A study published in Circulation: Arrhythmia and Electrophysiology analyzed more than 200,000 UK Biobank participants and found that consumption of two liters or more of sugar-sweetened drinks or artificially sweetened drinks per week, compared to the lower consumption of one liter of those beverages per week, was associated with an elevated risk of developing atrial fibrillation. This is a major insight for sweetened beverage product development, where safety and health impact need more focus.
Sweetened Beverages Associated with Increased Atrial Fibrillation Risk
A study published in Circulation: Arrhythmia and Electrophysiology analyzed more than 200,000 UK Biobank participants and found that consumption of two liters or more of sugar-sweetened drinks or artificially sweetened drinks per week, compared to the lower consumption of one liter of those beverages per week, was associated with an elevated risk of developing atrial fibrillation. This is a major insight for sweetened beverage product development, where safety and health impact need more focus.
However, drinking no more than one liter of pure, unsweetened juice (such as orange juice or vegetable juice) on a week-to-week basis was associated with lower risk of atrial fibrillation.
Researchers note that for an observational study, causation cannot be established, but the association was present even after accounting for a person’s genetic susceptibility to atrial fibrillation. [1]
What is Atrial Fibrillation (AFib)?
Atrial fibrillation (AFib) is a disorder defined by irregular heart rhythm, during which chambers at the top of the heart beat out of coordination with chambers at the bottom, resulting in a trial and ventricular contractions that are not regular. AFib increases the risk of having a stroke by five-fold, and according to the American Heart Association, it is anticipated there will be over 12 million people with ARfib in 2030. [2]
Lead Author’s Perspective
“Our study’s findings do not allow us to confidently conclude that one beverage is healthier than another largely because of the complexity of our diets and b/c some individuals might consume more than one type of beverage,” said first author Ningjian Wang, MD, PhD, a researcher at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. “That said, our findings lead us to suggest that people should limit or even avoid artificially sweetened and sugar-sweetened beverages whenever possible. Do not assume that drinking, low-sugar, low-calorie artificially sweetened beverages is a healthy choice as it allows for potential health risks.” This has critical implications for beverage product development and the way brands innovate for health-conscious product development.
Study Details
The study used data from the UK Biobank, a sizable biobehavioural database including over 200,000 adults who enrolled between 2006-2010; individuals were excluded if they had a diagnosis of atrial fibrillation (AFib) at the time of enrolment. Participants were queried about beverage intake through detailed dietary questionnaires, and data were publicly available for nearly the next decade of follow-up.
During these follow-up years, 9,362 cases of AFib were recorded, and when the researchers assessed beverage consumption, notable differences were detected in AFib risk. [3]
Key Findings
The details regarding beverage types, consumption levels, association with AFib, and risk percent change are displayed in the summary below:
Beverage Type | Consumption Level | Association with AFib | Risk Change |
Artificially sweetened drinks | ≥ 2 liters/week | Higher risk | 20% increased risk |
Sugar-sweetened drinks | ≥ 2 liters/week | Higher risk | 10% increased risk |
Pure unsweetened juice | ≤ 1 liter/week | Lower risk | 8% decreased risk |
Sugar-sweetened drinks (smokers only) | ≥ 2 liters/week | Higher risk | 31% increased risk compared to non-drinking smokers |
These results suggest that, both sugar-sweetened drinks and no-calorie artificially sweetened drinks are positively associated to risk independently; and that modest consumption of pure fruit or vegetable juice may offer benefits. This insight should guide safer drinks product development strategies.[4]
Participant Characteristics
Beverage consumption patterns differed based on both demographic and health profiles:
- Artificially sweetened beverage consumers typically, younger women with a higher BMI and a higher prevalence of type 2 diabetes.
- Sugar sweetened beverage consumers were more likely to be men, younger, with higher BMIs, greater prevalence of heart disease, and lower socioeconomic status.
