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By Dr. Liji Thomas, MD Reviewed by Benedette Cuffari, M.Sc. Dec 12 2024

Researchers uncover varying links between added sugar sources—like sweetened drinks, treats, and toppings—and risks for conditions such as heart failure, stroke, and aneurysms.

Study:  Added sugar intake and its associations with incidence of seven different cardiovascular diseases in 69,705 Swedish men and women. Image Credit: Sorapop Udomsri / Shutterstock.com

Cardiovascular disease (CVD) is a leading cause of disease and death in Europe. Multiple studies support the association between CVD and unhealthy dietary habits; however, the impact of added sugar and different types of CVD remains unclear.

A recent study published in Frontiers in Public Health examines the risk of seven different types of CVDs associated with added and free sugar in foods and beverages. The regulation of sugar intake

The incorporation of sugar into food products can cause consumers to overeat high-calorie, nutrient-empty foods at the cost of nutritious foods. Furthermore, added sugar increases the risk of tooth decay and weight gain.

Nordic guidelines recommend that less than 10% of total energy intake is provided by added and free sugar, including sugars naturally occurring in fruit juice concentrates, fruit juices, honey, and syrups. Likewise, both the American and World Health Organizations recommend less than 10% added and free sugar intake, respectively.

The European Food Safety Authority (EFSA) points to evidence that the risk of cardiometabolic disease rises with increased consumption of sugar-sweetened beverages (SSBs). Moderately strong evidence for obesity and high blood cholesterol levels with increased added and free sugar intake has also been reported.

Despite these observations, it remains unclear whether added and free sugar intake is directly associated with an increased risk of CVD. Moreover, the association with overall CVD risk does not correlate with the risk for individual cardiovascular conditions due to contradictory findings. Most studies that have examined this association have relied on a single measurement of added sugar consumption for their analyses and lack long-term follow-up data. About the study

The current study examines how the consumption of added sugar, sugar-sweetened foods (SSFs), and SSBs is associated with the risk of ischemic stroke (IS), hemorrhagic stroke (HS), myocardial infarction (MI), heart failure (HF), aortic stenosis (AS), atrial fibrillation (AF), and abdominal aortic aneurysm (AAA). Related StoriesBaycrest study discovers role of thalamus in post-stroke recoveryWomen skip post-stroke medications more often than men, study revealsStudy highlights disparities in stroke costs across healthcare services in Latin America

The study included 69,705 individuals in two Swedish cohorts. Data on added sugar intake (ASI) were collected in 1997 and 2009 in over 60% of study participants. The average body mass index (BMI) was 25.3 kg/m2, with a mean age of 59.9 years.

SSFs were classified as treats such as pastries, ice cream, and chocolates or toppings like marmalades, jams, sugar, and honey. SSBs included sweetened sodas and fruit drinks, excluding pure fruit juices.

The mean ASI was 9.1% of energy intake (E%) in 1997. Being male, doing more exercise, and having less education were associated with greater ASI, along with older age and higher energy intake. Low-to-moderate added sugar intake

After compensating for the effects of age, sex, and energy intake, ASI was associated with all seven CVDs; however, these associations were weakened after adjusting for lifestyle factors, BMI, and diet.

The highest category of ASI, over 20 E%, was associated with a 31% increased risk of AAA compared to the lowest intake category of five E% or less. At over 15-20 E%, the risk of IS was 9% higher.

For most outcomes, the lowest ASI was associated with the highest risk. The risk for most CVDs was lowest at 5-7.5 E%. Thus, MI, AF, IS, HF, and AS risks were reduced by 5-9% in this category compared to the lowest intake.

With ASI exceeding 7.5-10 E%, the risk of HF and AF was reduced by 6% and 4%, respectively. At over 10-15 E%, the risk of HF, AF, and AS decreased by 5%, 4% and 17% respectively. Higher ASI was associated with a greater AAA and IS risk among obese individuals, whereas higher HF risk was observed in normal-weight individuals. SSB intake

SSB intake was linearly associated with the risk of IS, HF, AF, and AAA. Consuming over eight SSB servings each week increased AF, IS, HF, and AAA risk by 11%, 18%, 19%, and 31%, respectively.

Analysis of the 2009 survey indicated an increased risk of IS and HF with greater artificially sweetened beverage consumption but not SSBs. This could be due to the small sample size for sweetened beverages, as current literature indicates a positive correlation of SSBs with increased CVD risk. SSF consumption

The lowest CVD risk was observed in the highest treat intake category, whereas the highest risk was observed among those who consumed two or fewer treats each week.

Although the mechanism remains unclear, this association might be due to better social health. In Sweden, coffee and pastries are part of fika, customary social gatherings, and may not indicate an overall unhealthy lifestyle.

