Dietary Sugar Intake Associated with a Higher Risk of Dementia in Community-Dwelling Older Adults

Article type: Research Article

Authors: Agarwal, Puja^{a; b; c; *} | Ford, Christopher N.^{b; e; †} | Leurgans, Sue E.^{a; d} | Beck, Todd^{b; e} | Desai, Pankaja^{b; e} | Dhana, Klodian^{b; e} | Evans, Denis A.^{b; e} | Halloway, Shannon^f | Holland, Thomas M.^{b; e} | Krueger, Kristin R.^{b; e} | Liu, Xiaoran^{b; e} | Rajan, Kumar Bharat^{b; e} | Bennett, David A.^{a; d}

Affiliations: [a] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [b] Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA | [c] Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA | [d] Department of Neurology, Rush University Medical Center, Chicago, IL, USA | [e] Rush Institute for Healthy Aging (Section of Community Epidemiology), Rush University Medical Center, Chicago, IL, USA | [f] Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA

Correspondence: [*] Correspondence to: Puja Agarwal, PhD, Rush Alzheimer’s Disease Center, Rush University Medical Center, 1750 W Harrison St., Chicago, IL, USA. Tel.: +1 312 947 7232; E-mail: puja_agarwal@rush.edu.

Note: [1] Deceased. This paper is dedicated to Dr. Christopher N. Ford. We would like to acknowledge Dr. Ford’s contribution to the development of this research idea, and the design of this paper before his untimely passing.

Abstract: Background:We have limited evidence for the relationship of high sugar intake with dementia risk. Objective:To determine whether high sugar intake is associated with an increased risk of dementia in community-dwelling older adults Methods:This study included 789 participants of the Rush Memory and Aging Project (community-based longitudinal cohort study of older adults free of known dementia at enrollment), with annual clinical assessments and complete nutrient data (obtained by validated food frequency questionnaire). Clinical diagnosis of dementia is based on the criteria of the joint working group of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association. We used Cox proportional hazard models. Results:118 participants developed dementia during 7.3±3.8 years of follow-up. Those in the highest quintile of total sugar intake were twice as likely to develop dementia than those in the lowest quintile (Q5 versus Q1:HR=2.10 (95% CI: 1.05, 4.19) when adjusted for age, sex, education, APOE ɛ4 allele, calories from sources other than sugar, physical activity, and diet score. Higher percent calories from sugar were positively associated with dementia risk (β=0.042, p = 0.0009). In exploratory analyses, the highest versus lowest quintile of fructose and sucrose in the diet had higher dementia risk by 2.8 (95% CI: 1.38, 5.67) and 1.93 (95% CI: 1.05, 3.54) times, respectively. Conclusions:A higher intake of total sugar or total calories from sugar is associated with increased dementia risk in older adults. Among simple sugars, fructose (e.g., sweetened beverages, snacks, packaged desserts) and sucrose (table sugar in juices, desserts, candies, and commercial cereals) are associated with higher dementia risk.

Keywords: Alzheimer’s disease, dementia, longitudinal, total sugar intake

DOI: 10.3233/JAD-230013

Journal: Journal of Alzheimer's Disease, vol. 95, no. 4, pp. 1417-1425, 2023