Soft drink consumption linked with increased all-cause mortality

1. In this population-based cohort study, consumption of total, sugar-, and artificially-sweetened soft drinks was linked with an increased risk of all-cause mortality.

2. The consumption of artificially-sweetened soft drinks was also linked to an increase in death from circulatory diseases. Sugar-sweetened soft drinks intake was associated with death from digestive diseases.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The frequent consumption of soft drinks has been linked to an increase risk of obesity, metabolic disease including diabetes, and cardiovascular disease. The current study sought to evaluate the mortality-risk related to consumption of both artificially- and sugar-sweetened soft drinks in a population from 10 European countries. The study found that there was an increase in all-cause mortality with frequency of any soft drinks, specifically with sugar-sweetened, and artificially-sweetened soft drinks. The consumption of sugar-sweetened drinks was linked with an increase of digestive disease-related death, while artificially-sweetened soft drinks was associated with death from circulatory disease.

The study provides further evidence that population health initiatives aimed at reduction of soft drink consumption may lead to decreased morbidity and mortality. The study strengths include the long-follow up of a large, diverse European population. The main limitation is the observational design which precludes the ability to attribute causality to the observed associations.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta‐analysis

In-Depth [prospective cohort]: This study is a population cohort involving adults from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. This study included participants from 10 European countries: (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom. Participants were recruited between 1992 and 2000. Participants were excluded if they had a baseline history of cancer, heart disease, stroke, were in the highest or lowest 1% of energy intake, were missing data on soft drink consumption, or had missing follow-up data. Dietary information was determined using self-administered questionnaires or personal interviews.

A total of 451,743 participants were included in the study, with a median age of 50.8 years, and mean (range) follow-up of 16.4 years. Compared to non-consumers (<1 glass/month) those who consumed 2 or more glasses/day of soft drinks had higher all-cause mortality (hazard ratio [HR], 1.17; 95%CI, 1.11-1.22; P < .001). Sugar-sweetened soft drinks also had increased all cause (HR, 1.08; 95%CI, 1.01-1.16; P = .004) and digestive disease related mortality (HR, 1.59; 95%CI, 1.24-2.05; P < .001). Artificially sweetened soft drinks were linked with greater all-cause (HR, 1.26; 95%CI, 1.16-1.35; P < .001) and circulatory disease mortality (HR, 1.52; 95%CI, 1.30-1.78; P < .001)

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