Topping intake showed a mixed pattern, as those who consumed toppings had a 10% reduced risk of HF as compared to the lowest intake category. AS risk was reduced by 14-20% with increasing ASI, whereas AAA risk increased by 34%. Conclusions

The study findings do not support lowering the recommendations for added sugar intake to below five E%.”

A low to moderate intake of added sugar is associated with lower CVD risk at 5-7.5 E% as compared to either over five E% or 10 E%. Both the sugar source and the studied clinical outcome affect the nature and direction of the association.

Future studies are needed to elucidate the mechanisms involved in these associations and the role of body weight. Furthermore, confounding factors like sodium intake, an independent CVD risk predictor, should also be considered. Journal reference: Janzi, S., Gonzalez-Padilla, E., Ramne, S., et al. (2024). Added sugar intake and its associations with incidence of seven different cardiovascular diseases in 69,705 Swedish men and women. Frontiers in Public Health. doi:10.3389/fpubh.2024.1452085.

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Politics

European leaders to meet in Ukraine for ‘coalition of the willing’ talks – and issue call to Russia

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European leaders to meet in Ukraine for 'coalition of the willing' talks - and issue call to Russia

Sir Keir Starmer will join other European leaders in Kyiv on Saturday for talks on the “coalition of the willing”.

The prime minister is attending the event alongside French President Emmanuel Macron, recently-elected German Chancellor Friedrich Merz and Polish Prime Minister Donald Tusk.

It will be the first time the leaders of the four countries will travel to Ukraine at the same time – on board a train to Kyiv – with their meeting hosted by President Volodymyr Zelenskyy.

Follow latest updates on the Ukraine war

Britain's Prime Minister Keir Starmer meets with French President Emanuel Macron and German Chancellor Friedrich Merz on board a train to the Ukrainian capital Kyiv where all three will hold meetings with Ukrainian President Volodymyr Zelensky, May 9, 2025. Stefan Rousseau/Pool via REUTERS
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Sir Keir Starmer, Emmanuel Macron and Friedrich Merz travelling in the saloon car of a special train to Kiev. Pic: Reuters

Military officers from around 30 countries have been involved in drawing up plans for the coalition, which would provide a peacekeeping force in the event of a ceasefire being agreed between Russia and Ukraine.

Ahead of the meeting on Saturday, Sir Keir, Mr Macron, Mr Tusk and Mr Merz released a joint statement voicing support for Ukraine and calling on Russia to agree to a 30-day ceasefire.

Sir Keir Starmer and Volodymyr Zelenskyy during a meeting in March. Pic: AP
Image:
Sir Keir and Volodymyr Zelenskyy during a meeting in March. Pic: AP

“We reiterate our backing for President Trump’s calls for a peace deal and call on Russia to stop obstructing efforts to secure an enduring peace,” they said.

“Alongside the US, we call on Russia to agree a full and unconditional 30-day ceasefire to create the space for talks on a just and lasting peace.”

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The leaders said they were “ready to support peace talks as soon as possible”.

But they warned that they would continue to “ratchet up pressure on Russia’s war machine” until Moscow agrees to a lasting ceasefire.

“We are clear the bloodshed must end, Russia must stop its illegal invasion, and Ukraine must be able to prosper as a safe, secure and sovereign nation within its internationally recognised borders for generations to come,” their statement added.

“We will continue to increase our support for Ukraine.”

Read more:
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The European leaders are set to visit the Maidan, a central square in Ukraine’s capital where flags represent those who died in the war.

They are also expected to host a virtual meeting for other leaders in the “coalition of the willing” to update them on progress towards a peacekeeping force.

This force “would help regenerate Ukraine’s armed forces after any peace deal and strengthen confidence in any future peace”, according to Number 10.

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Politics

The ‘tricky balancing act’ facing Starmer over US trade deal – and the real challenge to come

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The 'tricky balancing act' facing Starmer over US trade deal - and the real challenge to come

If you want a very visual representation of the challenges of transatlantic diplomacy in 2025, look no further than Oslo City Hall.

Its marbled mural-clad walls played home to a European military summit on Friday.

In December – as it does every year – it will host the Nobel Peace Prize ceremony. It’s an award Donald Trump has said he deserves to win.

But while the leaders gathering in the Norwegian capital may not say it publicly, they all have a very different perspective to the US president on how to win the peace – particularly when it comes to Ukraine.

Sir Keir Starmer at a summit in Oslo. Pic: PA
Image:
Sir Keir Starmer at a summit in Oslo. Pic: PA

So far, Sir Keir Starmer has managed to paper over these foreign policy gaps between the US and Europe with warm words and niceties.

But squaring the two sides off on trade may be more difficult.

The US-UK deal announced on Thursday contained no obvious red flags that could scupper deeper trade links with the EU.

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PM defends UK-US trade deal

However, that’s in part because it was more a reaction and remedy to Mr Trump’s tariff regime than a proactive attempt to meld the two countries together.

