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Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults
Open accessAbstract
Background: Whether consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) is associated with risk of mortality is of public health interest. Methods: We examined associations between consumption of SSBs and ASBs with risk of total and cause-specific mortality among 37 716 men from the Health Professional’s Follow-up study (from 1986 to 2014) and 80 647 women from the Nurses’ Health study (from 1980 to 2014) who were free from chronic diseases at baseline. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals. Results: We documented 36 436 deaths (7896 cardiovascular disease [CVD] and 12 380 cancer deaths) during 3 415 564 person-years of follow-up. After adjusting for major diet and lifestyle factors, consumption of SSBs was associated with a higher risk of total mortality; pooled hazard ratios (95% confidence intervals) across categories (<1/mo, 1–4/mo, 2–6/week, 1-<2/d, and ≥2/d) were 1.00 (reference), 1.01 (0.98, 1.04), 1.06 (1.03, 1.09), 1.14 (1.09, 1.19), and 1.21 (1.13, 1.28; P trend <0.0001). The association was observed for CVD mortality (hazard ratio comparing extreme categories was 1.31 [95% confidence interval, 1.15, 1.50], P trend <0.0001) and cancer mortality (1.16 [1.04, 1.29], P trend =0.0004). ASBs were associated with total and CVD mortality in the highest intake category only; pooled hazard ratios (95% confidence interval) across categories were 1.00 (reference), 0.96 (0.93, 0.99), 0.97 (0.95, 1.00), 0.98 (0.94, 1.03), and 1.04 (1.02, 1.12; P trend = 0.01) for total mortality and 1.00 (reference), 0.93 (0.87, 1.00), 0.95 (0.89, 1.00), 1.02 (0.94, 1.12), and 1.13 (1.02, 1.25; P trend = 0.02) for CVD mortality. In cohort-specific analysis, ASBs were associated with mortality in NHS (Nurses’ Health Study) but not in HPFS (Health Professionals Follow-up Study) ( P interaction, 0.01). ASBs were not associated with cancer mortality in either cohort. Conclusions: Consumption of SSBs was positively associated with mortality primarily through CVD mortality and showed a graded association with dose. The positive association between high intake levels of ASBs and total and CVD mortality observed among women requires further confirmation.
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“After adjustment for diet and lifestyle confounders, the consumption of two or more servings of sugar sweetened beverages a day was linked with a 21% (hazard ratio 1.21, 1.13 to 1.28) higher risk of total mortality, a 31% (1.31, 1.15 to 1.50) higher risk of cardiovascular disease mortality, and a 16% (1.16, 1.04 to 1.29) higher risk of cancer mortality.147”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [147]
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Metadata
- Authors
- Malik, V. S., Li, Y., Pan, A., De Koning, L., Schernhammer, E., Willett, W. C., & Hu, F. B.
- Affiliations
- Harvard University (US)
- Huazhong University of Science and Technology (CN)
- Departments of Pathology and Laboratory Medicine, Community Health Sciences and Pediatrics, University of Calgary, Alberta, Canada (L.D.K.).
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 2019-04-30
- Volume
- 139
- Issue
- 18
- Pages
- 2113-2125
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC6488380
- OpenAlex
- W2921424591
- Cited by
- 421
- References
- 41
- Citations by year
- 2026: 26 · 2025: 38 · 2024: 60 · 2023: 56 · 2022: 82 · 2021: 69 · 2020: 55 · 2019: 34
- FWCI
- 55.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL060712, R01HL035464, R01HL034594, R01HL088521)
- National Cancer Institute (P01CA087969, UM1CA176726, P01CA055075, UM1CA186107, UM1CA167552)
- 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 risk, cardiovascular mortality, cancer mortality, all-cause mortality, beverage consumption, Health Professionals Follow-up Study, Nurses' Health Study, dietary risk factors, sugar-sweetened beverage tax
- MeSH terms
- Sugars, Artificially Sweetened Beverages, Adult, Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality, Neoplasms, Risk Factors, Sweetening Agents, United States
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