links to weight and dental health. Of course, water is best, but overall, the evidence that artificial sweetened drinks are ‘harmful’ remains contested and I for one will continue to enjoy such drinks instead of sugar sweetened beverages on an occasional basis.”

Prof Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London (KCL), said:

“This report looked for an association between soft drink consumption and risk of developing atrial fibrillation (AF) and whether it was influenced by genetic susceptibility. Previous research has shown high soft drink consumption to be association with increased risk of AF. Risk of AF is well known to be associated with type 2 diabetes, binge drinking of alcohol (commonly called holiday heart) as well as illicit drug use (cocaine). The study failed to reveal any differences due to the genetics but confirmed an increased risk with increased high intakes of soft drink above 2 litres/week. This risk was greater (20%) with artificial sweetened drinks than with sugar sweetened drinks (10%) and fruit juice (5%). However, the 9% of high consumers of artificial sweeteners had diabetes compared to 3.6% of those who were high consumers of sugar sweetened drinks and 2.7% of those who were high consumer of fruit juice. They attempted to adjust for this in the statistics, but this did not alter the findings for artificially sweetened drinks.

“It is difficult to comprehend how artificially sweetened drinks could have such an effect as the amounts of sweeteners are typically concentrations 300-800 times lower than sugar. The main sweeteners used in drinks are aspartame, acesulfame K and sucralose. These molecules are pharmacologically inactive. It seems more likely that the selection of the artificially sweetened drinks is associated with another factor that increases risk of AF. As this is the first study that has reported such an effect, the finding needs replication before any conclusions can be drawn. It remains good dietary advice to recommend the consumption of low calorie artificially sweetened drink in place of sugar sweetened drinks and alcohol.”  

’Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study’ by Ningjian Wang et al. was published in Circulation: Arrhythmia and Electrophysiology at 10:00 UK time Tuesday 5 March.

DOI: 10.1161/CIRCEP.123.012145

Declared interests

Dr Mellor: I have worked with Frozen Brothers looking at safety aspects of glycerol in slush drinks.

Prof Sattar: No conflicts to declare.

Prof Sanders: I acted as a consultant for the aspartame advisory service until 2008 and when I was head of nutrition at King’s College London, Tate & Lyle funded establishment of a clinical research facility at St Thomas’ hospital in recognition to the discovery of sucralose by researchers at King’s College London.

No reply to our request for DIOs was received for other experts.