Adolescent boys and girls most vulnerable to endocrine disrupting chemicals

Identifying Subpopulations Vulnerable to the Thyroid-Blocking Effects of Perchlorate and Thiocyanate

Adolescents aged 12 to 21 years are two to three times more sensitive than the general population to common environmental contaminants that can disrupt thyroid function and therefore should have the latter checked, according to US researchers.

2017 Study Abstract

Context
Common environmental contaminants can disrupt normal thyroid function, which plays essential but varying roles at different ages.

Objective
To evaluate the relationship of perchlorate, thiocyanate, and nitrate, three sodium-iodide symporter (NIS) inhibitors, and thyroid function in different age-sex-stratified populations.

Design, Setting, Participants, and Intervention
This was a cross-sectional analysis of data from the 2009-2012 National Health and Nutrition Examination Surveys (NHANES) evaluating the exposure to perchlorate, thiocyanate, and nitrate in 3,151 participants aged 12-80.

Main Outcome Measure
Blood serum free thyroxine (FT4) as both a continuous and categorical variable. We also assessed blood serum thyroid stimulating hormone (TSH).

Results
Controlling for serum cotinine, BMI, total daily energy consumption, race/ethnicity, and poverty-to-income ratio, for each log unit increase in perchlorate, FT4 decreased by 0.03 ng/dL in both the general population (p=0.004) and in all women (p=0.005), and by 0.06 ng/dL in adolescent girls (p=0.029), corresponding to 4% and 8% decreases relative to median FT4, respectively. For each log unit increase thiocyanate, FT4 decreased by 0.07 ng/dL in adolescent boys (p=0.003), corresponding to a 9% decrease relative to median FT4, respectively.

Conclusions
Our results indicate that adolescent boys and girls represent vulnerable subpopulations to the thyroid-blocking effects of NIS symporter inhibitors. These results suggest a valuable screening and intervention opportunity.

Sources and Press Releases
  • Identifying Subpopulations Vulnerable to the Thyroid-Blocking Effects of Perchlorate and Thiocyanate, Oxford University Press, doi.org/10.1210/jc.2017-00046, 20 April 2017.
  • Teens Most Susceptible to Endocrine Disruption From Chemicals, medscape, April 27, 2017.
  • Image credit Meena Kadri.
About Endocrine Disruptors

The key role of androgen in male sex maintenance

Blockage of androgen and administration of estrogen induce transdifferentiation of testis into ovary

2017 Study Abstract

Induction of sex reversal of XY fish has been restricted to the sex undifferentiated period.

In the present study, differentiated XY tilapia were treated with trilostane (TR), metopirone (MN) and glycyrrhetinic acid (GA) (inhibitor of 3β-HSD, Cyp11b2 and 11β-HSD, respectively) alone or in combination with 17β-estradiol (E2) from 30 to 90 dah (days after hatching). At 180 dah, E2 alone resulted in 8.3%, and TR, MN and GA alone resulted in no secondary sex reversal (SSR), whereas TR + E2, MN + E2 and GA + E2 resulted in 88.3, 60.0 and 46.7% of SSR, respectively.

This sex reversal could be rescued by simultaneous administration of 11-ketotestosterone (11-KT). Compared with the control XY fish, decreased serum 11-KT and increased E2 level were detected in SSR fish. Immunohistochemistry analyses revealed that Cyp19a1a, Cyp11b2 and Dmrt1 were expressed in the gonads of GA + E2, MN + E2 and TR + E2 SSR XY fish at 90 dah, but only Cyp19a1a was expressed at 180 dah. When the treatment was applied from 60 to 120 dah, TR + E2 resulted in 3.3% of SSR, MN + E2 and GA + E2 resulted in no SSR.

These results demonstrated that once 11-KT was synthesized, it could antagonize E2-induced male-to-female SSR, which could be abolished by simultaneous treatment with the inhibitor of steroidogenic enzymes. The upper the enzyme was located in the steroidogenic pathway, the higher SSR rate was achieved when it was inhibited as some of the precursors, such as androstenedione, testosterone and 5α-dihydrotestosterone, could act as androgens. These results highlight the key role of androgen in male sex maintenance.

