Association of Consumption of Sugar-Sweetened Beverages or Artificially Sweetened Beverages with Mortality: A Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies

Abstract

Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) intakes have been reported to be associated with mortality; however, conclusions have been inconsistent. This review synthesized the evidence on the associations of SSB and ASB intakes with mortality from all causes, cardiovascular disease (CVD), and cancer among all populations (including general, diseased, or occupational populations, etc.). PubMed, EMBASE, Web of Science, Cochrane Library, ProQuest, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched up to March 2020. Fifteen studies including 17 cohorts were included in meta-analyses. Each serving (12 fluid ounces or 355 mL) increase in daily SSB consumption was associated with higher risks of all-cause (HR: 1.08; 95% CI: 1.04, 1.12; 11 cohorts with 965,851 participants) and CVD (HR: 1.08; 95% CI: 1.04, 1.12; 13 cohorts with 898,005 participants) mortality. The associations of ASB intakes with all-cause and CVD mortality were J-shaped, and HRs (95% CI) across different doses (0, 1, 1.5, 2, and 2.5 servings/d) were 1.00, 1.01 (0.99, 1.03), 1.04 (1.02, 1.07), 1.08 (1.05, 1.11), and 1.13 (1.09, 1.18) for all-cause mortality and 1.00, 1.01 (0.96, 1.07), 1.07 (1.01, 1.13), 1.15 (1.08, 1.23), and 1.25 (1.14, 1.37) for CVD mortality. No significant association was found for cancer mortality. According to the NutriGrade scoring system, the quality of evidence on the associations of SSB intakes with all-cause and CVD mortality was high, and the quality of evidence on other associations was low to moderate. In summary, higher SSB and ASB intakes were associated with higher risks of all-cause mortality and CVD mortality. Given the limited evidence, future studies should further investigate the association between ASB intakes and cause-specific mortality.

Association of sweetened beverages consumption with all-cause mortality risk among Dutch adults: the Lifelines Cohort Study (the SWEET project)

“…Positive associations between SSB and all-cause mortality risk have also been reported in recent meta-analyses of cohort studies [ 4 , 7 , 8 , 23 ], where particularly the largest studies support our findings [ 11 , 12 , 24 – 27 ]. A pooled prospective analysis of the Nurses’ Health Study and Health Professional Follow-up Study [ 12 ] yielded a 7% higher mortality risk for each additional serving/day.…”

“…Yet, evidence on the impact of sugar-sweetened beverages (SSB) and low/no-calorie beverages (LNCB) on mortality risk remains scarce and inconclusive. Recent dose–response meta-analyses showed significant positive associations between SSB and LNCB consumption and all-cause mortality risk [ 4 , 7 , 8 ], but also showed moderate to high heterogeneity.…”

“…In terms of composition, SSB mainly consists of liquids sweetened with various forms of added sugars, FJ contains sugars as well as polyphenols, vitamins, and minerals. Besides, as recent data suggest a potential J-shaped association between LNCB and all-cause mortality [ 7 ], and between 100% FJ and various cardiometabolic disease risks [ 9 , 10 ], there is a need to investigate the non-linearity of the associations. Finally, although SSB is often replaced by other beverages, substitution modelling of these replacements is scarce.…”

What should we advise MAFLD patients to eat and drink?

“…Epidemiological studies showed us that consumption of SSB is associated with an increased risk for central obesity and increased visceral fat [59][60][61][62] , MS [59,63] , dyslipidemia [64] , T2DM [63,[65][66][67] , cardiovascular diseases [63,68] , and mortality [69] .…”

Sugary Truth of Early-Onset Colorectal Neoplasia—Not So Sweet After All

“…Increasing fructose and SSB consumption, particularly among adolescents and young adults, is troublesome because substantial evidence links consumption to various health outcomes, including obesity, type 2 diabetes, cardiovascular disease, some cancers, all-cause mortality, and now early-onset high-risk adenoma. 10,11,21 Future research should explore the mechanisms by which excess fructose drives colorectal carcinogenesis, as well as the effects of SSBs' individual components, such as food coloring (eg, caramel). Although we are still a long way from connecting the dots from fructose to early-onset CRC, clinicians should continue to support public health policies discouraging or reducing consumption of simple sugars and SSBs in adolescents, for whom exposure might have lifelong consequences.…”