Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults

Abstract

Background: Whether consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) is associated with risk of mortality is of public health interest.

Methods: We examined associations between consumption of SSBs and ASBs with risk of total and cause-specific mortality among 37 716 men from the Health Professional's Follow-up study (from 1986 to 2014) and 80 647 women from the Nurses' Health study (from 1980 to 2014) who were free from chronic diseases at baseline. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals.

Results: We documented 36 436 deaths (7896 cardiovascular disease [CVD] and 12 380 cancer deaths) during 3 415 564 person-years of follow-up. After adjusting for major diet and lifestyle factors, consumption of SSBs was associated with a higher risk of total mortality; pooled hazard ratios (95% confidence intervals) across categories (<1/mo, 1-4/mo, 2-6/week, 1-<2/d, and ≥2/d) were 1.00 (reference), 1.01 (0.98, 1.04), 1.06 (1.03, 1.09), 1.14 (1.09, 1.19), and 1.21 (1.13, 1.28; P trend <0.0001). The association was observed for CVD mortality (hazard ratio comparing extreme categories was 1.31 [95% confidence interval, 1.15, 1.50], P trend <0.0001) and cancer mortality (1.16 [1.04, 1.29], P trend =0.0004). ASBs were associated with total and CVD mortality in the highest intake category only; pooled hazard ratios (95% confidence interval) across categories were 1.00 (reference), 0.96 (0.93, 0.99), 0.97 (0.95, 1.00), 0.98 (0.94, 1.03), and 1.04 (1.02, 1.12; P trend = 0.01) for total mortality and 1.00 (reference), 0.93 (0.87, 1.00), 0.95 (0.89, 1.00), 1.02 (0.94, 1.12), and 1.13 (1.02, 1.25; P trend = 0.02) for CVD mortality. In cohort-specific analysis, ASBs were associated with mortality in NHS (Nurses' Health Study) but not in HPFS (Health Professionals Follow-up Study) ( P interaction, 0.01). ASBs were not associated with cancer mortality in either cohort.

Conclusions: Consumption of SSBs was positively associated with mortality primarily through CVD mortality and showed a graded association with dose. The positive association between high intake levels of ASBs and total and CVD mortality observed among women requires further confirmation.

Keywords: all-cause death; artificially sweetened beverages; cardiovascular death; low calorie beverages; sugar-sweetened beverages.

Figure 1:

Total Mortality According to SSB Intake (Serving/Day) (A) and ASB (B) Stratified by Age, BMI, Physical Activity and Diet Quality based on pooled data from the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) and Pooled Data from Both Cohorts. Adjusted for: age, ASB or SSB, smoking, alcohol intake, postmenopausal hormone use (NHS), physical activity, family history of diabetes, family history of mi, family history of cancer, multivitamin use, ethnicity, aspirin use, baseline history of hypertension and hypercholesterolemia, intakes of whole grains, fruit, vegetables, red and processed meat, total energy and BMI. For SSB, all p-interaction >0.10. For ASB, p-interaction > 0.10 except for BMI (p-interaction, 0.01) and physical activity (p-interaction, 0.004) from the pooled analysis and BMI in the NHS (p-interaction, 0.002).

Figure 1:

Total Mortality According to SSB Intake (Serving/Day) (A) and ASB (B) Stratified by Age, BMI, Physical Activity and Diet Quality based on pooled data from the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) and Pooled Data from Both Cohorts. Adjusted for: age, ASB or SSB, smoking, alcohol intake, postmenopausal hormone use (NHS), physical activity, family history of diabetes, family history of mi, family history of cancer, multivitamin use, ethnicity, aspirin use, baseline history of hypertension and hypercholesterolemia, intakes of whole grains, fruit, vegetables, red and processed meat, total energy and BMI. For SSB, all p-interaction >0.10. For ASB, p-interaction > 0.10 except for BMI (p-interaction, 0.01) and physical activity (p-interaction, 0.004) from the pooled analysis and BMI in the NHS (p-interaction, 0.002).