Image credit Rusty Clark.

HPV vaccination not recommended by 1/3 of doctors

Primary Care Physicians’ Perspectives About HPV Vaccine

Around one third of doctors surveyed do not strongly recommend the HPV vaccine to parents. Researchers used a national survey asking approximately 600 paediatricians and family doctors, between October 2013 and January 2014, to outline their stance on the HPV vaccine.

January 2016 Study Abstract

BACKGROUND AND OBJECTIVES
Because physicians’ practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to:

  1. describe self-reported practices regarding recommending the HPV vaccine;
  2. estimate the frequency of parental deferral of HPV vaccination;
  3. and identify characteristics associated with not discussing it.

METHODS
A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined.

RESULTS
Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387).

  • For 11-12 year-old girls, 60% of pediatricians and 59% of family physicians (FP) strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen.
  • More than one-half reported ≥25% of parents deferred HPV vaccination.
  • At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination.
  • Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1–3.5), be male (aOR: 1.8 [95% CI: 1.1–3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3–4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1–6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4–17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8–6.4]).

CONCLUSIONS
Addressing physicians’ perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates.

Sources and Press Releases
  • Primary Care Physicians’ Perspectives About HPV Vaccine, pediatrics, January 2016.
  • ANOTHER MOTHER WANTS YOU TO SEE WHAT AN HPV VACCINE INJURY LOOKS LIKE, collective-evolution, APRIL 24, 2017.

Protecting Children from the Environment

Protecting Children from the Environment

Children, including adolescents, are exposed to a variety of hazards from the environments in which they live, learn and play.

More than 1 in 4 child deaths could be prevented by cleaning up the environment. Each year 1.7 million deaths of children under 5 years old are linked to the environment.

Early exposure to environmental risks contributes to childhood cancers.

SOURCES

Air Pollution and Children

Protecting Children from the Environment

Air pollution is the greatest environmental risk to children’s health.

Every year air pollution kills 570,000 children. With all the challenges children face, the air they breathe shouldn’t be one of them.

Exposure to air pollution may also increase children’s lifelong risk of heart disease, stroke and cancer.

SOURCES

Association between physicians’ interaction with pharmaceutical companies and their clinical practices

A systematic review and meta-analysis, 2017

Abstract

Background
Pharmaceutical company representatives likely influence the prescribing habits and professional behaviors of physicians. The objective of this study was to systematically review the association between physicians’ interactions with pharmaceutical companies and their clinical practices.

Methods
We used the standard systematic review methodology. Observational and experimental study designs examining any type of targeted interaction between practicing physicians and pharmaceutical companies were eligible. The search strategy included a search of MEDLINE and EMBASE databases up to July 2016. Two reviewers selected studies, abstracted data, and assessed risk of bias in duplicate and independently. We assessed the quality of evidence using the GRADE approach.

Results
Twenty articles reporting on 19 studies met our inclusion criteria. All of these studies were conducted in high-income countries and examined different types of interactions, including detailing, industry-funded continuing medical education, and receiving free gifts. While all included studies assessed prescribing behaviors, four studies also assessed financial outcomes, one assessed physicians’ knowledge, and one assessed their beliefs. None of the studies assessed clinical outcomes. Out of the 19 studies, 15 found a consistent association between interactions promoting a medication, and inappropriately increased prescribing rates, lower prescribing quality, and/or increased prescribing costs. The remaining four studies found both associations and lack of significant associations for the different types of exposures and drugs examined in the studies. A meta-analysis of six of these studies found a statistically significant association between exposure and physicians’ prescribing behaviors (OR = 2.52; 95% CI 1.82–3.50). The quality of evidence was downgraded to moderate for risk of bias and inconsistency. Sensitivity analysis excluding studies at high risk of bias did not substantially change these results. A subgroup analysis did not find a difference by type of exposure.

Conclusion
There is moderate quality evidence that physicians’ interactions with pharmaceutical companies are associated with their prescribing patterns and quality.

