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Archive for the ‘Clinical Studies’ Category

Relationship between insulin resistance and vitamin D

August 13 2014

by alex

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This Canadian cross-sectional cohort study adds to the body of evidence linking low Vitamin D status with higher risk of insulin resistance and type 2 diabetes mellitus.

Relationship between insulin resistance and plasma vitamin D in adults

Badawi A1, Sayegh S2, Sadoun E3, Al-Thani M2, Arora P4, Haddad PS5.
Diabetes Metab Syndr Obes. 2014 Jul 7;7:297-303.
doi: 10.2147/DMSO.S60569. eCollection 2014.

Abstract

A recent relationship between vitamin D deficiency and the risk of type 2 diabetes mellitus (T2DM) and insulin resistance has been established through several studies. Research suggests a correlation between serum vitamin D and glycemic status measures. The aim of this study was to investigate the relationship between the plasma vitamin D levels (25[OH]D) and the factors linked to insulin resistance in a representative sample of Canadians ranging in age from 16-79 years. Data were used from the Canadian Health Measures Survey where direct measures of health and wellness were reported from 1,928 subjects. These data were gathered from March 2007-February 2009 at 15 sites selected through a multistage sampling strategy. An inverse relationship between insulin resistance and plasma vitamin D level in both men and women was observed. This study provides additional evidence for the role of vitamin D in T2DM. If causally associated, the supplementation of vitamin D may help in preventing insulin resistance and subsequent T2DM.

PMID: 25045275
Full text: PMC4094570

In the Netherlands, a clinical trial to explore this relationship is underway.

Study protocol: a randomised placebo-controlled clinical trial to study the effect of vitamin D supplementation on glycaemic control in type 2 Diabetes Mellitus SUNNY trial.

Krul-Poel YH, Wijland Hv, Stam F, Ten Boekel E, Lips P, Simsek S1.
BMC Endocr Disord. 2014 Jul 17;14:59. doi: 10.1186/1472-6823-14-59.

Abstract

BACKGROUND: Besides the classical role of vitamin D on calcium and bone homeostasis, vitamin D deficiency has recently been identified as a contributing factor in the onset of insulin resistance in type 2 diabetes mellitus. However, it is uncertain whether vitamin D deficiency and poor glycaemic control are causally interrelated or that they constitute two independent features of type 2 diabetes mellitus. There are limited clinical trials carried out which measured the effect of vitamin D supplementation on glycaemic control.The objective of this study is to investigate the effect of vitamin D supplementation on glycaemic control and quality of life in patients with type 2 diabetes mellitus.

METHODS/DESIGN: In a randomised double-blind placebo-controlled trial conducted in five general practices in the Netherlands three hundred patients with type 2 diabetes mellitus treated with lifestyle advises or metformin or sulphonylurea-derivatives are randomised to receive either placebo or 50,000 IU Vitamin D3 at monthly intervals. The primary outcome measure is the change in glycated haemoglobin level between baseline and six months. Secondary outcome measures include blood pressure, anthropometric parameters, lipid profile, insulin resistance, quality of life, advanced glycation end products and safety profiles. Quality of life will be measured by The Short Form (SF-36) Health Survey questionnaire. Advanced glycation end products are measured by an AGE-reader.

DISCUSSION: This trial will be the first study exploring the effect of vitamin D supplementation on both glycaemic control and quality of life in patients with type 2 diabetes mellitus. Our findings will contribute to the knowledge of the relationship between vitamin D status and insulin resistance in patients with type 2 diabetes mellitus.

TRIAL REGISTRATION: The Netherlands trial register: NTR3154.

PMID: 25033925
PMCID: PMC4107614

Ginger as good as triptan for acute migraine

August 5 2014

by alex

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This study compared just 250 mg of powdered ginger root with sumatriptan 50 mg in 100 patients with acute migraine headache without aura. They were found to be equally effective but ginger had fewer side effects.

This very safe and well-tolerated botanical should be considered as a treatment option for acute migraine headache.

The plain powdered ginger root should be used, not an extract of ginger which is concentrated for other indications.

