Association of Consumption of Sugar-Sweetened Beverages or Artificially Sweetened Beverages with Mortality: A Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies
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Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) intakes have been reported to be associated with mortality; however, conclusions have been inconsistent. This review synthesized the evidence on the associations of SSB and ASB intakes with mortality from all causes, cardiovascular disease (CVD), and cancer among all populations (including general, diseased, or occupational populations, etc.). PubMed, EMBASE, Web of Science, Cochrane Library, ProQuest, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched up to March 2020. Fifteen studies including 17 cohorts were included in meta-analyses. Each serving (12 fluid ounces or 355 mL) increase in daily SSB consumption was associated with higher risks of all-cause (HR: 1.08; 95% CI: 1.04, 1.12; 11 cohorts with 965,851 participants) and CVD (HR: 1.08; 95% CI: 1.04, 1.12; 13 cohorts with 898,005 participants) mortality. The associations of ASB intakes with all-cause and CVD mortality were J-shaped, and HRs (95% CI) across different doses (0, 1, 1.5, 2, and 2.5 servings/d) were 1.00, 1.01 (0.99, 1.03), 1.04 (1.02, 1.07), 1.08 (1.05, 1.11), and 1.13 (1.09, 1.18) for all-cause mortality and 1.00, 1.01 (0.96, 1.07), 1.07 (1.01, 1.13), 1.15 (1.08, 1.23), and 1.25 (1.14, 1.37) for CVD mortality. No significant association was found for cancer mortality. According to the NutriGrade scoring system, the quality of evidence on the associations of SSB intakes with all-cause and CVD mortality was high, and the quality of evidence on other associations was low to moderate. In summary, higher SSB and ASB intakes were associated with higher risks of all-cause mortality and CVD mortality. Given the limited evidence, future studies should further investigate the association between ASB intakes and cause-specific mortality.
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The association between sugar sweetened beverage consumption and cardiovascular disease mortality is not statistically significant among participants from Asia.
“However, subgroup analysis found that the association between sugar sweetened beverage consumption and cardiovascular disease mortality was not statistically significant among participants from Asia.”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [68]
For cardiovascular disease mortality, each serving/day increment of sugar sweetened beverage consumption is linearly associated with a higher risk (HR 1.08, 95% CI 1.04 to 1.12).
“For cardiovascular disease mortality, each serving/day increment of sugar sweetened beverage consumption was also linearly associated with a higher risk (hazard ratio 1.08, 1.04 to 1.12).”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [68]
Harmful associations between dietary sugar consumption and cardiovascular outcomes were observed, including coronary heart disease, cardiovascular disease, cardiovascular disease mortality, hypertension in children and adolescents, hypertension in adults, myocardial infarction, change in systolic blood pressure in children and adolescents, and stroke.
“harmful associations between dietary sugar consumption and cardiovascular outcomes were also observed, including coronary heart disease,10 cardiovascular disease,8 cardiovascular disease mortality,68 71 hypertension in children and adolescents,69 hypertension in adults,70 myocardial infarction,66 change in systolic blood pressure in children and adolescents,69 and stroke.10”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [68]
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- Authors
- Zhang, Y.-B., Jiang, Y.-W., Chen, J.-X., Xia, P.-F., & Pan, A.
- Affiliations
- Huazhong University of Science and Technology (CN)
- Corresponding author
- Pan, An
- Venue
- Advances in Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 12
- Issue
- 2
- Pages
- 374-383
- ISSN
- 2156-5376 (ISSN-L)
- 2161-8313
- PMC
- PMC8009739
- OpenAlex
- W3087852540
- Cited by
- 60
- References
- 46
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 19 · 2023: 7 · 2022: 10 · 2021: 3
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Advances in Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Key Research and Development Program of China (2017YFC0907504)
- National Nature Science Foundation of China (81930124)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Nursing › Nutrition and Dietetics › Biochemical Analysis and Sensing Techniques
- Keywords
- sugar-sweetened beverages, artificially sweetened beverages, mortality, cardiovascular mortality, cancer mortality, all-cause mortality, dose-response relationship, J-shaped association, sugar consumption, beverage consumption, evidence quality assessment, prospective cohort, dietary risk factors, cardiovascular risk assessment
- MeSH terms
- Sugar-Sweetened Beverages, Artificially Sweetened Beverages, Beverages, Humans, Prospective Studies, Sweetening Agents
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