The association between sugar- and artificially sweetened beverages and risk of Alzheimer’s disease: systematic review and dose-response meta-analysis of prospective cohort studies

This study aimed to systematically review and meta-analyse prospective cohort studies to evaluate the association between consumption of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and soft drinks with the risk of AD. A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted up to September 2024 to identify observational studies reporting on the association between sweetened beverages and AD risk. A random-effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). The risk of bias was assessed using the ROBINS-I tool, and the GRADE approach was used to evaluate the certainty of the evidence. Nine studies met the inclusion criteria; seven were included in the meta-analysis. Higher SSB intake was associated with increased AD risk (RR: 1.49; 95% CI: 1.03-2.15; I2 = 79.0%), with dose-response analyses supporting a linear association. ASB intake was also positively associated with AD risk (RR: 1.42; 95% CI: 1.14-1.78; I2 = 0.0%). No significant association was observed between soft drinks intake and AD (RR: 1.13; 95% CI: 0.83-1.55). The certainty of evidence was rated as moderate for both SSB and ASB. Increased intake of SSBs and ASBs may elevate the risk of AD. Further research is required to clarify causal mechanisms and strengthen the evidence for public health recommendations aimed at reducing sugar consumption to prevent cognitive decline and AD. Registration: PROSPERO (CRD42024574650).