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 - 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.
UR - http://www.scopus.com/inward/record.url?scp=85071732581&partnerID=8YFLogxK
U2 - 10.1001/jamainternmed.2019.2478
DO - 10.1001/jamainternmed.2019.2478
M3 - Article
C2 - 31479109
AN - SCOPUS:85071732581
SN - 2168-6106
VL - 179
SP - 1479
EP - 1490
JO - JAMA Internal Medicine
JF - JAMA Internal Medicine
IS - 11
ER -