Further study to compare different dosages of ginger root would be of value.

Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine.
Maghbooli M1, Golipour F, Moghimi Esfandabadi A, Yousefi M.
Phytother Res. 2014 Mar;28(3):412-5. doi: 10.1002/ptr.4996. Epub 2013 May 9.

Abstract
Frequency and torment caused by migraines direct patients toward a variety of remedies. Few studies to date have proposed ginger derivates for migraine relief. This study aims to evaluate the efficacy of ginger in the ablation of common migraine attack in comparison to sumatriptan therapy. In this double-blinded randomized clinical trial, 100 patients who had acute migraine without aura were randomly allocated to receive either ginger powder or sumatriptan. Time of headache onset, its severity, time interval from headache beginning to taking drug and patient self-estimation about response for five subsequent migraine attacks were recorded by patients. Patients(,) satisfaction from treatment efficacy and their willingness to continue it was also evaluated after 1 month following intervention. Two hours after using either drug, mean headaches severity decreased significantly. Efficacy of ginger powder and sumatriptan was similar. Clinical adverse effects of ginger powder were less than sumatriptan. Patients’ satisfaction and willingness to continue did not differ. The effectiveness of ginger powder in the treatment of common migraine attacks is statistically comparable to sumatriptan. Ginger also poses a better side effect profile than sumatriptan.
PMID: 23657930

Vitamin D deficiency in those with IBD increases cancer risk

July 11 2014

by alex

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In this multi-institutional cohort of 2809 patients with inflammatory bowel disease, almost one-third had deficient levels of vitamin D (<20 ng/mL).
In a median follow-up period of 11 years, 7% (n = 196) of patients in the study developed cancer, with 41 cases of colorectal cancer. Patients with vitamin D deficiency had an increased risk of cancer (adjusted OR, 1.82; 95% CI, 1.25–2.65).
The authors conclude that vitamin D deficiency is associated with a greater risk of all cancer, but especially colorectal cancer.
The study has significant limitations, well outlined by the authors, and interventional studies of Vitamin D supplementation in IBD patients are yet to be done, but their bottom line recommendation that patients with inflammatory bowel disease should be screened routinely for Vitamin D deficiency appears to be valid.
Full text is open access.

 

Association Between Reduced Plasma 25-Hydroxy Vitamin D and Increased Risk of Cancer in Patients With Inflammatory Bowel Diseases

Ashwin N. Ananthakrishnan, Su–Chun Cheng, Tianxi Cai, Andrew Cagan, Vivian S. Gainer, Peter Szolovits, Stanley Y. Shaw, Susanne Churchill, Elizabeth W. Karlson, Shawn N. Murphy, Isaac Kohane, Katherine P. Liao
Clin. Gastroenterol. Hepatol. 2014 May 01;12(5)821-827

Abstract

BACKGROUND & AIMS
Vitamin D deficiency is common among patients with inflammatory bowel diseases (IBD) (Crohn’s disease or ulcerative colitis). The effects of low plasma 25-hydroxy vitamin D (25[OH]D) on outcomes other than bone health are understudied in patients with IBD. We examined the association between plasma level of 25(OH)D and risk of cancers in patients with IBD.

METHODS
From a multi-institutional cohort of patients with IBD, we identified those with at least 1 measurement of plasma 25(OH)D. The primary outcome was development of any cancer. We examined the association between plasma 25(OH)D and risk of specific subtypes of cancer, adjusting for potential confounders in a multivariate regression model.

RESULTS
We analyzed data from 2809 patients with IBD and a median plasma level of 25(OH)D of 26 ng/mL. Nearly one-third had deficient levels of vitamin D (<20 ng/mL). During a median follow-up period of 11 years, 196 patients (7%) developed cancer, excluding nonmelanoma skin cancer (41 cases of colorectal cancer). Patients with vitamin D deficiency had an increased risk of cancer (adjusted odds ratio, 1.82; 95% confidence interval, 1.25-2.65) compared with those with sufficient levels. Each 1-ng/mL increase in plasma 25(OH)D was associated with an 8% reduction in risk of colorectal cancer (odds ratio, 0.92; 95% confidence interval, 0.88-0.96). A weaker inverse association was also identified for lung cancer.

