Diet Soda Tied to Vascular Risk, With Caveats

February 9, 2011

Drinking diet soda -- but not regular soda -- was associated with a greater

risk of stroke, MI, or vascular death in an older, multiethnic cohort,

researchers found.

Individuals who reported drinking diet soda every day were 48% more likely

to have a vascular event through more than nine years of follow-up (RR 1.48,

95% CI 1.3 to 2.12), according to Hannah Gardener, ScD, of the University of

Miami in Florida.

There was no such association for less-frequent consumption of diet soda or

for any level of regular soda consumption, she reported at the American

Stroke Association's International Stroke Conference here.

In a separate study, Gardener and her research team also found that

individuals who had the highest daily sodium consumption had a nearly

threefold increased risk of stroke compared with those who met the American

Heart Association target of 1,500 mg a day.

Gardener acknowledged some limitations of the diet soda study, including the

use of self-reported dietary data at a single time point, and concluded that

the findings are " too preliminary to suggest any dietary advice. "

" If and only if the results are confirmed can we suggest that diet soda may

not be an optimal substitute for sugar-sweetened beverages, which have been

shown to have various health consequences, " she said.

Doctors contacted by ABC News and *MedPage Today* were also hesitant to

declare diet sodas the next great health risk, with many attributing the

increased vascular risk to other dietary factors that were not measured in

the study, such as the types of foods contributing to the total caloric

intake.

" Unfortunately, it may be that individuals with poor dietary habits do

resort [to] some kind of calorie balancing and continue to eat high-calorie

sweet foods but reduce their 'guilt' by drinking diet soda, "

Weintraub, MD, clinical director of the NYU Center for the Prevention of

Cardiovascular Disease, wrote in an e-mail.

The study " adds to the growing evidence of an association between diet sodas

and cardiovascular disease, " according to Cam , MD, a cardiologist

at the University of North Carolina at Chapel Hill. But, he added, that,

although the association cannot be ignored, it is too early to interpret

what it means.

" People need to know about this, but it is important for everyone to realize

that no general guidelines should be derived from these types of

observational studies, " wrote in an e-mail.

" I'll continue to pack a diet soda with my lunch, but I'll look more

carefully at what else is in my lunch box, and I'll pay more attention to

what I'm doing while I'm drinking my diet soda. "

Gardener and her colleagues analyzed data from the Northern Manhattan Study

(NOMAS), which includes individuals older than 40 living in New York City.

The current analysis included 2,564 participants. Their mean age was 69;

about half were Hispanic, one-fifth were white, and one-quarter were black.

Based on a food frequency questionnaire completed at baseline, 35% of the

cohort did not drink either regular or diet soda. Only 24% reported drinking

any amount of diet soda.

Diet soda consumption was associated with white race, diabetes, elevated

blood sugar, low HDL cholesterol, elevated waist circumference and body mass

index, peripheral vascular disease, and metabolic syndrome (*P*<0.05 for

all).

Through an average follow-up of 9.3 years, there were 559 incident vascular

events, including 212 strokes, 149 MIs, and 338 vascular deaths.

After adjustment for demographic and behavioral and vascular risk factors --

including BMI -- there was an increased risk of having a vascular event with

daily diet soda consumption, but no other levels of consumption of diet or

regular soda.

Commenting on the findings, Cannon, MD, of Brigham and Women's

Hospital in Boston, pointed out, however, that the number of participants

who drank diet soda daily was small -- 116 -- and that the lack of an

association with regular soda consumption was at odds with previous studies.

" This suggests that the finding may be spurious, and needs confirmation in a

much larger group of patients, " he wrote in an e-mail.

Gardener agreed that confirmation was needed before drawing any definitive

conclusions, with further studies that focus on a younger population with

more diet soda consumption and that collect diet information at multiple

time points.

She and her colleagues also examined the relationship between dietary sodium

intake and stroke in the NOMAS cohort.

Although the American Heart Association recommends consuming less than 1,500

mg a day, only 12% of the participants met that goal.

The average daily consumption at baseline was 3,031 mg, with one-fifth of

the cohort ingesting more than 4,000 mg a day.

Over a mean follow-up of 10 years, there were 227 strokes.

After adjustment for demographics and behavioral and vascular risk factors

-- including hypertension -- every 500 mg/day increase in sodium intake was

associated with an 18% relative increase in stroke risk (RR 1.18, 95% CI

1.08 to 1.27).

Those individuals who consumed the most -- more than 4,000 mg/day -- had a

2.67-fold (95% CI 1.31 to 5.41) increased risk compared with those who met

the AHA target.

" The results of our study suggest that the new AHA strategic dietary goals

will help promote ideal cardiovascular as well as brain health, " Gardener

said, " and this evidence can be used in campaigns aimed at reducing

cardiovascular disease risk by targeting dietary behavior. "

*Primary source: *American Stroke Association's International Stroke

Conference

Source reference:

Gardener H, et al " Soda consumption and risk of vascular events in the

Northern Manhattan Study " *ASA* 2011; Abstract P55.

LINK <http://www.medpagetoday.com/MeetingCoverage/ASA/24788>

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

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February 9, 2011

wow -very helpful. I'm sure it's linked to the aspartame, the metabolites to be

wary of are not just phenylalanine. The aspartic acid is a migraine menace and

you can't read labels for the Neotame - thank you for that link too.

I retract my earlier opinion that we need to not use processed foods if we want

anyone to lose weight. I actually do eat some junky food and I love candy, I

just eat more of the good stuff. A small serving of diet stuff with a meal will

probably not have the brain effects that the diet serving on an empty stomach

would have. Athletes may be well served to read labels for stevia or other

natural low calorie sweeteners in their rehydration choices.

My fear with manipulation of processed foods to acheive lower calorie and lower

sodium - is that what is likely to be increased is the artificial flavors and

fillers that may be even worse for us. (I think 'Eat less' may be interpreted as

keep the calories down - making that unlabeled Neotame even more attractive to

industry.)

R Vajda, R.D.

________________________________

To: RD-USA <rd-usa >

Sent: Wed, February 9, 2011 4:30:54 PM

Subject: Diet Soda Tied to Vascular Risk, With Caveats