Laced with party-political venom, yes, but the Tory leader Kemi Badenoch is getting at something when she says this agreement is “not even a trade deal, it’s a tariff deal and we are in a worse position now than we were six weeks ago”.

There may be more to come though.

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How good is the UK-US deal?

The government will talk up the possible benefits, but there are risks too.

Take the Digital Services Tax – much hated by the Trump White House as an unfair levy on US tech firms.

Despite the apparent pitch-rolling from the government, that was left untouched this week.

But asked to rule out changes in the future, the prime minister was non-committal, simply saying the current deal “doesn’t cover that”.

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For trade expert David Henig, the potential flashpoints in the transatlantic Venn diagram Downing Street is trying to draw around food standards, digital regulation and services.

“It is a tricky balancing act, at this stage it looks like the UK will go more with the EU on goods regulations, but perhaps a little bit more with the US on services regulations,” he said.

For veterans of the post-2016 Brexit battles, this may all sound like Labour embracing the Boris Johnson-era mantra of “cakeism” – or trying to have it both ways.

👉 Click here to listen to Electoral Dysfunction on your podcast app 👈

It’s ironic indeed, given Sir Keir is a politician who supported the Remain campaign and then called for a second referendum.

But what matters now is what works – not for Downing Street but for the swathes of voters who have abandoned Labour since they took office.

That’s why the prime minister was once again trying to humanise this week’s trade deals.

These are agreements, he said, that would be measured in the “many thousands of jobs” they would safeguard across the country.

That’s the real challenge now, taking the work done in the marbled halls of the world’s capitals and convincing people at home why it matters to them.

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World

European leaders to meet in Ukraine for ‘coalition of the willing’ talks – and issue call to Russia

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By

European leaders to meet in Ukraine for 'coalition of the willing' talks - and issue call to Russia

Sir Keir Starmer will join other European leaders in Kyiv on Saturday for talks on the “coalition of the willing”.

The prime minister is attending the event alongside French President Emmanuel Macron, recently-elected German Chancellor Friedrich Merz and Polish Prime Minister Donald Tusk.

It will be the first time the leaders of the four countries will travel to Ukraine at the same time – on board a train to Kyiv – with their meeting hosted by President Volodymyr Zelenskyy.

Follow latest updates on the Ukraine war

Britain's Prime Minister Keir Starmer meets with French President Emanuel Macron and German Chancellor Friedrich Merz on board a train to the Ukrainian capital Kyiv where all three will hold meetings with Ukrainian President Volodymyr Zelensky, May 9, 2025. Stefan Rousseau/Pool via REUTERS
Image:
Sir Keir Starmer, Emmanuel Macron and Friedrich Merz travelling in the saloon car of a special train to Kiev. Pic: Reuters

Military officers from around 30 countries have been involved in drawing up plans for the coalition, which would provide a peacekeeping force in the event of a ceasefire being agreed between Russia and Ukraine.

Ahead of the meeting on Saturday, Sir Keir, Mr Macron, Mr Tusk and Mr Merz released a joint statement voicing support for Ukraine and calling on Russia to agree to a 30-day ceasefire.

Sir Keir Starmer and Volodymyr Zelenskyy during a meeting in March. Pic: AP
Image:
Sir Keir and Volodymyr Zelenskyy during a meeting in March. Pic: AP

“We reiterate our backing for President Trump’s calls for a peace deal and call on Russia to stop obstructing efforts to secure an enduring peace,” they said.

“Alongside the US, we call on Russia to agree a full and unconditional 30-day ceasefire to create the space for talks on a just and lasting peace.”

Please use Chrome browser for a more accessible video player

Putin’s Victory Day parade explained

The leaders said they were “ready to support peace talks as soon as possible”.

But they warned that they would continue to “ratchet up pressure on Russia’s war machine” until Moscow agrees to a lasting ceasefire.

“We are clear the bloodshed must end, Russia must stop its illegal invasion, and Ukraine must be able to prosper as a safe, secure and sovereign nation within its internationally recognised borders for generations to come,” their statement added.

“We will continue to increase our support for Ukraine.”

Read more:
Russia’s VE Day parade felt like celebration of war
Michael Clarke Q&A on Ukraine war
Ukraine and Russia accuse each other of breaching ceasefire

Follow The World
Follow The World

Listen to The World with Richard Engel and Yalda Hakim every Wednesday

Tap to follow

The European leaders are set to visit the Maidan, a central square in Ukraine’s capital where flags represent those who died in the war.

They are also expected to host a virtual meeting for other leaders in the “coalition of the willing” to update them on progress towards a peacekeeping force.

This force “would help regenerate Ukraine’s armed forces after any peace deal and strengthen confidence in any future peace”, according to Number 10.

Continue Reading

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