Added Sugar Intake and Arterial Stiffness in Youth with Type 1 Diabetes: SEARCH Nutrition Ancillary Study

Abstract

In the diets of youth, added sugars account for fourteen percent of total calories, with the leading source being sugar‐sweetened beverages (SSB). Among youth with diabetes, fifty percent of youth with diabetes consumed SSB; additionally, higher intakes (≥1 serving per day vs. no intake) were associated with higher levels of total cholesterol, LDL‐cholesterol, and plasma triglycerides. However, the relationship of added sugars on arterial stiffness in youth with diabetes is not known. We examined the association between reported added sugar intake and arterial stiffness using data from the SEARCH for Diabetes in Youth Study, an ongoing multi‐center observational cohort study of youth with diabetes diagnosed at < 20 years of age. Participants included those with physician‐diagnosed type 1 diabetes (T1D) and positive diabetes autoantibody (glutamic acid decarboxylase‐65 or insulinoma‐associated‐2 autoantibodies) at enrollment (n=1,315; diabetes duration mean=10.0 months). Added sugar intake was assessed by food frequency questionnaire and pulse wave velocity (PWV) and augmentation index (AIx) were measured using a SphygmoCor tonometer. PWV was measured from the carotid artery to the femoral artery (PWV truck) and from the carotid artery to the radial artery (PWV arm). Separate, cross‐sectional linear regression models were used to evaluate the association between added sugar and measures of arterial stiffness. Models were adjusted for age, race, sex, household income, clinic site, diabetes duration, insulin regimen, and mean arterial pressure. Additionally, models for PWV were adjusted for heart rate, and models for AIx were adjusted for height. Among youth with T1D, added sugar intake was not associated with PWV arm (β=0.0001; p=0.9) or AIx (β=0.01; p=0.2). However, added sugar intake was positively associated with PWV trunk (β=0.002; p=0.03). The differential associations between added sugar intake and the arterial stiffness measures is expected given that PWV and AIx are not interchangeable measurements. PWV trunk is considered a noninvasive gold standard of arterial stiffness and coronary artery calcification. In contrast, PWV arm is a less robust measure, but may capture peripheral vascular damage, which is common in diabetes; and AIx is a measure of both peripheral and central vascular stiffness and reflects wave reflection and systemic arterial stiffness. Our findings suggest that added sugar intake differentially affect the vascular system, with a positive association on central arterial stiffness. Further research is needed to determine the longitudinal relationship between added sugar intake and arterial stiffness and to identify why added sugar intake may differentially affect the vascular system.Support or Funding InformationNational Institute of Diabetes and Digestive and Kidney Diseases: R01DK077949