Journal article
Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality
JAMA : the journal of the American Medical Association, Vol.330(6), pp.537-546
08/08/2023
DOI: 10.1001/jama.2023.12618
PMCID: PMC10410478
PMID: 37552302
Abstract
Importance Approximately 65% of adults in the US consume sugar-sweetened beverages daily. Objective To study the associations between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality. Design, Setting, and Participants A prospective cohort with 98 786 postmenopausal women aged 50 to 79 years enrolled in the Women’s Health Initiative from 1993 to 1998 at 40 clinical centers in the US and were followed up to March 1, 2020. Exposures Sugar-sweetened beverage intake was assessed based on a food frequency questionnaire administered at baseline and defined as the sum of regular soft drinks and fruit drinks (not including fruit juice); artificially sweetened beverage intake was measured at 3-year follow-up. Main Outcomes and Measures The primary outcomes were (1) liver cancer incidence, and (2) mortality due to chronic liver disease, defined as death from nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence and for chronic liver disease mortality, adjusting for potential confounders including demographics and lifestyle factors. Results During a median follow-up of 20.9 years, 207 women developed liver cancer and 148 died from chronic liver disease. At baseline, 6.8% of women consumed 1 or more sugar-sweetened beverage servings per day, and 13.1% consumed 1 or more artificially sweetened beverage servings per day at 3-year follow-up. Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100 000 person-years [ P value for trend = .02]; adjusted HR, 1.85 [95% CI, 1.16-2.96]; P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years [ P value for trend <.001]; adjusted HR, 1.68 [95% CI, 1.03-2.75]; P = .04). Compared with intake of 3 or fewer artificially sweetened beverages per month, individuals who consumed 1 or more artificially sweetened beverages per day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100 000 person-years [ P value for trend = .70]; adjusted HR, 1.17 [95% CI, 0.70-1.94]; P = .55) or chronic liver disease mortality (7.1 vs 5.3 per 100 000 person-years [ P value for trend = .32]; adjusted HR, 0.95 [95% CI, 0.49-1.84]; P = .88). Conclusions and Relevance In postmenopausal women, compared with consuming 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more sugar-sweetened beverages per day had a higher incidence of liver cancer and death from chronic liver disease. Future studies should confirm these findings and identify the biological pathways of these associations.
Details
- Title: Subtitle
- Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality
- Creators
- Longgang Zhao - University of South CarolinaXinyuan Zhang - Brigham and Women's HospitalMace Coday - University of Tennessee Health Science CenterDavid O. Garcia - University of ArizonaXinyi Li - Harvard UniversityYasmin Mossavar-Rahmani - Albert Einstein College of MedicineMichelle J. Naughton - The Ohio State UniversityMelissa Lopez-Pentecost - University of ArizonaNazmus Saquib - Sulaiman Al Rajhi CollegesAladdin H. Shadyab - University of California, San DiegoMichael S. Simon - Wayne State UniversityLinda G. Snetselaar - University of IowaFred K. Tabung - The Ohio State UniversityDeirdre K. Tobias - Harvard UniversityTrang VoPham - Fred Hutch Cancer CenterKatherine A. McGlynn - National Cancer InstituteHoward D. Sesso - Harvard UniversityEdward Giovannucci - Harvard UniversityJoAnn E. Manson - Brigham and Women's HospitalFrank B. Hu - Harvard UniversityLesley F. Tinker - Fred Hutch Cancer CenterXuehong Zhang - Harvard University
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.330(6), pp.537-546
- DOI
- 10.1001/jama.2023.12618
- PMID
- 37552302
- PMCID
- PMC10410478
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Language
- English
- Date published
- 08/08/2023
- Academic Unit
- Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
- Record Identifier
- 9984449560102771
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