The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study
Open Access
- 24 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Medicine
- Vol. 18 (1), 1-12
- https://doi.org/10.1186/s12916-020-01554-5
Abstract
Recent efforts to address the obesity epidemic have focused on sugar consumption, especially sugar-sweetened beverages. However, sugar takes many forms, is only one contributor to overall energy consumption and is correlated with other health-related lifestyle factors. The objective was to investigate the associations with all-cause mortality of sugar- and artificially sweetened beverages and naturally sweet juices. Setting: UK Biobank, UK. Participants joined the UK Biobank study from 2006 to 2010 and were followed up until 2016; 198,285 men and women aged 40–69 years were eligible for this study (40% of the UK Biobank), of whom 3166 (1.6%) died over a mean of 7 years follow-up. Design: prospective population-based cohort study. Exposure variables: dietary consumption of sugar-sweetened beverages, artificially sweetened beverages, naturally sweet juices (100% fruit/vegetable juices) and total sugar intake, self-reported via 24-h dietary assessment tool completed between 2009 and 2012. Main outcome: all-cause mortality. Cox regression analyses were used to study the association between the daily intake of the above beverages and all-cause mortality. Models were adjusted for sociodemographic, economic, lifestyle and dietary confounders. Total energy intake, total sugar intake and percentage of energy derived from sugar were comparable among participants who consumed > 2/day sugar-sweetened beverages and > 2/day fruit/vegetable juices (10,221 kJ/day versus 10,381 kJ/day; 183 g versus 190 g; 30.6% versus 31.0%). All-cause mortality was associated with total sugar intake (highest quintile adj. HR 1.28, 95% CI 1.06–1.55) and intake of sugar-sweetened beverages (> 2/day adj. HR 1.84, 95% CI 1.42–2.37) and remained so in sensitivity analyses. An association between artificially sweetened beverage intake and mortality did not persist after excluding deaths in the first 2 years of follow-up (landmark analysis) nor after excluding participants with recent weight loss. Furthermore, the inverse association between fruit/vegetable juice intake and mortality did not persist after additional adjustment for a diet quality score. Higher mortality is associated with sugar-sweetened beverages specifically. The lack of an adverse association with fruit/vegetable juices suggests that source of sugar may be important and the association with artificially sweetened beverage may reflect reverse causation.Keywords
This publication has 37 references indexed in Scilit:
- Diet Drink Consumption and the Risk of Cardiovascular Events: A Report from the Women’s Health InitiativeJournal of General Internal Medicine, 2014
- Sugars and risk of mortality in the NIH-AARP Diet and Health StudyThe American Journal of Clinical Nutrition, 2014
- Added Sugar Intake and Cardiovascular Diseases Mortality Among US AdultsJAMA Internal Medicine, 2014
- Lifestyle factors and mortality risk in individuals with diabetes mellitus: are the associations different from those in individuals without diabetes?Diabetologia, 2013
- Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysisThe American Journal of Clinical Nutrition, 2013
- Alternative Dietary Indices Both Strongly Predict Risk of Chronic DiseaseJournal of Nutrition, 2012
- Soda consumption and the risk of stroke in men and womenThe American Journal of Clinical Nutrition, 2012
- Development and evaluation of the Oxford WebQ, a low-cost, web-based method for assessment of previous 24 h dietary intakes in large-scale prospective studiesPublic Health Nutrition, 2011
- Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in Middle-Aged Adults in the CommunityCirculation, 2007
- Non-alcoholic beverage and caffeine consumption and mortality: The Leisure World Cohort StudyPreventive Medicine, 2007