Approximately 65% of adults in the United States consume sugar-sweetened beverages daily. Researchers led a study examining the associations among intake of sugar-sweetened or artificially sweetened beverages and the incidence of liver cancer and chronic liver disease mortality in a large cohort of postmenopausal women. Findings were published by Zhao et al in JAMA.
“To our knowledge, this is the first study to report an association between sugar-sweetened beverage intake and chronic liver disease mortality,” said first author Longgang Zhao, PhD, of the Brigham and Women’s Hospital Channing Division of Network Medicine. “Our findings, if confirmed, may pave the way to a public health strategy to reduce the risk of liver disease based on data from a large and geographically diverse cohort.”
Study Details
This observational study included nearly 100,000 postmenopausal women from the large, prospective Women’s Health Initiative study. Participants reported their usual soft drink and fruit drink (not including fruit juice) consumption, and then reported artificially sweetened beverage consumption after 3 years. Participants were followed for a median of more than 20 years. Researchers looked at self-reported liver cancer incidence and death due to chronic liver disease such as fibrosis, cirrhosis, or chronic hepatitis, which were further verified by medical records or the National Death Index. A total of 98,786 postmenopausal women were included in the final analyses.
Risk of Liver Cancer and Chronic Liver Disease
The 6.8% of women who consumed one or more sugar-sweetened beverages daily had an 85% higher risk of liver cancer and 68% higher risk of chronic liver disease mortality compared to those who had fewer than three sugar-sweetened beverages per month. Compared with an intake of three or fewer servings of sugar-sweetened beverages per month, those who consumed one or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100,000 person-years, P value for trend = .02, adjusted hazard ratio [HR] = 1.85, 95% confidence interval [CI] = 1.16-2.96, P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100,000 person-years, P value for trend < .001, adjusted HR = 1.68, 95% CI = 1.03–2.75, P = .04).
The authors noted that the study was observational—so causality cannot be inferred—and relied on self-reported responses about intake, sugar content, and outcomes. More studies are needed to validate this risk association and determine why sugary drinks appeared to increase risk of liver cancer and disease. Furthermore, more research is needed to elucidate the potential mechanisms involved by integrating genetics, preclinical, and experimental studies, and omics data.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