CONCLUSIONS
In a large multi-institutional IBD cohort, a low plasma level of 25(OH)D was associated with an increased risk of cancer, especially colorectal cancer.

Link to full text: www.cghjournal.org/article/S1542-3565(13)01644-3/fulltext

Higher prevalence of Celiac in children with IBS

July 2 2014

by alex

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Adults with a diagnosis of irritable bowel syndrome (IBS) have been shown to have a higher prevalence of celiac disease than the general population in several studies. This prospective study in children found a 4 percent prevalence of celiac disease in those with IBS, while the prevalence in the general population is 1 percent.

This suggests that both children and adults with IBS symptoms should be screened for celiac disease.

 

Increased Prevalence of Celiac Disease Among Pediatric Patients With Irritable Bowel Syndrome: A 6-Year Prospective Cohort Study

Cristofori F1, Fontana C1, Magistà A2, Capriati T1, Indrio F1, Castellaneta S3, Cavallo L1, Francavilla R1.
JAMA Pediatr. 2014 Apr 21. doi: 10.1001/jamapediatrics.2013.4984. [Epub ahead of print]

Abstract

IMPORTANCE Recurrent abdominal pain is a prevalent health issue in childhood. Clinical criteria (ie, the Rome criteria) have been established to aid diagnosis. Studies of adults have shown an increased prevalence of celiac disease among patients with irritable bowel syndrome (IBS); few data are available with regard to children.

OBJECTIVE To assess the prevalence of celiac disease among children with abdominal pain-related functional gastrointestinal disorders classified according to the Rome criteria.

DESIGN, SETTING, PARTICIPANTS Six-year (2006-2012) prospective cohort study conducted in a tertiary referral center for the diagnosis and follow-up of gastrointestinal disorders in southern Italy (ie, Bari, Italy). A total of 992 children (42.8% male; median age, 6.8 years) consecutively referred for recurrent abdominal pain by their primary care physicians without previous investigation were evaluated.

EXPOSURE Patients were classified according to Rome III criteria as having IBS, functional dyspepsia, functional abdominal pain, or abdominal migraine.

MAIN OUTCOMES AND MEASURES Prevalence of celiac disease in each category of abdominal pain-related functional gastrointestinal disorder. Concentrations of IgA, IgA antitissue transglutaminase, and endomysial antibodies were measured, and a duodenal biopsy was performed in case of antibody positivity.

RESULTS A total of 992 children were evaluated: 270 were classified as having IBS, 201 as having functional dyspepsia, and 311 as having functional abdominal pain, and 210 children were excluded from the study because they had an organic disorder or some other functional gastrointestinal disorder (not related to abdominal pain). Serologic testing was performed for all 782 children included in the study, and 15 patients tested positive for celiac disease (12 of 270 patients with IBS [4.4%], 2 of 201 patients with functional dyspepsia [1%], and 1 of 311 patients with functional abdominal pain [0.3%]). Children presenting with IBS have a 4 times higher risk of having celiac disease than children without IBS (odds ratio, 4.19 [95% CI, 2.03-8.49]; P < .001).

CONCLUSIONS AND RELEVANCE The prevalence of celiac disease among children with IBS is 4 times higher than among the general pediatric population. Rome III classification of abdominal pain-related functional gastrointestinal disorders might help to select children who deserve screening for celiac disease.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/24756157

Non-Celiac Gluten Sensitivity and Fibromyalgia

June 27 2014

by alex

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The association between fibromyalgia and non-celiac gluten sensitivity has been observed for some time. This article discusses recent research confirming this relationship. More importantly, gluten elimination resulted in improvement in all patients is this small series. The authors are following a larger cohort with 90 of 246 patients showing significant response to gluten-free diet.

 

Patients with fibromyalgia should be screened for celiac disease before commencing a gluten-free diet.

