TY - JOUR

T1 - Association between Soft Drink Consumption and Mortality in 10 European Countries

AU - Mullee, Amy

AU - Romaguera, Dora

AU - Pearson-Stuttard, Jonathan

AU - Viallon, Vivian

AU - Stepien, Magdalena

AU - Freisling, Heinz

AU - Fagherazzi, Guy

AU - Mancini, Francesca Romana

AU - Boutron-Ruault, Marie Christine

AU - Kühn, Tilman

AU - Kaaks, Rudolf

AU - Boeing, Heiner

AU - Aleksandrova, Krasimira

AU - Tjønneland, Anne

AU - Halkjær, Jytte

AU - Overvad, Kim

AU - Weiderpass, Elisabete

AU - Skeie, Guri

AU - Parr, Christine L.

AU - Quirós, J. Ramón

AU - Agudo, Antonio

AU - Sánchez, Maria Jose

AU - Amiano, Pilar

AU - Cirera, Lluís

AU - Ardanaz, Eva

AU - Khaw, Kay Tee

AU - Tong, Tammy Y.N.

AU - Schmidt, Julie A.

AU - Trichopoulou, Antonia

AU - Martimianaki, Georgia

AU - Karakatsani, Anna

AU - Palli, Domenico

AU - Agnoli, Claudia

AU - Tumino, Rosario

AU - Sacerdote, Carlotta

AU - Panico, Salvatore

AU - Bueno-De-Mesquita, Bas

AU - Verschuren, W. M.Monique

AU - Boer, Jolanda M.A.

AU - Vermeulen, Roel

AU - Ramne, Stina

AU - Sonestedt, Emily

AU - Van Guelpen, Bethany

AU - Holgersson, Pernilla Lif

AU - Tsilidis, Konstantinos K.

AU - Heath, Alicia K.

AU - Muller, David

AU - Riboli, Elio

AU - Gunter, Marc J.

AU - Murphy, Neil

N1 - Funding Information: reported receiving grants from University College Dublin and grants from International Agency for Research on Cancer during the conduct of the study. Dr Khaw reported receiving grants from the Medical Research Council during the conduct of the study. Dr Tong reported receiving grants from Cancer Research UK and grants from the Medical Research Council during the conduct of the study. Dr Schmidt reported receiving grants from Cancer Research UK and grants from the Medical Research Council during the conduct of the study. Dr Vermeulen reported receiving grants from The European Union during the conduct of the study. Dr Muller reported receiving grants from Cancer Research UK outside the submitted work. No other disclosures were reported. Funding Information: Investigation into Cancer and Nutrition) was funded by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by the Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, and Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum, and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); the Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF); ERC-2009-AdG 232997 and Nordforsk, and Nordic Centre of Excellence Programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS) (grant PI13/00061 to Granada, and grant PI13/ 01162 to EPIC-Murcia), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology (Spain); Swedish Cancer Society, Swedish Research Council, and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (grant 14136 to EPIC-Norfolk, and grants C570/A16491 and C8221/A19170 to EPIC-Oxford) and Medical Research Council (grant 1000143 to EPIC-Norfolk, and grant MR/M012190/1 to EPIC-Oxford) (United Kingdom). Dr Mullee’s work was supported by an IARC-Ireland Postdoctoral Research Training Fellowship from the Irish Cancer Society. Publisher Copyright: © 2019 American Medical Association. All rights reserved.

PY - 2019/11

Y1 - 2019/11

N2 - Importance: Soft drinks are frequently consumed, but whether this consumption is associated with mortality risk is unknown and has been understudied in European populations to date. Objective: To examine the association between total, sugar-sweetened, and artificially sweetened soft drink consumption and subsequent total and cause-specific mortality. Design, Setting, and Participants: This population-based cohort study involved participants (n = 451743 of the full cohort) in the European Prospective Investigation into Cancer and Nutrition (EPIC), an ongoing, large multinational cohort of people from 10 European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom), with participants recruited between January 1, 1992, and December 31, 2000. Excluded participants were those who reported cancer, heart disease, stroke, or diabetes at baseline; those with implausible dietary intake data; and those with missing soft drink consumption or follow-up information. Data analyses were performed from February 1, 2018, to October 1, 2018. Exposure: Consumption of total, sugar-sweetened, and artificially sweetened soft drinks. Main Outcomes and Measures: Total mortality and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models adjusted for other mortality risk factors. Results: In total, 521 330 individuals were enrolled. Of this total, 451743 (86.7%) were included in the study, with a mean (SD) age of 50.8 (9.8) years and with 321081 women (71.1%). During a mean (range) follow-up of 16.4 (11.1 in Greece to 19.2 in France) years, 41693 deaths occurred. Higher all-cause mortality was found among participants who consumed 2 or more glasses per day (vs consumers of <1 glass per month) of total soft drinks (hazard ratio [HR], 1.17; 95% CI, 1.11-1.22; P <.001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P =.004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P <.001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P <.001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P <.001). Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

AB - Importance: Soft drinks are frequently consumed, but whether this consumption is associated with mortality risk is unknown and has been understudied in European populations to date. Objective: To examine the association between total, sugar-sweetened, and artificially sweetened soft drink consumption and subsequent total and cause-specific mortality. Design, Setting, and Participants: This population-based cohort study involved participants (n = 451743 of the full cohort) in the European Prospective Investigation into Cancer and Nutrition (EPIC), an ongoing, large multinational cohort of people from 10 European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom), with participants recruited between January 1, 1992, and December 31, 2000. Excluded participants were those who reported cancer, heart disease, stroke, or diabetes at baseline; those with implausible dietary intake data; and those with missing soft drink consumption or follow-up information. Data analyses were performed from February 1, 2018, to October 1, 2018. Exposure: Consumption of total, sugar-sweetened, and artificially sweetened soft drinks. Main Outcomes and Measures: Total mortality and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models adjusted for other mortality risk factors. Results: In total, 521 330 individuals were enrolled. Of this total, 451743 (86.7%) were included in the study, with a mean (SD) age of 50.8 (9.8) years and with 321081 women (71.1%). During a mean (range) follow-up of 16.4 (11.1 in Greece to 19.2 in France) years, 41693 deaths occurred. Higher all-cause mortality was found among participants who consumed 2 or more glasses per day (vs consumers of <1 glass per month) of total soft drinks (hazard ratio [HR], 1.17; 95% CI, 1.11-1.22; P <.001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P =.004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P <.001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P <.001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P <.001). Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

U2 - 10.1001/jamainternmed.2019.2478

DO - 10.1001/jamainternmed.2019.2478

M3 - Journal article

C2 - 31479109

AN - SCOPUS:85071732581

VL - 179

SP - 1479

EP - 1490

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 11

ER -