- Juice consumers: tended to have a higher sugar intake overall but demonstrated a lower risk of AFib.
These indicate broader lifestyle and socioeconomic influences that should be considered in sweetened beverage product development.
Lifestyle Factors and Risk
There was an intriguing nuance for smoking. Among participants who smoked and drank high amounts of sugar-sweetened beverages, their risk of AFib was increased by 31%. However, the associations of total sweetened beverage consumption did not reach significance amongst non-smokers or former smokers, suggesting that the stress of cardiovascular health from smoking interacted with sugary beverages.
“These new findings concerning the relationships among risk of atrial fibrillation and sugar-sweetened, artificially sweetened beverages and pure juice, might possibly lead to presenting new prevention methods by considering decreasing sweetened beverages to improve heart health,” Wang said, also noting that insulin resistance, the body’s reaction to different sweeteners, was one of several explanations of the associations. [5]
Prior Warning from the American Heart Association (AHA)
The findings align with previous AHA warnings. In 2018, the AHA issued a science. The advisory acknowledged that evidence is limited regarding the use of artificial sweeteners. They felt that while artificial sweeteners may be useful in replacing sugary drinks for a while, ongoing use (especially for children) was not advised.
They suggested water as the healthiest drink and said that drinks that were sugar-sweetened or artificially sweetened may have long-term effects on health. [6]
Expert Commentary
According to Dr. Penny M. Kris-Etherton, PhD, RD, FAHA, a member of the AHA’s nutrition committee, the apparent risks are important even with modest use (about one diet drink per day).
“This is the first study to show an association between no or low-calorie sweeteners, sugar-sweetened beverages, and atrial fibrillation,” said Dr. Kris-Etherton. She noted the connection between sugar-sweetened beverages and cardiovascular disease is already well-established, while the artificial sweeteners are emerging as risks that need to be studied more, recommended now is time to explore it deep.
“We still need more research on these beverages to verify the results and understand all of the health consequences on heart disease and other health issues. For now, water is your best drink, based on this study one should limit or eliminate no or low-calorie sweetened beverages.”
Implications for Public Health
AFib is a significant and growing global health issue. While most attention has been paid to lifestyle characteristics (diet, exercise, smoking), the role of beverage consumption has not been studied comprehensively until recently. This study (Sullivan et al.) shows that:
- High consumption of sweetened beverages, regardless of calories, are associated with an increased AFib risk
- Pure fruit and vegetable juice, consumed in moderation, may be protective
- When it comes to beverages, water appears to be the best option for reducing future risk of AFib. [7]
Reasons for Recommendations to Individuals
- Reduce consumption of sugar-sweetened and artificial (non-caloric) sweetened beverages.
- Use water as your beverage of choice.
- When consuming juice, opt for pure fruit or vegetable juice with no added sugar, and limit consumption to less than one liter per week.
- Consider larger lifestyle changes: reduce smoking, maintain a healthy weight, and develop regular physical activity.
Limitations of the Study and Future Directions
While the study is observational from the perspective of developing AFib, the study does not yet prove causality; therefore, additional clinical trials are needed to:
- Investigate the chemical and biological mechanisms linking sweeteners to increased risk of AFib
- Identify the influence of different types of artificial sweeteners
- Identify whether long-term consumption of juices has the same protective effect in larger populations
- Determine whether reducing beverage consumption can reduce the incidence of AFib. [8]
Conclusion
This research indicates that daily intake of sugar- and artificially sweetened drinks may increase atrial fibrillation risk, while moderate consumption of pure juice may decrease it. As possible causal pathways remain unconfirmed, the safest and advisable option for heart health is water. Future studies, particularly in beverage product development and sweetened beverage product development, will be vital for creating safer, scientifically validated health-conscious product development strategies that shape the future of drinks product development and long-term cardiovascular health. Such investigations are commonly carried out by food research lab, which continue to study how different beverages and sweeteners impact human health to guide safer and more effective product innovations.
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