Study authors note that additional research is necessary to confirm findings and identify biological pathways of associations between sweetened beverages and diseases of the liver.
Metabolic disorders, such as type 2 diabetes, obesity, and metabolic syndrome, are known to be risk factors for liver cancer and chronic liver disease. In an effort to identify which dietary risk factors are associated with liver cancer and chronic liver disease mortality, the authors of a study published by JAMA Network Open evaluated patient cohorts to determine whether the intake of sugar-sweetened beverages or artificially sweetened beverages was associated with higher rates of liver diseases.
Researchers selected 98,786 postmenopausal women, aged 50 to 79 years, from the Women’s Health Initiative. The study population was asked to self-report their usual intake of regular—not diet—soft drinks or fruit drinks on a scale from “never or less than once per month” to “6 or more per day,” with serving sizes from small (6 fl oz) to large (18 fl oz) during the past 3 months on a baseline food frequency questionnaire. For liver cancer and chronic liver disease mortality, person-years were calculated from the date of baseline enrollment (sugar-sweetened beverage analyses) or the date for questionnaire return at 3-year follow-up until the date of diagnosis of liver cancer, date of death, or the end of follow-up depending on which occurred first.
Further, covariates such as age, body mass index, physical activity, nonsteroidal anti-inflammatory drug use, and family history of cancer were taken into consideration during the study’s duration. Participants were excluded from the study if they had a history of cancer at baseline (except for nonmelanoma skin cancer), those missing sugar-sweetened beverage intake or covariate data, and those with implausible total energy intake (<600 kcal per day or >5000 kcal per day).
The results showed that a statistically significant association between greater sugar-sweetened beverage intake and increased risk of liver cancer and chronic disease mortality; however, there were no significant associations between artificially sweetened beverage intake with liver cancer or chronic liver disease mortality. Women who consumed 3 or fewer servings of sugar-sweetened beverages per month had a higher occurrence of liver cancer and death from chronic liver disease compared to those who consumed 1 or more sugar-sweetened beverages per day. Over a median 20.9 years of follow-up, 207 new cases of liver cancer and 148 chronic liver disease deaths were recorded.
A total of 6692 women (6.8%) consumed 1 or more servings of sugar-sweetened beverages per day, and 8506 (13.1%) consumed 1 or more artificially sweetened beverages per day. In women who consumed 1 or more sugar-sweetened beverages per day, rates of chronic liver disease mortality were 17.7 per 100,000 person-years compared to 7.1 per 100,000 person-years in women who consumed 3 or fewer per month (P value for trend <.001; multivariable-adjusted HR, 1.68 [95% CI, 1.03-2.75]; P = .04). Further, rates of chronic liver disease mortality were 19.8 per 100 000 person-years in women who consumed 1 or more soft drinks per day compared with 7.2 per 100,000 person-years in women who consumed 3 or fewer regular soft drinks per month (P value for trend <.001; multivariable-adjusted HR, 1.80 [95% CI, 1.07-3.03]; P = .03). Both fruit drinks (1 or more per day vs 3 or fewer per month, 9.6 vs 7.5 per 100 000 person-years [P value for trend = .33]; HR, 0.95 [95% CI, 0.30-3.02]; P = .93) and artificially sweetened beverage intake were not associated significantly with chronic liver disease mortality.
Limitations of the study included the lack of questions on the survey (2 questions on sugar-sweetened beverage intake and 1 on artificially sweetened beverage intake) and the lack of information on sugar content or sweetener type in beverages consumed. Additionally, chronic liver disease mortality, rather than incidence data, was used due to the unavailability of chronic liver disease registries in the United States. Additional research is necessary to confirm the study’s findings and biological pathways of these associations, the authors concluded.
Zhao L, Zhang X, Coday M, et al. Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality. JAMA. 2023;330(6):537–546. doi:10.1001/jama.2023.12618