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Comparative Study
. 2023 Aug 8;330(6):537-546.
doi: 10.1001/jama.2023.12618.

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

Longgang Zhao  1   2 , Xinyuan Zhang  2 , Mace Coday  3 , David O Garcia  4 , Xinyi Li  5 , Yasmin Mossavar-Rahmani  6 , Michelle J Naughton  7 , Melissa Lopez-Pentecost  8 , Nazmus Saquib  9 , Aladdin H Shadyab  10 , Michael S Simon  11   12 , Linda G Snetselaar  13 , Fred K Tabung  14   15   16 , Deirdre K Tobias  16   17 , Trang VoPham  18   19 , Katherine A McGlynn  20 , Howard D Sesso  5   16 , Edward Giovannucci  5   16 , JoAnn E Manson  5   17 , Frank B Hu  5   16 , Lesley F Tinker  21 , Xuehong Zhang  2   16
Affiliations
Comparative Study

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

Longgang Zhao et al. JAMA. .

Abstract

Importance: Approximately 65% of adults in the US consume sugar-sweetened beverages daily.

Objective: To 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 participants: A 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.

Exposures: Sugar-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 measures: The 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.

Results: During 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 relevance: In 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Naughton reported grants from the National Institute on Aging (NIA) to The Ohio State University (to support the analysis and use of the Women’s Health Initiative [WHI] data for multiple publications during the conduct of the study); and grants from Merck Foundation (to support a research project not related to this article) outside the submitted work. Dr Tobias reported grants from the National Cancer Institute (NCI) and grants from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK) during the conduct of the study. Dr VoPham reported personal fees from Georgetown University (speaker honorarium); and grants from NIH/NIDDK (K01 DK125612), NIH/NCI (P20 CA252732; P30 CA015704), and NIH/NHLBI (National Heart, Lung, and Blood Institute; 75N92019R0030) outside the submitted work. Dr Manson reported grants from NIH during the conduct of the study and grants from NIH and Mars Edge outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Potential Participants, Exclusions, and Cohort Development for the Women’s Health Initiative
aThis exclusion indicates all cancers except nonmelanoma skin cancer (ie, patients with nonmelanoma skin cancer were not excluded). bIndicates new cases of liver cancer and confirmed deaths over a median 20.9 years of follow-up. cOne serving was defined as 12 fl oz or 355 mL.
Figure 2.
Figure 2.. Cumulative Probability of Liver Cancer and Chronic Liver Disease Mortality, According to Categories of Sugar-Sweetened Beverage Intake
See this image and copyright information in PMC

Comment in

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