Sugary drinks from childhood linked to adult hypertension risk

Drinking fruit juice and sugar-sweetened beverages from childhood through adulthood may be linked to an increased risk of developing high blood pressure as an adult, according to new research published today in the American Heart Association's flagship journal Circulation.

"Dietary habits in early life can have lasting health consequences," said senior study author Vasanti Malik, Sc.D., M.Sc., an associate professor and Canada Research Chair in Nutrition and Chronic Disease Prevention in the department of nutritional sciences at Temerty Faculty of Medicine at the University of Toronto, and an adjunct faculty member in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston.

"High blood pressure is also emerging earlier in life, with growing rates being seen in younger adults, in children and adolescents, which highlights the importance of early detection and prevention," she said.

High blood pressure can lead to other serious health conditions or events, such as heart attack and stroke. While some risk factors for blood pressure such as family history, age, gender and race cannot be changed, unhealthy lifestyle factors, such as lack of physical activity, smoking and poor diet, can increase the risk of high blood pressure.

The analysis included more than 25,000 participants from a study of U.S. youths. Participants reported how often, on average, they consumed sugar-sweetened beverages, including sodas, punches, lemonades, teas and sports drinks; fruit juice and whole fruits. They also reported their intake of other foods and beverages typically consumed and their body measurements and habits, such as physical activity and smoking, via questionnaires completed every 1 to 4 years.

Researchers estimated the associations of total fructose and sugar-sweetened beverages, fruit juice and whole fruit intake with self-reported high blood pressure diagnoses. They also developed models of the effect of substituting sugar-sweetened beverages or fruit juice with whole fruit, milk and water. Participants were followed for up to 25 years.

What are the key results of the analysis?:

• Participants who drank two or more servings of sugar-sweetened beverages per day had a 52% higher risk of later developing high blood pressure compared to those who consumed less than three servings a week. A typical serving was defined as a 12-ounce can or glass.
• Among sugary drink subtypes, each daily serving of soda and sports drinks was associated with a 23% and 36% higher risk of high blood pressure, respectively.
• Those who drank 1.5 or more servings of fruit juice per day had a 35% higher risk of developing high blood pressure compared to those who said they drank less than one serving a week. One serving was defined as an 8-ounce glass.
• For subtypes of fruit juice, each daily serving of orange juice was associated with a 20% higher risk of high blood pressure, while apple and other juices were not. However, the researchers noted the potential for misclassification, as orange-flavored drinks with added sugars may have been misreported as orange juice.
• The substitution analysis suggested that replacing a daily serving of sugary beverage with whole fruit could be associated with a 22% lower risk of developing high blood pressure.
• Similarly, replacing fruit juice with whole fruit could result in a 19% lower risk of developing high blood pressure.
• Substituting sugar-sweetened beverages with milk or water in the model analysis was associated with up to a 13% lower risk of developing high blood pressure, whereas no significant association was found for replacing fruit juice with milk or water.
• This link between sugary drinks/fruit juice and high blood pressure was independent of overall diet quality, physical activity and other factors.

Sugar-sweetened beverages, such as soda and sports drinks, which are often marketed as somewhat healthy, should be limited. Fruit juice intake may be harmless at low levels yet harmful at higher intake levels. They should always be 100% fruit juice, and even so, consumed only in moderation. Whole fruit should be emphasized over sugary beverages."

Vasanti Malik, Sc.D., M.Sc., Associate Professor and Canada Research Chair in Nutrition and Chronic Disease Prevention, Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto

A 2026 Dietary Guidance to Improve Cardiovascular Health scientific statement from the American Heart Association notes that added sugar in beverages and foods should be minimized.

American Heart Association volunteer expert Amit Khera, M.D., FAHA, vice-chair of the dietary guidance writing committee, said that while the association between sugar-sweetened beverages and increased hypertension and cardiovascular risk is generally consistent across studies, these findings add several new insights: "First, the focus on childhood and the importance of health behaviors in childhood with adult risk factor development provides a critical opportunity for prevention. As has been seen in adults, the total amount of fructose seems less important for the development of hypertension than the type of food where it is consumed, so sugar-sweetened beverages and fruit juice relate to increased risk, while whole fruit does not.

"Secondly, there has been a misconception about fructose in general being harmful for cardiovascular health regardless of the source, and that fruit juices are beneficial for health. This study demonstrates that neither seems to be correct," added Khera, the director of preventive cardiology and clinical chief of cardiology at the University of Texas Southwestern Medical Center in Dallas.

He also noted this study's population was mostly white children and adults; "however, non‑Hispanic Black and Hispanic American populations have the highest sugar-sweetened beverages intake, so these findings may be even more relevant for those groups."

The American Heart Association advocates for science-based policies that reduce consumption of sugary drinks. These policies include:

• Establishing taxes on sugary drinks to decrease consumption.
• Improving nutrition standards in school meals.
• Enhancing "informed dining" in restaurants.
• Improving diet quality in the Supplemental Nutrition Assistance Program (SNAP).

What are the details, background, design and limitations of the study?

• The participants were from the Growing Up Today Study (GUTS), which included the GUTS I study initiated in 1996 and the GUTS II, which was initiated in 2004. The offspring of participants in the Nurses' Health Study II were recruited for GUTS nationwide.
• The study followed 25,749 participants, ages 9 to 16, (about 55% female and 96% non-Hispanic white participants) for up to 25 years. The median age of the participants by the end of the follow-up period was 36 years.
• Participants completed 132-item food frequency questionnaires, administered annually from 1996 to 1998, then in 2001, 2004, 2006, 2008, 2011 and 2015. Children with high blood pressure or with missing dietary information at baseline were not included in this analysis.
• The food frequency that was used to assess diet asked how often, on average, they consumed a standard serving of a food or beverage, ranging from "never or less than once per month" to "6 or more per day". A serving was specified as a 12-ounce can or glass of sugar-sweetened beverages and an 8-ounce glass of fruit juice.
• Sugar-sweetened beverages were defined as sodas, fruit punches, lemonades, iced teas, sports drinks and non-carbonated fruit drinks. Fruit juice included orange juice, apple juice and other 100% fruit juice drinks. Whole fruits included apples, oranges, bananas, mangos, grapes, pears, melons, strawberries and peaches.
• Substitution analyses were conducted by contrasting one serving per day of sugar-sweetened beverages or fruit juice with a serving of fruit juice, milk (1%, 2% and whole milk but not chocolate or flavored milk), water or whole fruit.
• Blood pressure was self-reported through the 2010 to 2021 questionnaires. Participants were asked if they had ever been diagnosed by a healthcare professional with high blood pressure. In the 2010 questionnaire, the earliest response option for the year of diagnosis was "before 1996" and ranged until "2010+".
• Limitations of the study include the inability to prove cause and effect because it was based on questionnaires and self-reports and some factors not included in this analysis may have affected the results. In addition, the findings may not apply to other groups not included in this study.