Analysis reveals unsweetened and coffee sweetened with sugar provide similar mortality benefit

6th June 2022

Coffee sweetened with sugar has similar mortality benefits to unsweetened coffee, although artificial agents provide a less consistent benefit

Drinking coffee sweetened with sugar provides broadly similar mortality benefits to consumption of unsweetened coffee although benefits from drinking coffee sweetened with artificial agents are much less consistent. This was the finding of a prospective cohort study by a team of researchers based at the Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong, China.

A 2019 meta-analysis concluded that moderate coffee consumption, for example, 2 to 4 cups every day, was associated with reduced all-cause and cause-specific mortality in comparison to those who did not consume the beverage. In fact, consumption of 8 or more cups of coffee per day, even among those with slower or faster caffeine metabolism, has been shown to be inversely associated with mortality. Nevertheless, what has not been explored in the literature is the extent to which sweetened coffee retains these health benefits, given the potential adverse health effects of sweetened beverages.

For the present study, the researchers turned to data held in the UK Biobank to determine the association between consumption of coffee sweetened with either sugar or artificial agents and overall and specific cause mortality. A further objective was to explore whether sweetening affected any mortality benefits depending on how the coffee was prepared, e.g., instant, ground, or decaffeinated. Participants in the UK Biobank completed dietary recall data using a web-based questionnaire from which the researchers collected information on whether sugar or artificial sweeteners were used in coffee. The level of coffee consumption was categorised as 0 – 1.5 cups/day, > 1.5 – 2.5 cups/day, > 2.5 – 3.5 cups/day and > 4.5 cups/day and the type of coffee drank was classed as instant, ground or decaffeinated. Regression analysis was used to estimate the hazard ratios for coffee consumption and mortality, adjusted for several factors such as age, gender, co-morbidities etc.

Coffee sweetened with sugar/artificial agents and mortality outcomes

A total of 171,616 individuals with a mean age of 55.6 years (44.6% male) were included in the final analysis and followed for a median of 7 years. Among this cohort, 24.2% were non-coffee drinkers, 55.4% drank unsweetened coffee with the remainder adding either sugar (14.3%) or artificial sweeteners (6.1%). Those who sweetened their coffee added an average of 1.1 teaspoons of sugar and 1.4 teaspoons of a sweetener.

During the follow-up period there were 3177 deaths, 1725 from cancer and 628 from CVD. Compared with those who did not drink coffee, after adjustment, the risk of death associated with drinking > 3.5 to 4.5 cups of unsweetened coffee/day was 29% lower (hazard ratio, HR = 0.71, 95% CI 0.60 – 0.84). For those drinking a similar amount of coffee sweetened with sugar, there was a similar reduced risk of death (HR = 0.79, 95% CI 0.60 – 1.06). For the same level of consumption, drinking coffee sweetened with an artificial agent had a significant all-cause mortality benefit (HR = 0.65, 95% CI 0.45 – 0.92).

When considering how the coffee was prepared, there were significant mortality benefits associated with drinking > 3.5 to 4.5 cups/day of unsweetened coffee. In contrast, the mortality benefits for a similar level of consumption of sugar-sweetened coffee were slightly less and non-significant for all three methods of preparation. Among those using artificial sweeteners, benefits were derived from instant (HR = 0.66, 95% CI 0.46 – 0.96) and ground coffee (HR = 0.51, 95% CI 0.27 – 0.95) but not decaffeinated (HR = 0.52, 95% CI 0.23 – 1.17).

The authors concluded that taking the data as a whole, it seemed that consumption of either unsweetened or sugar-sweetened coffee provided broadly similar mortality benefits. In contrast, the effect of sweetening coffee with artificial agents was less consistent, possibly due to the smaller number of people in this group.

Citation
Liu D et al. Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality. A Large Prospective Cohort Study Ann Intern Med 2022

Muscle-strengthening activities reduces CVD, cancer and all-cause mortality risk

11th March 2022

Muscle-strengthening activities independent of aerobic activity are linked to a reduced risk of CVD, cancer and all-cause mortality

Undertaking muscle-strengthening activities, independently of aerobics, reduces the risk of cardiovascular disease (CVD), total cancer and all-cause mortality. This was the main finding from a meta-analysis by researchers from the Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Miyagi, Japan.

Increasing muscle strength is recognised as a marker of good health and the World Health Organization recommends regular muscle-strengthening activity for all age groups. The importance of muscle-strengthening activities was highlighted in a 2018 review which concluded that higher levels of upper- and lower-body muscular strength are associated with a lower risk of mortality in the adult population, regardless of age and follow-up period. Moreover, grip strength, which is a marker for overall strength, has also been found to be an independent predictor of all-cause mortality and cardiovascular diseases.

Although aerobic activities have become an established route for reducing both CVD and all-cause mortality risk, the relationship with muscular strength has been less well studied. For the present analysis, the Japanese team looked at the strength of the association between muscle-strengthening activities and the risk of CVD, cancer and mortality in adults. In addition, they were wanted to determine the dose-response relationship with health outcomes and also whether there were synergistic benefits from combing muscle strengthening and aerobic activities.