Environment and human health

Human health and well‑being are intimately linked to environmental quality

Preface

Human health and well-being are intimately linked to environmental quality. This has been recognised for decades amongst policymakers in Europe, and most recently appears as a cornerstone in the European Commission’s proposal for the 7th Environment Action Programme. This report, produced jointly by the European Environment Agency and the European Commission’s Joint Research Centre, outlines a number of environmental issues with a direct influence on people’s health and well-being and is a follow-up and update to the 2005 EEA/JRC report.

In the 8 years that have passed, the political context of environment and health has evolved. As highlighted in EEA’s The European Environment — state and outlook 2010 the policy focus is increasingly shifting from single environmental pollution issues towards systemic challenges regarding the maintenance of ecosystem resilience and the delivery of ecosystem services to human society. Climate change is a good example with its combined impacts on food and water security, heat waves, flooding risks and potential spread of diseases.

Human health and well‑being are intimately linked to environmental quality. This report, produced jointly by the European Environment Agency (EEA) and the European Commission’s Joint Research Centre (JRC), outlines a number of environmental issues with a direct influence on people’s health and well-being.

Where problem detection and measures in the environment and health area have typically been based on dose-effect studies of individual polluting substances and stressors, this new report makes the case for a more integrated take on health issues, acknowledging the complex inter-linkages between resource-use patterns, environmental pressures, multiple exposures and disease burden, as well as the key role that social inequalities play.

It also touches upon emerging issues resulting from long-term environmental and socio-economic trends, such as climate change, lifestyle and consumption changes and the rapid uptake and application of new chemicals and technologies. As such, it complements the recent EEA publication Late lessons from early warnings; science, precaution and innovation, which makes a strong argument for precautionary science in political decision-making, allowing us to strike a better balance between using economic opportunities and avoiding disproportionate risks to the environment and human health and well-being.

Environment and health is not just ‘an aspect’ of environmental policy, it is at the heart of it. In fact, it is central to Europe’s ambition to move towards a Green Economy. With this report, taking stock of the most pertinent environment and health issues, and combining the expertise of our two institutes in environmental reporting and scientific research, we hope to contribute to this goal.

Overview
  1. Setting the scene
  2. Chemicals
  3. Outdoor air
  4. Indoor air
  5. Radon
  6. Water
  7. Noise
  8. Electromagnetic fields
  9. Ultraviolet radiation
  10. Nanotechnology
  11. Green spaces and the natural environment
  12. Climate change
  13. Analytical and policy considerations
More Information
Endocrine Disruptors

The potential downsides of long-term analgesic use

The Ibuprofen Risks You Need to Know

“Painkillers you can get without a prescription—like acetaminophen, as well as ibuprofen, naproxen, and other so-called non steroidal anti-inflammatory drugs (NSAIDs)—are generally pretty safe. That’s why they are available over the counter to relieve mild-to-moderate pain from headaches, sore muscles and achy joints.

But if they’re used more frequently, or over long periods of time, they may pose dangers to the heart, kidneys, bone and even hearing.”

… continue reading The Ibuprofen Risks You Need to Know on TIME Health, Apr 20, 2017. Image credit andrea.

Late lessons from early warnings : science, precaution, innovation

An investment in knowledge pays the best interest ~ Benjamin Franklin ~

Preface

There is something profoundly wrong with the way we are living today. There are corrosive pathologies of inequality all around us — be they access to a safe environment, healthcare, education or clean water. These are reinforced by short-term political actions and a socially divisive language based on the adulation of wealth. A progressive response will require not only greater knowledge about the state of the planet and its resources, but also an awareness that many aspects will remain unknown. We will need a more ethical form of public decision-making based on a language in which our moral instincts and concerns can be better expressed. These are the overall aims of Volume 2 of Late lessons from early warnings.

