Summary:
High intake of sugar is extremely common in many diets worldwide and is increasingly discussed in public health policy, including debates about sugar taxes and restrictions on sugars in infant foods. Understanding whether exposure to high levels of sugar early in life contributes to chronic disease risk later in life is therefore an important question. The period from conception to two years of age is considered a biologically sensitive window. During this time, rapid development of metabolic and cardiovascular systems occurs, and these systems are highly responsive to environmental influences such as nutrition. Evidence suggests that exposures during this period can shape long-term disease risk. Despite this, intake of added sugars is high. Pregnant and breastfeeding women often consume far more added sugar than recommended. Although breast milk itself does not contain added sugars and its natural glucose levels are largely unaffected by maternal diet, infants may be exposed to added sugars once solid foods are introduce as many processed infant foods, formulas, and commercial baby products contain sucrose or other added sugars. Studies have reported associations between maternal metabolic health and cardiovascular markers in children. For example, higher maternal glucose levels during pregnancy have been linked with reduced cardiac function and higher blood pressure in offspring, while maternal obesity has been associated with structural changes in the developing heart. However, evidence on the long-term cardiovascular effects of early sugar exposure remains limited. This study examined this exact question. During and after the Second World War, the UK implemented a national rationing system that strictly limited the amount of sugar and sweets available to the population. Individuals received fixed weekly allowances through a ration book system, which kept average sugar consumption relatively low. Children under two years of age were not allocated sugar or sweets. When rationing ended in 1954, sugar consumption increased sharply. This study examined whether exposure to restricted sugar intake during the first 1000 days of life was associated with cardiovascular outcomes in adulthood. 63,433 participants were included who were born between 1951 and 1956. Exposure status was determined by whether participants were born before or after the end of sugar rationing. The study assessed several cardiovascular outcomes, including cardiovascular disease, myocardial infarction, heart failure, atrial fibrillation, stroke, and cardiovascular mortality. Statistical models accounted for demographic, socioeconomic, lifestyle, parental health, genetic, and geographic factors. The results indicated that longer exposure to sugar rationing during early life was associated with lower cardiovascular risk in adulthood. Individuals exposed to restricted sugar intake during both fetal development and early childhood had lower risks of cardiovascular disease, myocardial infarction, heart failure, atrial fibrillation, stroke, and cardiovascular mortality compared with those who were never exposed to rationing. Overall, this study found that limited sugar exposure during the first 1000 days of life was associated with reduced cardiovascular risk later in adulthood and improved cardiac function measures. These findings suggest that reducing added sugar intake during early development may provide long-term cardiovascular health benefits.
Abstract:
Objective To examine whether exposure to sugar rationing during early life is associated with a reduction in the risk of cardiovascular outcomes in adulthood. Design Natural experiment study. Setting UK population based cohort. Participants 63 433 UK Biobank participants born between October 1951 and March 1956 without prevalent cardiovascular disease, multiple births, adoption, or birth outside the UK. Exposure was quasi-experimentally assigned on the basis of birth date relative to the end of sugar rationing in 1953. External validation cohorts from the Health and Retirement Study and the English Longitudinal Study of Ageing were used. Main outcome measures Primary outcomes were incident cardiovascular disease, myocardial infarction, heart failure, atrial fibrillation, stroke, and cardiovascular disease mortality, ascertained through linked health records. Hazard ratios were estimated using Cox and parametric hazard models adjusted for demographic, socioeconomic, lifestyle, parental health, and genetic factors and geographical controls. Multiple cardiac parameters were measured in a subset undergoing cardiac magnetic resonance imaging. Results Longer exposure to sugar rationing was associated with progressively lower cardiovascular risks in adulthood. Compared with people never exposed to rationing, those exposed in utero plus 1-2 years had hazard ratios of 0.80 (95% confidence interval (CI) 0.73 to 0.90) for cardiovascular disease, 0.75 (0.63 to 0.90) for myocardial infarction, 0.74 (0.59 to 0.95) for heart failure, 0.76 (0.66 to 0.92) for atrial fibrillation, 0.69 (0.53 to 0.89) for stroke, and 0.73 (0.54 to 0.98) for cardiovascular disease mortality. Incident diabetes and hypertension jointly mediated 31.1% of the sugar rationing-cardiovascular disease association, whereas birth weight contributed only 2.2%. Sugar rationing was also associated with a modest increase in left ventricular stroke volume index (0.73 (95% CI 0.05 to 1.41) mL/m2) and ejection fraction (0.84%, 95% CI 0.40% to 1.28%). Conclusion Exposure to sugar rationing during the first 1000 days of life was associated with lower cardiovascular risks in adulthood and slightly more favourable cardiac indices, suggesting long term cardiovascular benefits of early life sugar restriction.
Article Publication Date: 22/10/2025
DOI: 10.1136/bmj-2024-083890