 

Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia

Carlos Isasi1, Isabel Colmenero, Fernando Casco, Eva Tejerina, Natalia Fernandez, José I. Serrano-Vela, Maria J. Castro and Luis F. Villa
Rheumatology International Clinical and Experimental Investigations 2014
10.1007/s00296-014-2990-6

Abstract:
Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5–31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.

 

Full-text link (open access):
http://link.springer.com/article/10.1007%2Fs00296-014-2990-6/fulltext.html

Improving Training of Physicians in Nutrition

June 25 2014

by alex

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The abstract says it all.

The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness

Penny M Kris-Etherton, Sharon R Akabas, Connie W Bales, Bruce Bistrian, Lynne Braun, Marilyn S Edwards, Celia Laur, Carine M Lenders, Matthew D Levy, Carole A Palmer, Charlotte A Pratt, Sumantra Ray, Cheryl L Rock, Edward Saltzman, Douglas L Seidner, Linda Van Horn

Am J Clin Nutr May 2014 ajcn.073502 First published April 9, 2014
doi: 10.3945/​ajcn.113.073502

Abstract

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.

More Details about Brain Inflammation in Chronic Fatigue Syndrome

June 18 2014

by alex

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This is an important study. There has long been a hypothesis that neuroinflammation plays a prominent role in chronic fatigue syndrome, usually called myalgic encephalomyelitis in Europe. Encephalomyelitis is the medical term for brain inflammation.

This imaging study confirms this inflammation and gives detail about which parts of the brain are affected. Levels of inflammation in subjects compared with controls were higher in cingulate cortex, hippocampus, amygdala, thalamus, midbrain, and pons were 45%–199% higher in CFS/ME patients than in healthy controls.
Not surprisingly, the regions affected correlate with symptoms:
amygdala, thalamus, and midbrain inflammation correlated with cognitive impairment (brain fog),
cingulate cortex and thalamus inflammation correlated with pain,
hippocampus involvement correlated with depression.
Integrative treatment approaches attempt to address this brain inflammation amongst other things.

Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An 11C-(R)-PK11195 PET Study
Yasuhito Nakatomi1, Kei Mizuno, Akira Ishii, Yasuhiro Wada, Masaaki Tanaka, Shusaku Tazawa, Kayo Onoe, Sanae Fukuda, Joji Kawabe, Kazuhiro Takahashi, Yosky Kataoka, Susumu Shiomi, Kouzi Yamaguti, Masaaki Inaba1, Hirohiko Kuratsune and Yasuyoshi Watanabe
J Nucl Med 2014 jnumed.113.131045 published ahead of print March 24, 2014

 
Abstract:
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disease characterized by chronic, profound, disabling, and unexplained fatigue. Although it is hypothesized that brain inflammation is involved in the pathophysiology of CFS/ME, there is no direct evidence of neuroinflammation in patients with CFS/ME. Activation of microglia or astrocytes is related to neuroinflammation. 11C-(R)-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinoline-carboxamide (11C-(R)-PK11195) is a ligand of PET for a translocator protein that is expressed by activated microglia or astrocytes. We used 11C-(R)-PK11195 and PET to investigate the existence of neuroinflammation in CFS/ME patients.
Methods: Nine CFS/ME patients and 10 healthy controls underwent 11C-(R)-PK11195 PET and completed questionnaires about fatigue, fatigue sensation, cognitive impairments, pain, and depression. To measure the density of translocator protein, nondisplaceable binding potential (BPND) values were determined using linear graphical analysis with the cerebellum as a reference region.
Results: The BPND values of 11C-(R)-PK11195 in the cingulate cortex, hippocampus, amygdala, thalamus, midbrain, and pons were 45%–199% higher in CFS/ME patients than in healthy controls. In CFS/ME patients, the BPND values of 11C-(R)-PK11195 in the amygdala, thalamus, and midbrain positively correlated with cognitive impairment score, the BPND values in the cingulate cortex and thalamus positively correlated with pain score, and the BPND value in the hippocampus positively correlated with depression score.