Volume 1 of Late lessons from early warnings was published at a time when the world was experiencing an economic slowdown, China had joined the World Trade Organization and western Europe was still a 15-member Union. Global grain production had declined for the third time in four years due mainly to droughts in North America and Australia, and the world saw major recalls of contaminated meat, foot and mouth disease and bovine spongiform encephalopathy (mad cow disease). Global temperatures continued to climb and many bird populations were in decline, but the United States of America had rejected the Kyoto Protocol. We were seeing ourselves through the lens of the first human genome sequence, yet we were trying to manage chemicals known to be harmful to humans and ecosystems, through international conventions and treaties such as the Basel Convention to deal with toxic waste dumping in the developing world; the OSPAR/HELCOM Conventions to reduce the discharges, emissions and the loss of hazardous substances into the sea and the Montreal Protocol, to phase out ozone-depleting substances. The destruction of the World Trade Center had just happened.

The 2013 Late lessons from early warnings report is the second of its type produced by the European Environment Agency (EEA) in collaboration with a broad range of external authors and peer reviewers.

Since then, we have witnessed a period of extraordinary hubris. Most visibly, the financial profligacy of the first decade of the century led inexorably to the crises of 2007–2009 whereby the major components of the international financial system were weakened to the extreme by indebtedness, mispriced products, lax monetary policies and mis-engineered protection against risks and uncertainty. The world experienced more not less volatility. Political systems became silted up by vested interests and a determination by citizens to protect assets accumulated in easier times, and beneath it all lay a deeper environmental crisis epitomised by climate change and biodiversity loss.

There was also a collapse of trust, not only in financial institutions but in big companies, as they abandoned staff, pensions and health care schemes. Recent evidence from social psychology has shown that despite rising levels of education and innovation in products and services, people trust only those they know and not strangers. As Stephen Green said in Good value: reflections on money, morality, and an uncertain world in 2009:

‘There has been a massive breakdown of trust: trust in the financial system, trust in bankers, trust in business and business leaders, trust in politicians, trust in the media, trust in the whole process of globalisation — all have been severely damaged, in rich countries and poor countries alike’.

The scientific elites have also been slowly losing public support. This is in part because of the growing number of instances of misplaced certainty about the absence of harm, which has delayed preventive actions to reduce risks to human health, despite evidence to the contrary.

Suddenly, our problems have grown into what Charles W. Churchman in 1967 termed wicked problems — difficult or impossible to solve because of incomplete, contradictory and changing requirements, difficult to recognize, resistant to resolution because of the complexity of their interdependencies and needing to be tackled not by one but via many forms of social power. Solving them requires a new combination of hierarchical power, solidarity and individualism.

What could this mean, for example, for the 100 thousand chemicals currently in commercial use?

To begin with we have more conventions and treaties in place than a decade ago: the 2004 Rotterdam Convention on the Prior Informed Consent (PIC) Procedure covering international trade of 24 pesticides, four severely hazardous pesticide formulations and 11 industrial chemicals; the 2004 Stockholm Convention on Persistent Organic Pollutants to protect human health and the environment from substances which are highly toxic, persistent, bio-accumulative and move long distances in the environment, such as DDT, PCBs, various industrial chemicals, and a set of unintentional chemical by-products such as dioxin. But these conventions only address the top-down hierarchical approach to power.

At the same time Europe has put in place legislation to achieve a global regulatory influence including the EU Cosmetic Directive banning the use of chemicals known or strongly suspected of being carcinogens, reproductive toxins, or mutagens causing cancer, mutation or birth defects; the EU Restriction of Hazardous Substances Directive, which restricts the use of hazardous materials in the manufacture of various types of electronic and electrical equipment including lead, mercury, cadmium, hexavalent chromium, the flame retardents polybrominated biphenyls and polybrominated diphenyl ethers, and which encourages the substitution to safe/or safer alternatives in the electric and electronic equipment industry; the closely linked 2006 EU Waste Electrical and Electronic Equipment Directive for collection, recycling and recovery of electrical goods; the 2006 Strategic Approach to International Chemicals Management (SAICM); and the 2007 EU Registration, Evaluation and Authorisation of Chemicals, widely known as REACH, to assign greater responsibility to industry to manage the risks from chemicals and to provide safety information on substances. The effects of these regulatory tools are described in different chapters, but once again point to the main economic actors rather than communities or individuals.

