Influence of different beverages and sugars on clinically relevant endpoints

Abstract

Poor dietary habits are ranked among the top three leading risk factors for mortality and noncommunicable diseases worldwide. As various beverages are part of every diet, their potential health consequences need to be investigated. CVD and dementia are of particular concern, as they contribute to a high number of deaths, especially as the global population ages. Four major research gaps were identified and addressed in this thesis: 1) How is the consumption of wine and non-wine alcoholic beverages, coffee, and tea related to all-cause mortality? 2) How is the intake of wine and non-wine alcoholic beverages, coffee, and tea associated with the risk for incident dementia? 3) How are various types of sugars, i.e., FS and their subtypes, as well as IS, related to dementia risk? 4) How are various types of sugars, i.e., FS and their subtypes, as well as IS, associated with CVD? These research gaps have been addressed in four publications. In the first publication, light to moderate consumption of wine is associated with decreased allcause, non-cancer and CVD mortality. Non-wine is positively related to all types of mortality. Coffee intake is significantly associated with all-cause and non-cancer mortality, whereas tea intake is associated with a consistently decreased risk of all mortality types studied. In the second publication, moderate consumption of wine is related to dementia risk in a U-shaped fashion. In contrast, non-wine intake is positively related to incident dementia. No significant association is found for coffee, while tea intake is related in a U-shaped fashion with dementia risk. In the third publication, a linear-shaped association between FS subtype intake and dementia risk is most consistently found for FS in beverages. No significant association is found for FS in solids. In the fourth publication, associations of incident CVD depend on the source of the sugars with a linear relation for FS in beverages but different associations for other sources of FS. Relations are more robust for ischemic heart disease as compared to stroke. Further research should focus on the following six areas: 1) Studies concerning alcoholic beverages should be better standardised especially concerning former drinker bias and alcoholic beverage type. 2) Excessive alcohol intake should be discouraged via policy measures including excise taxes, MUP, and volumetric taxation to reduce the burden of alcohol-related health risks. 3) Tea intake should be recommended within nutrition guidelines to better reflect data on its health-promoting effects. 4) Intake of SSB and ASB should be limited through policy measures to reduce SSB- and ASB-mediated negative health outcomes. 5) New methods of assessing diets such as FPQ should be applied to provide a more comprehensive capture of dietary intake. 6) Shrinkage techniques like LASSO regression should be applied to identify the dietary factors most closely linked with important health outcomes.