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Sugary drinks linked to higher dementia risk, new study from UK Biobank reveals
In a recent study published in the Nutrition Journal, researchers examined a prospective population-based United Kingdom (U.K.) Biobank cohort to examine associations between free and intrinsic sugar sources and the risk of dementia.
Background
Dementia is characterized as a decline in cognitive function beyond the level associated with normal aging. There are approximately 55 million cases of dementia across the world, and the incidence increases by 10 million cases each year. Furthermore, while age is an established risk factor for dementia, obesity and overweight during mid-life are believed to increase the risk of dementia. However, despite the extensive research conducted on dementia and its risk factors, there are no effective treatments to date, and lifestyle and dietary interventions remain the primary approaches to slow the progression of the disease.
Dietary interventions to slow the progression of dementia often also address problems of obesity and overweight. A low-carbohydrate diet is believed to improve glucose control and reduce low-grade inflammation while providing promising results in delaying dementia.
However, the absence of diverse food choices is often a limitation to achieving a low-carbohydrate diet, as adherence to the diet might require excluding foods such as whole grains, legumes, and some fruits and vegetables that are thought to improve cognition. Therefore, recent studies have focused on limiting specific carbohydrates such as sugars.
About the study
In the present study, the researchers examined the association between an increased risk of dementia and the consumption of free and intrinsic sugar sources. Free sugars are those that are added to foods during manufacturing, cooking, or consumption, while intrinsic sugars naturally occur in foods, such as those in vegetables, fruits, honey, and dairy products.
The World Health Organization recommends that the consumption of free sugars be below 10% of the total energy intake and less than 5% per day. To understand whether consumption of free sugars from various sources, such as solid foods, beverages, and subtypes of solid foods and beverages, was associated with an increased risk of dementia, the researchers conducted a prospective cohort study using a population of U.K. Biobank participants.
The researchers hypothesized that the correlation between free sugar consumption and incident dementia would be dependent on the source of free sugars, with free sugars from beverages and beverage subtypes showing a positive association with incident dementia but a similar association being absent between free sugars from solid foods. They also examined whether consumption of intrinsic sugars was associated with an increased dementia risk.
The study included U.K. Biobank participants who had filled out at least one online dietary questionnaire assessing the 24-hour dietary intake. Those participants for whom information on lifestyle risk factors, socioeconomic factors such as household income, Townsend deprivation index, ethnic background, and educational qualifications, and health parameters such as systolic blood pressure and body mass index were missing, as well as those who had been diagnosed with dementia before the administration of the questionnaire, or had a history of diabetes, were excluded from the study.
Sugar intake was assessed based on the specific food types reported in the web-based questionnaire, such as fruit juices, milk-based drinks, coffee, tea, treats, sauces, toppings, and breakfast cereals. The examined primary outcome was the incidence of all-cause dementia.
Results
The results reported a linear association between the consumption of free sugars in beverages such as fruit drinks, sodas, and milk-based drinks and the risk of dementia. Free and intrinsic sugar intake showed significant associations with the risk of dementia, with a J-shaped association and the lowest hazard ratios being observed at 8% and 9% of intrinsic and free-sugar consumption, respectively.
While the consumption of free sugars in beverages showed a significant and linear association with the risk of incident dementia, no significant association was observed between dementia risk and the consumption of free sugars through solid foods.
Furthermore, within the various subtypes of beverages that were examined, fruit drinks, sodas, and milk-based drinks showed a positive and significant association with the risk of dementia, while juices showed similar associations, but to a lesser extent. Tea and coffee did not show any significant association with dementia risk.
Conclusions
Overall, the findings reported that consuming free sugars, primarily through beverages such as fruit, milk-based drinks, and sodas, increased the risk of incident dementia. Fruit juices showed a similar association, but to a lesser extent, while consuming free sugars through coffee and tea was not associated with an increased risk of dementia. Free sugars consumed through solid foods were not linked to an increased risk of dementia.
注释：
glucose: n
表示"葡萄糖"， 如：Glucose has a simple sugar molecule.葡萄糖含有单糖分子。
legume: n
表示" 豆类；豆荚"，如：The legume has been considered lucky among Southerners ever since.豆荚一直被南方人视为幸运的食物。
subtype: n
表示" 子类型"，如： natural subtype 自然子类型
cohort: n
表示" 一群人"，means "a company of companions or supporters"，如：The gangster walked into the room surrounded by his cohort. 一名匪徒走进被他的一帮人包围的屋子。
systolic: adj
表示"（心脏）收缩的"，means "of or relating to a systole or happening during a systole"，如：systolic thrill 收缩期震颤
中文简要说明：
世卫统计全球失智症患者约5500万人，每年以1000万例高速增加，目前仍无有效治疗方法，改变生活方式与饮食内容仍是目前的最佳预防之道。除了年龄因子，中年时期肥胖也是罹病风险之一，特定碳水化合物摄取量应当积极控制，例如糖。德国一项研究发现，日常生活常见的3类含糖饮料恐令失智风险大增，最高达到39%。
英国《太阳报》、医疗保健新闻网站News Medical报导，德国基森大学（University of Giessen）研究摄取不同形式的糖分对于失智症风险有何影响发现，含有大量游离糖的饮料会导致失智风险增加，包括调味果汁饮品、调味牛奶饮品、碳酸饮料。纯果汁影响程度相对较小，茶与咖啡则不会增加失智风险。
游离糖（free sugar）是指制作餐饮过程添加的任何糖分。相对于此，一些含有天然糖分的食材与失智程度也有关联，但程度较轻微。
研究团队分析英国人体生物数据库（UK Biobank）18万6622人的饮食数据，年龄37岁至73岁，10年之间有1498人罹患失智症。参与者的糖分摄取量依照特定摄食种类评估，例如果汁、牛奶饮品、咖啡、茶、零嘴、酱汁、配料、早餐谷片等等。
参与者的整体健康状况、社经状况、家庭病史均纳入考虑。每天喝少量调味牛奶饮品，例如麦当劳香草奶昔，10年之间罹患失智症风险增加39%；每天喝一杯标准配方的可乐，风险增加21%。若摄取含有游离糖或天然糖分的固体食物，研究团队「并未发现显著关联」。研究成果已发表于施普林格自然集团（Springer Nature）旗下的《营养期刊》（Nutrition Journal）。
此前有研究显示，糖分会引起发炎，发炎在神经性退化疾病扮演重要关键，例如阿兹海默症，这是最常见的失智症类型。
其他个别研究已发现，比起固体食物，以液体形式摄取糖分对于健康而言糟糕许多，部分原因在于大脑不会注意到液体糖分，「喝」热量不会引发与进食一样的饱足感讯号，很可能会摄取过多热量，很可能令体重增加或发胖。液态糖也可能拉高血糖浓度、增加胰岛素阻抗，因而引起糖尿病。世卫建议游离糖摄取量在摄取总热量占比低于10%，每天摄取占比则应低于5%。
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