One thing that has become clearer over the past decade is that certain chemical substances are highly stable in nature and can have long-lasting and wide ranging effects before being broken down into a harmless form. The risk of a stable compound is that it can be bio-accumulated in fatty tissues at concentrations many times higher than in the surrounding environment. Predators, such as polar bears, fish and seals, are known to bio-magnify certain chemicals in even higher concentrations with devastating consequences for both humans and ecosystems. So exposure to toxic chemicals and certain foodstuffs are at risk of causing harm, especially to vulnerable groups such as foetuses in the womb or during childhood when the endocrine system is being actively built. Even with small dose exposures, the consequences can in some instances be devastating with problems ranging from cancer, serious impacts on human development, chronic diseases and learning disabilities. Here the power to act could be more properly set by well-informed individuals and communities.

The relationship between knowledge and power lies at the heart of Volume 2. In many chapters, the implicit links between the sources of scientific knowledge about pollutants, changes in the environment and new technologies, and strong vested interests, both economic and paradigmatic, are exposed. A number of authors also explore in greater depth, the short-sightedness of regulatory science and its role in the identification, evaluation and governance of natural resources, physical and chemical hazards. By creating a better understanding of these normally invisible aspects, it is hoped that this volume will enable communities and people to become more effective stakeholders and participants in the governance of innovation and economic activities in relation to the associated risks to humans and the planet.

Much of what we are able to learn from the histories of past environmental and public health mistakes is also directly applicable to the better regulation and governance of global institutions and financial and economic risks. Robin G. Collingwood argued in his Autobiography (1939), that:

‘History can offer something altogether different from [scientific] rules, namely insight. The true function of insight is to inform people about the present…we study history in order to see more clearly into the situation in which we are called upon to act… the plane on which, ultimately, all problems arise is the plane of ‘real’ life: that to which they are referred for their solution is history.’

In this volume, we go further. Whilst still drawing lessons from such widely accepted tragedies as leaded petrol, mercury poisoning in Japan’s Minamata Bay and older pesticides which sterilised many men who used it, we have ventured into the uncertainties of potential yet contested harm, from genetically modified products; nanotechnologies; chemicals such as Bisphenol A; new pesticides and mobile phones. There is also an examination of the 80 or so potential ‘false positives’ where there had been indications of harm but where it was subsequently claimed that there were in fact no risks to prevent: these cases too can provide information that can help to improve future decision-making about innovation and emerging technologies.

A major part of effective decision-making lies in the way issues are framed. In the case of climate change, the first order question is whether it is worth worrying about at all. US Vice President Al Gore chose to make the question a matter of choice between believers and sceptics. However, problems arose when the public was asked to make a scientific decision when too few people had the qualifications to make any kind of reasoned judgement. They were in fact asked to make a false choice. Instead the question should have been framed around which areas should people and governments make decisions and which should be delegated to experts.

In the end there are few certain and enduring truths in the ecological and biological sciences, nor in the economics, psychologies, sociologies and politics that we use to govern them. One, however, comes from the work of Elinor Ostrom, a late and widely missed colleague, who showed from her work on managing fisheries and ecosystems that complex problems can be solved if communication is transparent and open, visions are shared, trust is high and communities are activated to work from the bottom-up as well as from the top down.

As we navigate the Anthropocene, the epoch named in recognition of our impact on the planet, we will need to encourage more people to become involved in solving the wicked problems of our times. Whether through gathering local information or becoming more aware of the many uncertainties and unpredictabilities in our surroundings, the power structures of knowledge will need to change. And if we are to respond more responsibly to the early warning signals of change, we will need to re-design our style of governance to one which reflects a future defined by the local and specific rather than only the global and the average. We hope that Volume 2 of Late lessons from early warnings with its many lessons and insights can help us all meet such a challenge.

