Association Between Soft Drink Consumption and Mortality in 10 European Countries

Amy Mullee; Dora Romaguera; Jonathan Pearson-Stuttard; Vivian Viallon; Magdalena Stepien; Heinz Freisling; Guy Fagherazzi; Francesca Romana Mancini; Marie-Christine Boutron-Ruault; Tilman Kühn; Rudolf Kaaks; Heiner Boeing; Krasimira Aleksandrova; Anne Tjønneland; Jytte Halkjær; Kim Overvad; Elisabete Weiderpass; Guri Skeie; Christine L Parr; J Ramón Quirós; Antonio Agudo; Maria-Jose Sánchez; Pilar Amiano; Lluís Cirera; Eva Ardanaz; Kay-Tee Khaw; Tammy Y N Tong; Julie A Schmidt; Antonia Trichopoulou; Georgia Martimianaki; Anna Karakatsani; Domenico Palli; Claudia Agnoli; Rosario Tumino; Carlotta Sacerdote; Salvatore Panico; Bas Bueno-de-Mesquita; W M Monique Verschuren; Jolanda M A Boer; Roel Vermeulen; Stina Ramne; Emily Sonestedt; Bethany van Guelpen; Pernilla Lif Holgersson; Konstantinos K Tsilidis; Alicia K Heath; David Muller; Elio Riboli; Marc J Gunter; Neil Murphy

doi:10.1001/jamainternmed.2019.2478

Association Between Soft Drink Consumption and Mortality in 10 European Countries

Amy Mullee, Dora Romaguera, Jonathan Pearson-Stuttard, Vivian Viallon, Magdalena Stepien, Heinz Freisling, Guy Fagherazzi, Francesca Romana Mancini, Marie-Christine Boutron-Ruault, Tilman Kühn, Rudolf Kaaks, Heiner Boeing, Krasimira Aleksandrova, Anne Tjønneland, Jytte Halkjær, Kim Overvad, Elisabete Weiderpass, Guri Skeie, Christine L Parr, J Ramón QuirósAntonio Agudo, Maria-Jose Sánchez, Pilar Amiano, Lluís Cirera, Eva Ardanaz, Kay-Tee Khaw, Tammy Y N Tong, Julie A Schmidt, Antonia Trichopoulou, Georgia Martimianaki, Anna Karakatsani, Domenico Palli, Claudia Agnoli, Rosario Tumino, Carlotta Sacerdote, Salvatore Panico, Bas Bueno-de-Mesquita, W M Monique Verschuren, Jolanda M A Boer, Roel Vermeulen, Stina Ramne, Emily Sonestedt, Bethany van Guelpen, Pernilla Lif Holgersson, Konstantinos K Tsilidis, Alicia K Heath, David Muller, Elio Riboli, Marc J Gunter, Neil Murphy

School of Biological Sciences

Research output: Contribution to journal › Article › peer-review

190 Citations (Scopus)

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 < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P < .001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P < .001).

Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

Original language	English
Pages (from-to)	1479-1490
Journal	JAMA Internal Medicine
Volume	179
Issue number	11
Early online date	03 Sept 2019
DOIs	https://doi.org/10.1001/jamainternmed.2019.2478
Publication status	Early online date - 03 Sept 2019

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Mullee, A., Romaguera, D., Pearson-Stuttard, J., Viallon, V., Stepien, M., Freisling, H., Fagherazzi, G., Mancini, F. R., Boutron-Ruault, M.-C., Kühn, T., Kaaks, R., Boeing, H., Aleksandrova, K., Tjønneland, A., Halkjær, J., Overvad, K., Weiderpass, E., Skeie, G., Parr, C. L., ... Murphy, N. (2019). Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Internal Medicine, 179(11), 1479-1490. Advance online publication. https://doi.org/10.1001/jamainternmed.2019.2478

@article{0c18248941d54c76a00b5a739950944f,

title = "Association Between Soft Drink Consumption and Mortality in 10 European Countries",

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 < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P < .001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P < .001).Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.",

