Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality

Abstract

ImportanceApproximately 65% of adults in the US consume sugar-sweetened beverages daily.ObjectiveTo 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 ParticipantsA 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.ExposuresSugar-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 MeasuresThe 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.ResultsDuring 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 RelevanceIn 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.

The Quality of Menu Offerings in Independently Owned Restaurants in Baltimore, Maryland: Results from Mixed-Methods Formative Research for the FRESH Trial

“…Finally, sugar reduction was the least supported concept by participants. In restaurants, sugar consumption primarily comes from sugar-sweetened beverages (SSBs), not food; however, reducing added sugar in beverages faces challenges due to a longstanding preference for sugary drinks in the United States, as indicated by a prospective cohort study from the Women's Health Initiative, which tracked participants for a median of 20.9 years to analyze their intake of SSBs [41]. Research and policy efforts to reduce sugar consumption from restaurant sources have been implemented across jurisdictions outside of Baltimore, but these measures mostly apply to chain restaurants, rather than IORs [42,43].…”

Sugar-Sweetened Beverages and Risk of Liver Disease

“…To the Editor A recent study investigated associations between sugar-sweetened and artificially sweetened beverages and risk of chronic liver disease and liver cancer in women . Compared with intake of 3 or fewer sugar-sweetened beverages per month, individuals who consumed 1 or more sugar-sweetened beverages per day had a significantly higher risk of developing liver cancer.…”

Sugar-Sweetened Beverages and Risk of Liver Disease—Reply

“…As mentioned in the article’s Methods section, we have information on chronic liver disease mortality, which includes deaths due to NAFLD. We also have data on history of liver disease at baseline but not on a NAFLD-specific diagnosis at baseline or on the incidence of NAFLD during the follow-up period in the Women’s Health Initiative (WHI).…”