Sugar-sweetened and artificially-sweetened beverages and changes in cognitive function in the SUN project

ABSTRACT

Background: Sugar-sweetened beverages (SSB) and artificially-sweetened beverages (ASB) have been inconsistently associated with declines in cognitive function. Because of their low caloric content and replacement of sugar, ASB are often seen as ‘healthy’ alternatives to SSB.

Objective: We longitudinally assessed the association between the consumption of SSB or ASB and cognitive function.

Design: A subsample of the ‘Seguimiento Universidad de Navarra’ (SUN) cohort of university graduates aged over 55 years old was evaluated with the Spanish Telephone Interview for Cognitive Status (STICS-m) at two-time points, separated by 6 years. Consumption of SSB and ASB was appraised using a validated food-frequency questionnaire. Linear regression models were fitted, adjusting for potential confounders, including cardiometabolic variables, with the change in the STICS-m score at year 6 as the dependent variable.

Results: A significant association between the consumption of SSB and changes in cognitive function as measured by the STICS-m was observed in the total sample, with a change of −0.43 (95% CI −0.85, −0.02, p = 0.04) in those that consumed >1 beverage/month compared to never/seldom consumers. The association was not significant for the consumption of ASB, but point estimates showed negative values, suggesting declines in cognition.

Conclusions: Only the consumption of SSB, but not ASB, was significantly associated with a decline in cognitive function after 6 years. Further longitudinal studies are needed to explore the relationship between these beverages and cognitive function and the potential mechanisms through which they might be harmful.

KEYWORDS:

• Sugar-sweetened beverages
• artificially-sweetened beverages
• cognitive screening test
• cognitive function
• dementia

Acknowledgments

We thank all the SUN participants for their collaboration. We also thank the other SUN Project investigators (Alonso A, Barrio Lopez MT, Basterra-Gortari FJ, Benito Corchon S, Bes-Rastrollo M, Beunza JJ, Carlos S, de Irala J, de la Rosa PA, de la Fuente C, Donat-Vargas CL, Donazar M, Fernandez Montero A, Galbete-Ciaurriz C, Gea A, Goni-Ochandorena E, Lahortiga F, Llorca J, Lopez del Burgo C, Mari-Sanchís A, Marti A, Mendonça R, Nuñez-Cordoba JM, Pimenta AM, Rico A, Ramallal Martínez R, Ruiz Zambrana A, Ruiz-Canela López M, Sayon-Orea C, Toledo-Atucha J, Vazquez Ruiz Z, Zazpe Garcıa I).

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Mariana I. Muñoz-García is an M.D., and currently a Ph.D. student in the University of Navarra, Pamplona, Spain, researching associations between diet and cognitive function.

Miguel A. Martínez-González is an M.D. Ph.D., and specialist in Preventive Medicine & Public Health, currently a tenured Professor & Chair of Preventive Medicine & Public Health in the University of Navarra, a group coordinator of the CIBER-OBN (coordinates groups researching the physiopathology of obesity & nutrition in Spain), and an adjunct professor in the Department of nutrition in the Harvard TH Chan School of Public Health.

José M Martín-Moreno is an M.D., Ph.D. and specialist in Preventive Medicine & Public Health and Occupational Medicine. Currently, he is a professor of Preventive Medicine and Public Health at the University of Valencia and the Quality Coordinator at the University Clinical Hospital. Additionally, he is also Member of the European Advisory Committee on Health Research of the WHO – Regional Office for Europe, Temporary Adviser to the European Observatory on Health Systems and Policies, and Senior Associate at the Johns Hopkins University School of Public Health (joint appointment, Department of Health Policy and Management and Department of Epidemiology) (https://www.uv.es/jomarmo6/Home.html).

Cristina Razquin is a Ph.D., currently a research associate in the Department of Preventive Medicine & Public Health in the University of Navarra.

Sebastián Cervantes is an M.D., Ph.D. and specialist in Neurology and Radiology, and currently working in the Department of Radiology in the Hospital of Navarre in Pamplona, Spain.

Francisco Guillén-Grima is an M.D., Ph.D., and a specialist in Preventive Medicine & Public Health, currently director of Preventive Medicine and Public Health in the Clinica Universidad de Navarra (CUN) and a tenured professor in the University of Navarra.

Estefanía Toledo is an M.D., Ph.D. and specialist in Preventive Medicine & Public Health, currently an associate Professor in the department of Preventive Medicine & Public Health in the University of Navarra, and co-Principal investigator in the CIBER-OBN group (researching the physiopathology of obesity & nutrition in Spain).

Additional information

Funding

The SUN Project has received funding from the Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) [grant number RD 06/0045], CIBER-OBN [grant number PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, and G03/140], the Navarra Regional Government [grant number 45/2011, 122/2014], and the University of Navarra. MAMG, FGG, CR and ET were responsible for obtaining funding.