author = "Amy Mullee and Dora Romaguera and Jonathan Pearson-Stuttard and Vivian Viallon and Magdalena Stepien and Heinz Freisling and Guy Fagherazzi and Mancini, {Francesca Romana} and Marie-Christine Boutron-Ruault and Tilman K{\"u}hn and Rudolf Kaaks and Heiner Boeing and Krasimira Aleksandrova and Anne Tj{\o}nneland and Jytte Halkj{\ae}r and Kim Overvad and Elisabete Weiderpass and Guri Skeie and Parr, {Christine L} and Quir{\'o}s, {J Ram{\'o}n} and Antonio Agudo and Maria-Jose S{\'a}nchez and Pilar Amiano and Llu{\'i}s Cirera and Eva Ardanaz and Kay-Tee Khaw and Tong, {Tammy Y N} and Schmidt, {Julie A} and Antonia Trichopoulou and Georgia Martimianaki and Anna Karakatsani and Domenico Palli and Claudia Agnoli and Rosario Tumino and Carlotta Sacerdote and Salvatore Panico and Bas Bueno-de-Mesquita and Verschuren, {W M Monique} and Boer, {Jolanda M A} and Roel Vermeulen and Stina Ramne and Emily Sonestedt and {van Guelpen}, Bethany and Holgersson, {Pernilla Lif} and Tsilidis, {Konstantinos K} and Heath, {Alicia K} and David Muller and Elio Riboli and Gunter, {Marc J} and Neil Murphy",

year = "2019",

month = sep,

day = "3",

doi = "10.1001/jamainternmed.2019.2478",

language = "English",

volume = "179",

pages = "1479--1490",

journal = "JAMA Internal Medicine",

issn = "2168-6106",

publisher = "American Medical Association",

number = "11",

}

Mullee, A, Romaguera, D, Pearson-Stuttard, J, Viallon, V, Stepien, M, Freisling, H, Fagherazzi, G, Mancini, FR, Boutron-Ruault, M-C, Kühn, T, Kaaks, R, Boeing, H, Aleksandrova, K, Tjønneland, A, Halkjær, J, Overvad, K, Weiderpass, E, Skeie, G, Parr, CL, Quirós, JR, Agudo, A, Sánchez, M-J, Amiano, P, Cirera, L, Ardanaz, E, Khaw, K-T, Tong, TYN, Schmidt, JA, Trichopoulou, A, Martimianaki, G, Karakatsani, A, Palli, D, Agnoli, C, Tumino, R, Sacerdote, C, Panico, S, Bueno-de-Mesquita, B, Verschuren, WMM, Boer, JMA, Vermeulen, R, Ramne, S, Sonestedt, E, van Guelpen, B, Holgersson, PL, Tsilidis, KK, Heath, AK, Muller, D, Riboli, E, Gunter, MJ & Murphy, N 2019, 'Association Between Soft Drink Consumption and Mortality in 10 European Countries', JAMA Internal Medicine, vol. 179, no. 11, pp. 1479-1490. https://doi.org/10.1001/jamainternmed.2019.2478

TY - JOUR

T1 - Association Between Soft Drink Consumption and Mortality in 10 European Countries

AU - Mullee, Amy

AU - Romaguera, Dora

AU - Pearson-Stuttard, Jonathan

AU - Viallon, Vivian

AU - Stepien, Magdalena

AU - Freisling, Heinz

AU - Fagherazzi, Guy

AU - Mancini, Francesca Romana

AU - Boutron-Ruault, Marie-Christine

AU - Kühn, Tilman

AU - Kaaks, Rudolf

AU - Boeing, Heiner

AU - Aleksandrova, Krasimira

AU - Tjønneland, Anne

AU - Halkjær, Jytte

AU - Overvad, Kim

AU - Weiderpass, Elisabete

AU - Skeie, Guri

AU - Parr, Christine L

AU - Quirós, J Ramón

AU - Agudo, Antonio

AU - Sánchez, Maria-Jose

AU - Amiano, Pilar

AU - Cirera, Lluís

AU - Ardanaz, Eva

AU - Khaw, Kay-Tee

AU - Tong, Tammy Y N

AU - Schmidt, Julie A

AU - Trichopoulou, Antonia

AU - Martimianaki, Georgia

AU - Karakatsani, Anna

AU - Palli, Domenico

AU - Agnoli, Claudia

AU - Tumino, Rosario

AU - Sacerdote, Carlotta

AU - Panico, Salvatore

AU - Bueno-de-Mesquita, Bas

AU - Verschuren, W M Monique

AU - Boer, Jolanda M A

AU - Vermeulen, Roel

AU - Ramne, Stina

AU - Sonestedt, Emily

AU - van Guelpen, Bethany

AU - Holgersson, Pernilla Lif

AU - Tsilidis, Konstantinos K

AU - Heath, Alicia K

AU - Muller, David

AU - Riboli, Elio

AU - Gunter, Marc J

AU - Murphy, Neil

PY - 2019/9/3

Y1 - 2019/9/3

N2 - 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 < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P < .001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P < .001).Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

AB - 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 < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P < .001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P < .001).Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

U2 - 10.1001/jamainternmed.2019.2478

DO - 10.1001/jamainternmed.2019.2478

M3 - Article

C2 - 31479109

SN - 2168-6106

VL - 179

SP - 1479

EP - 1490

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

IS - 11

ER -

Association Between Soft Drink Consumption and Mortality in 10 European Countries

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