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Sweetened beverages and cardiovascular outcomes: an umbrella review of mortality and health outcomes

Mehrdad Jamali,Paniz Anvarifard,B. Hosseini,M. Razaghi,Leila Khorraminezhad,Ehsan Alvandi,Mona Albadawy,Meysam Zarezadeh,Ahmad Saedisomeolia

Published 2025 in Nutrix Journal

ABSTRACT

The increasing intake of sugar-sweetened (SSBs) and artificially sweetened beverages (ASBs) raises concerns over their potential impact on cardiovascular health. This umbrella meta-analysis examines their association with cardiovascular outcomes, synthesizing existing evidence comprehensively. A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar databases, covering studies published up to November 2024. Eligible meta-analyses were synthesized using a random-effects model to calculate pooled effect sizes and 95% confidence intervals. Subgroup and sensitivity analyses were performed, and the methodological quality of studies was evaluated using AMSTAR 2 tools. Nineteen meta-analyses encompassing 67 datasets met the inclusion criteria. ASB consumption was associated with a 10% increased risk of mortality (RR: 1.10; 95% CI: 1.07 to 1.12), including an 8% increased risk of cardiovascular disease (CVD) mortality (RR: 1.08; 95% CI: 1.05 to 1.11). SSB intake was linked to a 9% higher overall mortality risk (RR: 1.09; 95% CI: 1.07 to 1.11) and a 10% increased CVD mortality risk (RR: 1.10; 95% CI: 1.07 to 1.13). Additional cardiovascular risks associated with both beverages included hypertension (RR range: 1.12–1.19), coronary heart disease (RR range: 1.09–1.20), metabolic syndrome (RR range: 1.19–1.31), and stroke (RR range: 1.06–1.25). The results underscore a clear link between the intake of sweetened beverages and elevated risks of mortality and major cardiovascular outcomes, suggesting an urgent need to reduce their consumption as part of public health initiatives. Targeted strategies, including consumer education and policy interventions, may help mitigate these risks and improve cardiovascular health outcomes.

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