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Association Between Soft Drink Consumption and Mortality in 10 European Countries

Mullee A 1 , Romaguera D 2 , Pearson-Stuttard J 3 , Viallon V 4 , Stepien M 4 , Freisling H 4 Show all authors , Fagherazzi G 5 , Mancini FR 5 , Boutron-Ruault MC 5 , Kühn T 6 , Kaaks R 6 , Boeing H 7 , Aleksandrova K 8 , Tjønneland A 9 , Halkjær J 9 , Overvad K 10 , Weiderpass E 11 , Skeie G 12 , Parr CL 13 , Quirós JR 14 , Agudo A 15 , Sánchez MJ 16 , Amiano P 17 , Cirera L 17 , Ardanaz E 17 , Khaw KT 18 , Tong TYN 19 , Schmidt JA 19 , Trichopoulou A 20 , Martimianaki G 20 , Karakatsani A 20 , Palli D 21 , Agnoli C 22 , Tumino R 23 , Sacerdote C 24 , Panico S 25 , Bueno-de-Mesquita B 26 , Verschuren WMM 27 , Boer JMA 27 , Vermeulen R 28 , Ramne S 29 , Sonestedt E 29 , van Guelpen B 30 , Holgersson PL 30 , Tsilidis KK 26 , Heath AK 26 , Muller D 26 , Riboli E 26 , Gunter MJ 4 , Murphy N 4

Affiliations 

  • 1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  • 2 Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital of Son Espases, Palma de Mallorca, Spain
  • 3 School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
  • 4 Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
  • 5 CESP, Faculté de Médecine, Université Paris-Sud, Faculté de Médecine, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
  • 6 German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
  • 7 Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
  • 8 Nutrition, Immunity and Metabolism Start-up Lab, Department of Epidemiology, Potsdam-Rehbrücke, Germany
  • 9 Danish Cancer Society Research Center, Copenhagen, Denmark
  • 10 Department of Public Health, Aarhus University, Aarhus, Denmark
  • 11 Office of the Director, International Agency for Research on Cancer, Lyon, France
  • 12 Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
  • 13 Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
  • 14 Public Health Directorate, Asturias, Spain
  • 15 Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
  • 16 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria Granada, Granada, Spain
  • 17 CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  • 18 University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
  • 19 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • 20 Hellenic Health Foundation, Athens, Greece
  • 21 Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy
  • 22 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  • 23 Cancer Registry and Histopathology Department, Civic-M. P. Arezzo Hospital, ASP Ragusa, Ragusa, Italy
  • 24 Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
  • 25 Dipartimento di Medicina Clinica e Sperimentale, Federico II University, Naples, Italy
  • 26 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
  • 27 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
  • 28 Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
  • 29 Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
  • 30 Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
JAMA Intern Med, 2019 Nov 01;179(11):1479-1490.
PMID: 31479109 DOI: 10.1001/jamainternmed.2019.2478

Abstract

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 = 451 743 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, 451 743 (86.7%) were included in the study, with a mean (SD) age of 50.8 (9.8) years and with 321 081 women (71.1%). During a mean (range) follow-up of 16.4 (11.1 in Greece to 19.2 in France) years, 41 693 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 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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