 
Conclusion: Neuroinflammation is present in widespread brain areas in CFS/ME patients and was associated with the severity of neuropsychologic symptoms. Evaluation of neuroinflammation in CFS/ME patients may be essential for understanding the core pathophysiology and for developing objective diagnostic criteria and effective medical treatments.

Link: jnm.snmjournals.org/content/early/2014/03/21/jnumed.113.131045.abstract

Mediterranean Diet affects BP, glucose and lipids

June 9 2014

by alex

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The most studied dietary pattern continues to be studied further. Of course, outcomes such as heart attacks, strokes and death matter most, but this study helps to explain some of the ways that the cardiovascular benefits are mediated.

 

Mediterranean Diet Reduces 24-Hour Ambulatory Blood Pressure, Blood Glucose, and Lipids: One-Year Randomized, Clinical Trial

M Doménech, P Roman, J Lapetra, FJ García de la Corte, A Sala-Vila, R de la Torre, D Corella, J Salas-Salvadó, V Ruiz-Gutiérrez, RM Lamuela-Raventós, E Toledo, R Estruch, A Coca, E Ros

Hypertension 2014 May 05 [epub ahead of print]

Abstract

The PREvención con DIeta MEDiterránea (PREDIMED) trial showed that Mediterranean diets (MedDiets) supplemented with either extravirgin olive oil or nuts reduced cardiovascular events, particularly stroke, compared with a control, lower fat diet. The mechanisms of cardiovascular protection remain unclear. We evaluated the 1-year effects of supplemented MedDiets on 24-hour ambulatory blood pressure (BP), blood glucose, and lipids. Randomized, parallel-design, controlled trial was conducted in 2 PREDIMED sites. Diets were ad libitum, and no advice on increasing physical activity or reducing sodium intake was given. Participants were 235 subjects (56.5% women; mean age, 66.5 years) at high cardiovascular risk (85.4% with hypertension). Adjusted changes from baseline in mean systolic BP were -2.3 (95% confidence interval [CI], -4.0 to -0.5) mm Hg and -2.6 (95% CI, -4.3 to -0.9) mm Hg in the MedDiets with olive oil and the MedDiets with nuts, respectively, and 1.7 (95% CI, -0.1 to 3.5) mm Hg in the control group (P<0.001). Respective changes in mean diastolic BP were -1.2 (95% CI, -2.2 to -0.2), -1.2 (95% CI, -2.2 to -0.2), and 0.7 (95% CI, -0.4 to 1.7) mm Hg (P=0.017). Daytime and nighttime BP followed similar patterns. Mean changes from baseline in fasting blood glucose were -6.1, -4.6, and 3.5 mg/dL (P=0.016) in the MedDiets with olive oil, MedDiets with nuts, and control diet, respectively; those of total cholesterol were -11.3, -13.6, and -4.4 mg/dL (P=0.043), respectively. In high-risk individuals, most with treated hypertension, MedDiets supplemented with extravirgin olive oil or nuts reduced 24-hour ambulatory BP, total cholesterol, and fasting glucose.

 

Link to abstract:hyper.ahajournals.org/content/early/2014/05/05/HYPERTENSIONAHA.113.03353.abstract

Exercise and Aging

May 23 2014

by alex

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An interesting new study has shown that plasma irisin, a hormone released from muscle after exercise, is associated with telomere length which is a marker of aging. Irisin is known to signal your body to shift to fat-burning instead of fat storage. This may be the molecular link between exercise and healthier aging.

