Association Between Soft Drink Consumption and Mortality in 10 European Countries

Mullee, Amy; Romaguera, Dora; Pearson‐Stuttard, Jonathan; Viallon, Vivian; Stępień, Magdalena; Freisling, Heinz; Fagherazzi, Guy; Mancini, Francesca Romana; Boutron-Ruault, Marie Christine; Kühn, Tilman; Kaaks, Rudolf; Boeing, Heiner; Aleksandrova, Krasimira; Tjønneland, Anne; Halkjær, Jytte; Overvad, Kim; Weiderpass, Elisabete; Skeie, Guri; Parr, Christine Louise; Quiŕos, J. Ramón; Agudo, Antonio; Sánchez, María José; Amiano, Pilar; Cirera, Lluís; Ardanaz, Eva; Khaw, Kay Tee; Tong, Tammy Y.N.; Schmidt, Julie A.; Trichopoulou, Antonia; Martimianaki, Georgia; Karakatsani, Anna; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Sacerdote, Carlotta; Panico, Salvatore; Bueno‐de‐Mesquita, Bas; Verschuren, W M Monique; Boer, Jolanda M. A.; Vermeulen, Roel; Ramne, Stina; Sonestedt, Emily; Guelpen, Bethany Van; Holgersson, Pernilla Lif; Tsilidis, Konstantinos K.; Heath, Alicia K.; Muller, David C.; Riboli, Elio; Gunter, Marc J.; Murphy, Neil

doi:10.1001/jamainternmed.2019.2478

Cited by 197 publications

(233 citation statements)

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“…It has been recommended that high consumption of artificially sweetened beverages should be discouraged [3] and not be promoted as a safe substitute for sugarsweetened beverages [26]. Meta-analyses, of three and four studies, respectively, have demonstrated an association between consumption of artificially sweetened beverages and hypertension [27] and cardiovascular disease [4]. A meta-analysis of 17 studies showed that artificially sweetened beverages were also associated with type 2 diabetes, independent of adiposity [28].…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…Individual studies have demonstrated associations with metabolic syndrome [15], stroke [29] and all-cause mortality [30]. However, in the EPIC, NHS and HPFS cohorts, and in the Women's Health Initiative Observational Study, only the highest intake of artificially sweetened beverages was associated with all-cause mortality [3][4][5], and a more recent systemic review and meta-analysis of randomised and non-randomised control trials and observational studies, of non-sugar sweeteners (including artificially sweetened beverages) was inconclusive in relation to whether they were associated with harm [31]. Our initial findings also suggested an association between artificially sweetened beverages and mortality in the highest intake category.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…However, they found that the consumption of artificially sweetened beverages (ASB) was only associated with all-cause mortality in women. Another study that examined the associations with the SSB and ASB intake in participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) found an association between both SSB and ASB however only for those who consume large amounts (1 or more glasses daily) compared to less than once a month, with ASB showing a higher risk than SSB for the most frequent consumers [4]. ASB were also positively associated with all-cause mortality in the most frequent consumers (2 or more glasses daily) in the study of postmenopausal women in the USA [5].…”

Section: Introductionmentioning

confidence: 99%

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The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study

Anderson

Gray

Welsh

et al. 2020

BMC Med

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Background: Recent efforts to address the obesity epidemic have focused on sugar consumption, especially sugarsweetened beverages. However, sugar takes many forms, is only one contributor to overall energy consumption and is correlated with other health-related lifestyle factors. The objective was to investigate the associations with allcause mortality of sugar-and artificially sweetened beverages and naturally sweet juices. Methods: Setting: UK Biobank, UK. Participants joined the UK Biobank study from 2006 to 2010 and were followed up until 2016; 198,285 men and women aged 40-69 years were eligible for this study (40% of the UK Biobank), of whom 3166 (1.6%) died over a mean of 7 years follow-up. Design: prospective population-based cohort study. Exposure variables: dietary consumption of sugar-sweetened beverages, artificially sweetened beverages, naturally sweet juices (100% fruit/vegetable juices) and total sugar intake, self-reported via 24-h dietary assessment tool completed between 2009 and 2012. Main outcome: all-cause mortality. Cox regression analyses were used to study the association between the daily intake of the above beverages and all-cause mortality. Models were adjusted for sociodemographic, economic, lifestyle and dietary confounders. Results: Total energy intake, total sugar intake and percentage of energy derived from sugar were comparable among participants who consumed > 2/day sugar-sweetened beverages and > 2/day fruit/vegetable juices (10,221 kJ/day versus 10,381 kJ/day; 183 g versus 190 g; 30.6% versus 31.0%). All-cause mortality was associated with total sugar intake (highest quintile adj. HR 1.28, 95% CI 1.06-1.55) and intake of sugar-sweetened beverages (> 2/day adj. HR 1.84, 95% CI 1.42-2.37) and remained so in sensitivity analyses. An association between artificially sweetened beverage intake and mortality did not persist after excluding deaths in the first 2 years of follow-up (landmark analysis) nor after excluding participants with recent weight loss. Furthermore, the inverse association between fruit/vegetable juice intake and mortality did not persist after additional adjustment for a diet quality score. (Continued on next page)Conclusions: Higher mortality is associated with sugar-sweetened beverages specifically. The lack of an adverse association with fruit/vegetable juices suggests that source of sugar may be important and the association with artificially sweetened beverage may reflect reverse causation.

