Sugar Intake Linked to Fat Deposits Around the Heart

Increased pericardial adipose tissue volume leads to coronary heart disease, coronary artery calcification, atrial fibrillation, and reduced left ventricular function. 

The American Heart Association recommends limiting daily sugar intake to no more than 37.5 grams for men and 25 grams for women. Diets with high sugar content have been associated with numerous diseases and health conditions besides diabetes and obesity, such as cardiovascular diseases, which represent the leading cause of death in the U.S. 

Multiple risk factors, including high volumes of pericardial adipose tissue (PAT), are tied to cardiovascular diseases. Increased PAT volume leads to coronary heart disease, coronary artery calcification, atrial fibrillation, and reduced left ventricular function. 

A recent study published in the European Journal of Preventive Cardiology examined 3070 adults who had participated in a longitudinal study (CARDIA) to determine the relationship between the volume of adipose tissue and the intake of added sugar, including sugar-sweetened beverages.   

The population of this study consisted of 872 white women, 865 black women, 766 white men, and 567 black men. Their age ranged from 18 to 30 years old, and they were generally healthy. They were followed for 25 years to assess their dietary intake, and C.T. scans of their abdomen and chest were used to calculate volumes of PAT, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). 

Demographic and lifestyle characteristics were collected from the participants using standard questionnaires. The participants also provided details about the food and beverages they consumed. Nutrient values were obtained from a diet data software program called the Nutrition Data System for Research (NDSR).  

A cardiac C.T. scan was performed to measure the volume of the adipose tissue; this was done using 64 channel multi-detector scanners.  

The baseline characteristics of the participants were stratified across quintiles of added sugar. The researchers found that participants in the highest quintile were more likely to be younger, male, current smokers, black, nondrinkers, physically inactive than those in the lowest quintile. 

Three statistical models were developed: 

• Model 1 adjusted for age, sex, race, education, field center, and energy intake. 
• Model 2 adjusted for model 1 and lifestyle factors such as physical activity, smoking and drinking status, height, and nutrients. 
• Model 3 adjusted for model 2 and Y25 diabetes and BMI. 

In model 2 added sugar intake was associated with higher volumes of PAT (ptrend = 0.001), VAT (ptrend <0.001) and SAT (ptrend = 0.04), it was also associated with higher Y25 BMI (ptrend = 0.02).  

In model 3, the association between added sugar and the volumes of PAT (ptrend = 0.02) and VAT (ptrend = 0.004) was slightly reduced after adjusting for diabetes and Y25 BMI, and there was no association with the volume of SAT (ptrend = 0.77). 

Participants who consumed more than 50 grams of added sugar daily had higher PAT (p=0.009), VAT(p<0.001), and SAT(p=0.002). Similar patterns were seen in participants with a high intake of sugar-sweetened beverages.  

The study concluded that added sugar’s long-term intake is associated with higher volumes of PAT, VAT, and SAT and higher BMI, while sugar-sweetened beverages were associated with higher volumes of PAT and VAT.  

One of the limitations of this study was self-reported dietary intake due to variance in measurement; however, sugar-sweetened beverages are measured more accurately since they are available in cans or bottles. Furthermore, the study had many strengths, including the prospective design, the long time of follow-up (25 years), and the population which consisted of white and black men and women. 

Multiple health efforts have been launched to encourage the public to reduce their consumption of added sugar, like the dietary guidelines for Americans and the WHO’s recommendations to limit the daily intake of added sugar, and the inclusion of the amount of added sugar in the new Nutrition Facts label. 

Practice Pearls:  

• High sugar diets are associated with health risks, including cardiovascular diseases. 
• A study carried out on a cohort of more than 3000 participants established that an increase in the volume of pericardial, visceral, and subcutaneous adipose tissues was associated with a high sugar diet.  
• The public should be educated about the risks associated with high sugar intake, which extend beyond diabetes and obesity. 

So-Yun Yi, Lyn M Steffen, James G Terry, et al. Added sugar intake is associated with pericardial adipose tissue volume. Eur J Prev Cardiol. 2020 June 28;2047487320931303. 

Fairuz Afram, PharmD Candidate, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences. 

See more about sugar consumption and health.