Observational Study Finds No Association between LNCS Beverages and the Development of Dyslipidemia

Some Changes Reported in Lipoprotein Concentrations but More Research is Needed

Evidence from observational studies suggests that there is a positive association between added sugar intake and risk of cardiovascular disease (CVD).1-3 To help minimize this risk, 100% fruit juice and low- and no-calorie sweetened beverages (LCSB) are commonly-used alternatives to sugar-sweetened beverages (SSBs). However, research regarding potential associations between these alternatives and CVD risk are inconclusive. There is also limited available data on the prospective relationship between the overall consumption of these beverages and plasma lipid and lipoprotein concentrations.

A new study entitled, Beverage Consumption and Longitudinal Changes in Lipoprotein Concentrations and Incident Dyslipidemia in US Adults: The Framingham Heart Study, was published in the February 2020 issue of the Journal of the American Heart Association. For this study, researchers utilized fasting plasma lipoprotein concentrations and beverage intake data from the Framingham Offspring Study and Generation Three cohorts to determine possible associations between beverage consumption and lipoprotein concentrations. Intake data (SSBs, fruit juice, and LCSB) was estimated from food frequency questionnaires and then grouped into five categories based on frequency of consumption.

Mixed results were observed for LCSB consumption, which points to no significant association with development of dyslipidemia. Some adverse changes in lipoprotein concentrations with recent consumption were observed, but the authors note that further research is warranted. Regular consumption of 100% fruit juice (up to 1.5 servings per day) was not associated with adverse changes in lipoprotein concentrations or incident dyslipidemias.

There are several points to consider when interpreting the results of this study. First, self‐reported dietary data from food frequency questionnaires was used to surmise dietary intakes. This method is prone to underreporting and other errors, and may have led to misclassification of food, beverage, and nutrient intakes. Further, observational studies are only able to determine possible associations, so well-controlled, long-term randomized trials are needed in order to confirm associations and establish potential causality. Next, the strong potential for reverse causality must not be ruled out, as those diagnosed with high plasma cholesterol concentrations may have been advised to change their diet in order to help improve lipid profiles.

Also, though the investigators attempted to adjust for potentially confounding variables, including demographic, dietary, and lifestyle factors, the possibility of residual (i.e., unmeasured or incorrectly defined) confounding remains. Lastly, the study sample included adults of European descent who are middle‐aged or older, which limits the generalizability of the findings to this population. Further, there is a potential for bias, as participants who were excluded from the study based on the eligibility criteria may differ significantly from those that were included.

In summary, results from observational studies should be considered very carefully. And although some potential observations were observed, the authors state more research is needed to draw any strong associations.


  1. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among us adults. JAMA Intern Med. 2014;174:516–524.
  2. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LM, Wylie-Rosett J. Dietary sugars intake and cardiovascular health. Circulation. 2009;120:1011–1020.
  3. Malik VS. Sugar sweetened beverages and cardiometabolic health. Curr Opin Cardiol. 2017;32:572–579.
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