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The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study.
BMC Med. 2020 04 24; 18(1):97.BM

Abstract

BACKGROUND

Recent efforts to address the obesity epidemic have focused on sugar consumption, especially sugar-sweetened beverages. However, sugar takes many forms, is only one contributor to overall energy consumption and is correlated with other health-related lifestyle factors. The objective was to investigate the associations with all-cause mortality of sugar- and artificially sweetened beverages and naturally sweet juices.

METHODS

Setting: UK Biobank, UK. Participants joined the UK Biobank study from 2006 to 2010 and were followed up until 2016; 198,285 men and women aged 40-69 years were eligible for this study (40% of the UK Biobank), of whom 3166 (1.6%) died over a mean of 7 years follow-up.

DESIGN

prospective population-based cohort study. Exposure variables: dietary consumption of sugar-sweetened beverages, artificially sweetened beverages, naturally sweet juices (100% fruit/vegetable juices) and total sugar intake, self-reported via 24-h dietary assessment tool completed between 2009 and 2012.

MAIN OUTCOME

all-cause mortality. Cox regression analyses were used to study the association between the daily intake of the above beverages and all-cause mortality. Models were adjusted for sociodemographic, economic, lifestyle and dietary confounders.

RESULTS

Total energy intake, total sugar intake and percentage of energy derived from sugar were comparable among participants who consumed > 2/day sugar-sweetened beverages and > 2/day fruit/vegetable juices (10,221 kJ/day versus 10,381 kJ/day; 183 g versus 190 g; 30.6% versus 31.0%). All-cause mortality was associated with total sugar intake (highest quintile adj. HR 1.28, 95% CI 1.06-1.55) and intake of sugar-sweetened beverages (> 2/day adj. HR 1.84, 95% CI 1.42-2.37) and remained so in sensitivity analyses. An association between artificially sweetened beverage intake and mortality did not persist after excluding deaths in the first 2 years of follow-up (landmark analysis) nor after excluding participants with recent weight loss. Furthermore, the inverse association between fruit/vegetable juice intake and mortality did not persist after additional adjustment for a diet quality score.

CONCLUSIONS

Higher mortality is associated with sugar-sweetened beverages specifically. The lack of an adverse association with fruit/vegetable juices suggests that source of sugar may be important and the association with artificially sweetened beverage may reflect reverse causation.

Authors+Show Affiliations

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK.Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK.Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK.Health Research Institute, University of Limerick, Limerick, Ireland.Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK. Jill.pell@glasgow.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32326961

Citation

Anderson, Jana J., et al. "The Associations of Sugar-sweetened, Artificially Sweetened and Naturally Sweet Juices With All-cause Mortality in 198,285 UK Biobank Participants: a Prospective Cohort Study." BMC Medicine, vol. 18, no. 1, 2020, p. 97.
Anderson JJ, Gray SR, Welsh P, et al. The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study. BMC Med. 2020;18(1):97.
Anderson, J. J., Gray, S. R., Welsh, P., Mackay, D. F., Celis-Morales, C. A., Lyall, D. M., Forbes, J., Sattar, N., Gill, J. M. R., & Pell, J. P. (2020). The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study. BMC Medicine, 18(1), 97. https://doi.org/10.1186/s12916-020-01554-5
Anderson JJ, et al. The Associations of Sugar-sweetened, Artificially Sweetened and Naturally Sweet Juices With All-cause Mortality in 198,285 UK Biobank Participants: a Prospective Cohort Study. BMC Med. 2020 04 24;18(1):97. PubMed PMID: 32326961.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198,285 UK Biobank participants: a prospective cohort study. AU - Anderson,Jana J, AU - Gray,Stuart R, AU - Welsh,Paul, AU - Mackay,Daniel F, AU - Celis-Morales,Carlos A, AU - Lyall,Donald M, AU - Forbes,John, AU - Sattar,Naveed, AU - Gill,Jason M R, AU - Pell,Jill P, Y1 - 2020/04/24/ PY - 2019/09/11/received PY - 2020/03/10/accepted PY - 2020/4/25/entrez PY - 2020/4/25/pubmed PY - 2020/12/17/medline KW - Diet KW - Fruit juice KW - Mortality KW - Sugar KW - UK Biobank SP - 97 EP - 97 JF - BMC medicine JO - BMC Med VL - 18 IS - 1 N2 - BACKGROUND: Recent efforts to address the obesity epidemic have focused on sugar consumption, especially sugar-sweetened beverages. However, sugar takes many forms, is only one contributor to overall energy consumption and is correlated with other health-related lifestyle factors. The objective was to investigate the associations with all-cause mortality of sugar- and artificially sweetened beverages and naturally sweet juices. METHODS: Setting: UK Biobank, UK. Participants joined the UK Biobank study from 2006 to 2010 and were followed up until 2016; 198,285 men and women aged 40-69 years were eligible for this study (40% of the UK Biobank), of whom 3166 (1.6%) died over a mean of 7 years follow-up. DESIGN: prospective population-based cohort study. Exposure variables: dietary consumption of sugar-sweetened beverages, artificially sweetened beverages, naturally sweet juices (100% fruit/vegetable juices) and total sugar intake, self-reported via 24-h dietary assessment tool completed between 2009 and 2012. MAIN OUTCOME: all-cause mortality. Cox regression analyses were used to study the association between the daily intake of the above beverages and all-cause mortality. Models were adjusted for sociodemographic, economic, lifestyle and dietary confounders. RESULTS: Total energy intake, total sugar intake and percentage of energy derived from sugar were comparable among participants who consumed > 2/day sugar-sweetened beverages and > 2/day fruit/vegetable juices (10,221 kJ/day versus 10,381 kJ/day; 183 g versus 190 g; 30.6% versus 31.0%). All-cause mortality was associated with total sugar intake (highest quintile adj. HR 1.28, 95% CI 1.06-1.55) and intake of sugar-sweetened beverages (> 2/day adj. HR 1.84, 95% CI 1.42-2.37) and remained so in sensitivity analyses. An association between artificially sweetened beverage intake and mortality did not persist after excluding deaths in the first 2 years of follow-up (landmark analysis) nor after excluding participants with recent weight loss. Furthermore, the inverse association between fruit/vegetable juice intake and mortality did not persist after additional adjustment for a diet quality score. CONCLUSIONS: Higher mortality is associated with sugar-sweetened beverages specifically. The lack of an adverse association with fruit/vegetable juices suggests that source of sugar may be important and the association with artificially sweetened beverage may reflect reverse causation. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/32326961/The_associations_of_sugar_sweetened_artificially_sweetened_and_naturally_sweet_juices_with_all_cause_mortality_in_198285_UK_Biobank_participants:_a_prospective_cohort_study_ L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01554-5 DB - PRIME DP - Unbound Medicine ER -