Overview
  1. Introduction
  2. The precautionary principle and false alarms — lessons learned
  3. Lead in petrol ‘makes the mind give way’
  4. Too much to swallow: PCE contamination of mains water
  5. Minamata disease: a challenge for democracy and justice
  6. Beryllium’s ‘public relations problem’
  7. Tobacco industry manipulation of research
  8. Vinyl chloride: a saga of secrecy
  9. The pesticide DBCP and male infertility
  10. Bisphenol A: contested science, divergent safety evaluations
  11. DDT: fifty years since Silent Spring
  12. Booster biocide antifoulants: is history repeating itself?
  13. Ethinyl oestradiol in the aquatic environment
  14. Climate change: science and the precautionary principle
  15. Floods: lessons about early warning systems
  16. Seed‑dressing systemic insecticides and honeybees
  17. Ecosystems and managing the dynamics of change
  18. Late lessons from Chernobyl, early warnings from Fukushima
  19. Hungry for innovation: from GM crops to agroecology
  20. Invasive alien species: a growing but neglected threat?
  21. Mobile phones and brain tumour risk: early warnings, early actions?.
  22. Nanotechnology — early lessons from early warnings
  23. Understanding and accounting for the costs of inaction
  24. Protecting early warners and late victims
  25. Why did business not react with precaution to early warnings?
  26. Science for precautionary decision‑making
  27. More or less precaution?
  28. In conclusion.
More Information
Endocrine Disruptors

Diet sodas and artificially sweetened soft drinks linked to brain damage

Diet drinks TRIPLE your risk of stroke and dementia – and are FAR more dangerous than drinks sweetened with sugar

Two new studies from the same research group have found that those who consume one or more sugary drinks per day showed more brain shrinkage on MRI scans and performed more poorly on memory tests.

The researchers also said these diet drink consumers were twice as likely to have Alzheimer’s dementia.

2017 Study Abstract

Background and Purpose
Sugar- and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. We examined whether sugar- or artificially sweetened beverage consumption was associated with the prospective risks of incident stroke or dementia in the community-based Framingham Heart Study Offspring cohort.

Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia, stroke.ahajournals, doi.org/10.1161/STROKEAHA.116.016027, April 20, 2017.

Image credit m01229.

Methods
We studied 2888 participants aged >45 years for incident stroke (mean age 62 [SD, 9] years; 45% men) and 1484 participants aged >60 years for incident dementia (mean age 69 [SD, 6] years; 46% men). Beverage intake was quantified using a food-frequency questionnaire at cohort examinations 5 (1991–1995), 6 (1995–1998), and 7 (1998–2001). We quantified recent consumption at examination 7 and cumulative consumption by averaging across examinations. Surveillance for incident events commenced at examination 7 and continued for 10 years. We observed 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer’s disease).

Results
After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia. When comparing daily cumulative intake to 0 per week (reference), the hazard ratios were 2.96 (95% confidence interval, 1.26–6.97) for ischemic stroke and 2.89 (95% confidence interval, 1.18–7.07) for Alzheimer’s disease. Sugar-sweetened beverages were not associated with stroke or dementia.

Conclusions
Artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia.

2017 Study Abstract

Sugary beverage intake and preclinical Alzheimer’s disease in the community, alzheimersanddementia, dx.doi.org/10.1016/j.jalz.2017.01.024, March 05, 2017.

Introduction
Excess sugar consumption has been linked with Alzheimer’s disease (AD) pathology in animal models.

Methods
We examined the cross-sectional association of sugary beverage consumption with neuropsychological (N = 4276) and magnetic resonance imaging (N = 3846) markers of preclinical Alzheimer’s disease and vascular brain injury (VBI) in the community-based Framingham Heart Study. Intake of sugary beverages was estimated using a food frequency questionnaire.

Results
Relative to consuming less than one sugary beverage per day, higher intake of sugary beverages was associated with lower total brain volume (1–2/day, β ± standard error [SE] = −0.55 ± 0.14 mean percent difference, P = .0002; >2/day, β ± SE = −0.68 ± 0.18, P < .0001), and poorer performance on tests of episodic memory (all P < .01). Daily fruit juice intake was associated with lower total brain volume, hippocampal volume, and poorer episodic memory (all P < .05). Sugary beverage intake was not associated with VBI in a consistent manner across outcomes.

Discussion
Higher intake of sugary beverages was associated cross-sectionally with markers of preclinical AD.