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Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study

Anderson

Gray

Welsh

et al. 2020

BMC Med

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“…The frequency of stroke and renal failure are also higher in young adults with history of childhood obesity [89,90]. In a recent study published in JAMA, positive associations were observed between consumption of artificially sweetened soft drinks and death due to circulatory diseases (>2 drinks/day vs. <1 glass per month; HR 1.52; 95%CI 1.30-1.78, p = 0.001) [91].…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Obesity in School Children in India

Sashindran¹,

Dudeja²

2020

Public Health in Developing Countries - Challenges and Opportunities

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The global prevalence of obesity has doubled from 1990 to 2015. Worryingly, the increase is more in children than in adults. In just three decades, the number of school-going children and adolescents with obesity has increased by 10-fold, and the International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) reckon that 200 million school children worldwide are either overweight or obese. The prevalence of obesity among 5-to 19-year-old Indian children, ranged between 3.6 and 11.7%. It is predicted that by 2025 there will be 17 million obese children in India. Urbanisation is the single most important factor linked to obesity in India. Epigenetic, dietary, familial, psychosocial, parental education and parental occupation are other important factors. About 50% of obese children will become obese adults. The prevalence of hypertension, type 2 diabetes dyslipidaemia and non-alcoholic fatty liver disease in children is also increasing parallelly. Prevention of childhood obesity is vital because it is near impossible to get children to lose weight and maintain it. A healthy diet and an active lifestyle should start from the pre-conception time itself and be continued through all stages of childhood. 2 been tried in different countries, and each one of them has important lessons for public health specialists and health policy makers. The WHO's Commission for Ending Childhood Obesity opines that this problem requires, 'a whole-government approach in which policies across all sectors systematically take health into account, avoid harmful health impacts, and thus improve population health and health equity' [4]. The magnitude of the problem, causative factors, complications of childhood obesity and some solutions will be discussed. Prevalence Global prevalenceObesity in school children is today an uncomfortable reality. The global prevalence of obesity has doubled between 1990 and 2015. Worryingly, the rate of increase in obesity in children is higher than that in adults in many countries [5]. Globally, about 10% of school children in the 5-17 age groups are obese or overweight [5]. The prevalence varies from 30% in America to less than 2% in sub-Saharan Africa. In just three decades, the number of school-going children and adolescents with obesity has increased by 10-fold, from 11 million to 124 million (2016 estimates). In addition to this, another 216 million children were estimated to be overweight though not obese in 2016 [6]. The International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) reckon that 200 million school children worldwide are either overweight or obese [7]. The problem probably starts early in childhood. A 2010 report estimated that 42 million children under the age of 5 were overweight and of these, 35 million lived in developing countries. While the prevalence of childhood obesity may be plateauing in some developed countries, it is showing a steep rise in developing countries of Asia and Africa. Within Asia, China ha...

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“…The evaluation of behavioral and lifestyle interventions remains extremely rare in spite of their importance for developing effective population health strategies and establishing health systems. This notwithstanding, PH researchers and other non-HTA professionals frequently study a variety of approaches for prevention interventions that directly target the general population (22,23). However, associated recommendations and more generalized implementation of campaigns and interventions do not belong to their mainstream responsibilities.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

Stojanovic

Wübbeler

Geis

et al. 2020

Front. Public Health

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Introduction: Public health (PH) interventions are crucial for ensuring sustainable healthcare services. Nevertheless, they represent a neglected area in the field of health technology assessment (HTA) due to various methodological issues and their complex design that goes beyond clinical setting. The present study provides an environmental scan of HTA initiatives related to the assessment of PH technologies on a global level.Methods: We conducted a cross-sectional survey among 85 HTA-related European and international societies, health bodies, and networks from September 2018 to January 2019. The questionnaire contained four sections and 18 questions regarding activities related to the evaluation of PH technologies, information on existing PH technologies, and methodologies of assessment as well as barriers and facilitators to reaching a decision and implementing a PH technology.Results: Among 52 survey responses, the majority of the respondents came from European countries (35%), followed by North American (27%), and South American (19%) countries. The main type of organizations covered by our survey included HTA agencies, public administrations, and research institutes. Seventy-one % of the institutions reported engagement in any aspect of HTA in the area of PH (N = 37). Among those, 81% evaluated less than 5 PH technologies from 2013 to 2018. The most common barriers for reaching a decision on PH technologies were lack of data, conflicting stakeholder priorities, and methodological issues. A total of 76 PH interventions were reported, and most cited initiatives were related to chronic disease screening, prevention of infectious diseases, and maternal, prenatal, and neonatal screening.Conclusion: Our survey reported a rather limited involvement of HTA in the evaluation of PH technologies. In particular, an evaluation of behavioral and lifestyle interventions remains extremely rare. The implementation of collaborative HTA approaches in the setting of PH practice and policy needs to be prioritized and further strengthened. Moreover, ensuring reliable data structures and consolidation of HTA methods for the evaluation of PH technologies will be crucial for tackling the enormous burden of non-communicable diseases in societies.

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Association Between Soft Drink Consumption and Mortality in 10 European Countries

Cited by 197 publications

References 40 publications

The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study

The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study

Obesity in School Children in India

Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

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