Plasma irisin levels predict telomere length in healthy adults

Karan S. Rana, Muhammad Arif, Eric J. Hill, Sarah Aldred, David A. Nagel, Alan Nevill, Harpal S. Randeva, Clifford J. Bailey, Srikanth Bellary, James E. Brown
AGE, 2014; DOI: 10.1007/s11357-014-9620-9

Abstract

The ageing process is strongly influenced by nutrient balance, such that modest calorie restriction (CR) extends lifespan in mammals. Irisin, a newly described hormone released from skeletal muscles after exercise, may induce CR-like effects by increasing adipose tissue energy expenditure. Using telomere length as a marker of ageing, this study investigates associations between body composition, plasma irisin levels and peripheral blood mononuclear cell telomere length in healthy, non-obese individuals. Segmental body composition (by bioimpedance), telomere length and plasma irisin levels were assessed in 81 healthy individuals (age 43 ± 15.8 years, BMI 24.3 ± 2.9 kg/m2). Data showed significant correlations between log-transformed relative telomere length and the following: age (p < 0.001), height (p = 0.045), total body fat percentage (p = 0.031), abdominal fat percentage (p = 0.038), visceral fat level (p < 0.001), plasma leptin (p = 0.029) and plasma irisin (p = 0.011), respectively. Multiple regression analysis using backward elimination revealed that relative telomere length can be predicted by age (b = −0.00735, p = 0.001) and plasma irisin levels (b = 0.04527, p = 0.021). These data support the view that irisin may have a role in the modulation of both energy balance and the ageing process.

Full text link:
http://link.springer.com/article/10.1007%2Fs11357-014-9620-9/fulltext.html

Higher Sugar Intake Associated with Higher CV Mortality

May 16 2014

by alex

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This prospective cohort study confirms what epidemiologic studies have shown: that higher intakes of sugar correlate with a higher risk of death from cardiovascular causes. In this study they found a clear dose-response curve, with higher intakes being associated with higher risk of cardiovascular death.
This study emphasizes the need to reduce sugar intake more aggressively.

 

Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults

Quanhe Yang, Zefeng Zhang, Edward W. Gregg, W. Dana Flanders, Robert Merritt, Frank B. Hu

JAMA Intern Med. Published online February 03, 2014. doi:10.1001/jamainternmed.2013.13563

Importance:
Epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease (CVD) risk factors. Few prospective studies have examined the association of added sugar intake with CVD mortality.

Objective:
To examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with CVD mortality.

Design, Setting, and Participants:
National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III], 1999-2004, and 2005-2010 [n = 31 147]) for the time trend analysis and NHANES III Linked Mortality cohort (1988-2006 [n = 11 733]), a prospective cohort of a nationally representative sample of US adults for the association study.

Main Outcomes and Measures:
Cardiovascular disease mortality.

Results:
Among US adults, the adjusted mean percentage of daily calories from added sugar increased from 15.7% (95% CI, 15.0%-16.4%) in 1988-1994 to 16.8% (16.0%-17.7%; P = .02) in 1999-2004 and decreased to 14.9% (14.2%-15.5%; P < .001) in 2005-2010. Most adults consumed 10% or more of calories from added sugar (71.4%) and approximately 10% consumed 25% or more in 2005-2010. During a median follow-up period of 14.6 years, we documented 831 CVD deaths during 163 039 person-years. Age-, sex-, and race/ethnicity–adjusted hazard ratios (HRs) of CVD mortality across quintiles of the percentage of daily calories consumed from added sugar were 1.00 (reference), 1.09 (95% CI, 1.05-1.13), 1.23 (1.12-1.34), 1.49 (1.24-1.78), and 2.43 (1.63-3.62; P < .001), respectively. After additional adjustment for sociodemographic, behavioral, and clinical characteristics, HRs were 1.00 (reference), 1.07 (1.02-1.12), 1.18 (1.06-1.31), 1.38 (1.11-1.70), and 2.03 (1.26-3.27; P = .004), respectively. Adjusted HRs were 1.30 (95% CI, 1.09-1.55) and 2.75 (1.40-5.42; P = .004), respectively, comparing participants who consumed 10.0% to 24.9% or 25.0% or more calories from added sugar with those who consumed less than 10.0% of calories from added sugar. These findings were largely consistent across age group, sex, race/ethnicity (except among non-Hispanic blacks), educational attainment, physical activity, health eating index, and body mass index.

Conclusions and Relevance:
Most US adults consume more added sugar than is recommended for a healthy diet. We observed a significant relationship between added sugar consumption and increased risk for CVD mortality.