A long-term study spanning 25 years has found that individuals who consumed sugary beverages and fruit juice beginning in childhood had a significantly higher risk of developing high blood pressure as adults. The research, published today in the American Heart Association's flagship journal Circulation, suggests that dietary habits established early in life can have lasting consequences on cardiovascular health.
The analysis included over 25,000 participants from the Growing Up Today Study (GUTS), who were followed from ages 9 to 16 through adulthood, with a median age of 36 by the end of the follow-up period. Participants reported their intake of sugar-sweetened beverages (including sodas, punches, lemonades, teas, and sports drinks), fruit juice, and whole fruits via food frequency questionnaires administered every 1 to 4 years. Researchers estimated associations with self-reported high blood pressure diagnoses and modeled the effects of substituting sugary drinks or fruit juice with whole fruit, milk, or water.
The results showed that participants who drank two or more servings of sugar-sweetened beverages per day had a 52% higher risk of later developing high blood pressure compared to those who consumed less than three servings per week. Among subtypes, each daily serving of soda was associated with a 23% higher risk, and sports drinks with a 36% higher risk. Fruit juice intake of 1.5 or more servings per day was linked to a 35% higher risk, with each daily serving of orange juice associated with a 20% higher risk, though apple and other juices did not show a significant association. The researchers noted potential misclassification of orange-flavored drinks with added sugars as orange juice.
Importantly, the substitution analysis suggested that replacing a daily serving of sugary beverages with whole fruit could lower the risk of high blood pressure by 22%, while replacing fruit juice with whole fruit could reduce risk by 19%. Substituting sugary drinks with milk or water was associated with up to a 13% lower risk, but no significant benefit was found for replacing fruit juice with milk or water. These associations were independent of overall diet quality, physical activity, and other factors.
Senior study author Vasanti Malik, Sc.D., of the University of Toronto and Harvard T.H. Chan School of Public Health, emphasized the importance of early prevention. “Dietary habits in early life can have lasting health consequences,” she said. “High blood pressure is also emerging earlier in life, with growing rates seen in younger adults, children, and adolescents, which highlights the importance of early detection and prevention.” She recommended limiting sugar-sweetened beverages, including those marketed as healthy, and consuming 100% fruit juice only in moderation, while emphasizing whole fruit over sugary beverages.
The American Heart Association's 2026 Dietary Guidance to Improve Cardiovascular Health advises minimizing added sugars. Dr. Amit Khera, vice-chair of the dietary guidance writing committee, noted that this study adds new insights by focusing on childhood and demonstrating that the type of food matters more than total fructose intake. “There has been a misconception about fructose being harmful regardless of source, and that fruit juices are beneficial. This study demonstrates neither is correct,” he said. He also noted that non-Hispanic Black and Hispanic populations have the highest sugary drink intake, making these findings particularly relevant.
The American Heart Association advocates for policies to reduce sugary drink consumption, including taxes, improved school nutrition standards, and enhanced diet quality in programs like SNAP. The study's limitations include its reliance on self-reports and a predominantly white participant pool, meaning findings may not apply to other groups.