The team searched all the major databases from inception to 2020 for studies which considered the health outcomes from muscle strengthening activities in those without severe health conditions such as cancer at baseline.

Muscle strengthening activities and health outcomes

A total of 16 studies were included in the final analysis which covered all-cause mortality (8), CVD (9), total cancer (7), type 2 diabetes (5) and site-specific cancers (2). The number of participants varied between 3809 to 479,856 and the median duration of follow-up was 25.2 years and included patients 18 to 97 years of age.

Among studies which considered all-cause mortality, muscle-strengthening activities were associated with a 15% reduced risk of death (Relative risk, RR = 0.85, 95% CI 0.79 – 0.93, p < 0.001). With respect to the duration of activities, the lowest RR was seen at 40 minutes/week (RR = 0.83, 95% CI 0.79 – 0.86). Combing muscle and aerobic activities led to a 40% lower mortality risk (RR = 0.60, 95% CI 0.54 – 0.67) compared to no activity.

For CVD, there was a 17% lower risk from undertaking muscle-strengthening exercises (RR = 0.83, 95% CI 0.73 – 0.93) and the lowest relative risk occurred with training for at least 60 minutes/week (RR = 0.82, 95% CI 0.76 – 0.90).

Finally, muscle-strengthening activities led to a 12% lower risk of total cancer incidence (RR = 0.88) and a 17% lower incidence of diabetes (RR = 0.83).

Discussing their findings, the authors noted that there was a J-shaped relationship between muscle-strengthening activities and all-cause, CVD and total cancer mortality, with the greatest benefit (i.e., highest risk reduction) after 30 to 60 minutes/week of activities.

They concluded that the greatest benefit was accrued from combining muscle and aerobic activities although added the caveat that since the available data are currently limited, further studies are required to increase the certainty of the evidence.

Citation
Momma H et al. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies Br J Sports Med 2022

Sex-related heart failure mortality influenced by left ventricular ejection fraction

4th January 2022

Sex-related differences in mortality after heart-failure hospitalisation is influenced by the left ventricular ejection fraction

Sex-related differences in mortality in patients with heart failure hospitalisations appear to be affected by the left ventricular ejection fraction according to researchers from the Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.

Although the risk of heart failure (HF) is similar between men and women, there are some notable sex-related differences, with men being predisposed to HF with reduced ejection fraction and women with preserved ejection fraction. Although there is some evidence that women with HF live longer than men, they experience more psychological and physical disability. However, much of the available data is derived from patients with stable HF and what is less clear, is if there are any sex-related prognostic differences among patients hospitalised following decompensated heart failure.

For the present study, the Spanish team retrospectively examined gender differences in mortality across the left ventricular ejection fraction spectrum in a cohort of patients after a hospitalisation for acute HF. The researchers used a multi-centre prospective registry of those hospitalised and collected demographics, medical history, laboratory and echocardiographic parameters and followed patients over a 6-month period. The primary study endpoints were all-cause, cardiovascular and HF-related mortality. Cardiovascular death was considered secondary to a worsening of HF, acute myocardial infarction, stroke or transient ischaemic attack, whereas HF-related deaths were considered secondary to a worsening of the HF or a sudden cardiac death.

Findings

A total of 4812 patients with a mean age of 74.2 years (46.6% women) were included in the analysis. The proportion of patients with a left ventricular ejection fraction (LVEF) of < 40%, 41 – 49% and > 50% was 31.5%, 14.3% and 54.2% respectively. Women were generally older with a mean age of 76.8 years compared to 71.9 years for men and had a higher preserved ejection fraction (70.5% vs 39.9%, female vs male, p < 0.001).

After 6 months, 645 (13.4%) of the patients had died with mortality rates of 13.3% and 13.5% (women vs men, p = 0.82) and there were no significant sex-related differences in all-cause mortality. Moreover, LVEF was not an independent predictor of mortality (HR = 1.02, 95% CI 0.99 – 1.05, p = 0.13). Similarly, rates of cardiovascular mortality were not different between the sexes. However, there was a significant interaction between sex and levels of LVEF (p for interaction = 0.030) and women had a significantly lower risk of cardiovascular mortality at lower LVEF levels (< 25%). There were also no differences between the sexes in HF-related mortality although as with cardiovascular mortality, there were differences across the levels of LVEF and women had a reduced risk of HR-related death. For example, compared to men, women had a reduced risk of HF death at a LVEF of < 43% (HR = 0.77, 95% CI 0.59 – 0.99) In contrast, this risk of death in women became higher as the LVEF increased above 80%.

Commenting on these findings, the authors noted that while sex was not a determinant of 6 month all-cause mortality, women had a lower risk of cardiovascular and HR-related mortality where the LVEF was < 25% and < 43% but higher where the LVEF was > 80%. They concluded that further work is required to confirm these findings and to evaluate the potential negative implications of a supra-normal LVEF in women with a preserved ejection fraction.

Citation

Santas E et al. Sex-Related Differences in Mortality Following Admission for Acute Heart Failure Across the Left Ventricular Ejection Fraction Spectrum J Am Heart Assoc 2021