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Association of sugar-sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US National Health and Nutrition Examination Survey

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Abstract

Purpose

Current evidence on the associations between sugar-sweetened beverage (SSB) intakes and mortality is inconsistent, whereas the evidence on artificially sweetened beverages (ASBs) was sparse. We aimed to investigate the associations of SSB and ASB intakes with mortality in a nationally representative sample of US adults.

Methods

Participants from the National Health and Nutrition Examination Survey (NHANES, 1999–2014; n = 31,402) were linked to the US mortality registry by the end of 2015. SSB and ASB intakes were collected using 24-h dietary recalls. Cox proportional hazard regression models were used to assess the associations of intakes of SSBs, ASBs, and added sugar from SSBs with mortality with adjustment for demographic, lifestyle, comorbidity, and dietary factors.

Results

After a mean follow-up of 7.9 years, 3878 deaths were identified. The multivariate-adjusted hazard ratios (95% confidence intervals) associated with each additional serving/d of SSB were 1.05 (1.01–1.09) for all-cause mortality and 1.11 (1.03–1.21) for heart disease mortality. Hazard ratios (95% confidence intervals) comparing the extreme quintiles of added sugar intakes from SSBs were 1.22 (1.05–1.42) for all-cause mortality and 1.45 (1.06–1.97) for heart disease mortality. No significant relationship was found between SSB intakes and cancer mortality or between high ASB intakes and mortality. Substituting one serving/d of SSB by an equivalent amount of ASBs, unsweetened coffees and teas, and plain water was associated with a 4–7% lower risk of all-cause mortality.

Conclusion

Higher SSB intakes were associated with higher risks of all-cause mortality and heart disease mortality. High ASB intakes were not significantly associated with mortality. ASBs, unsweetened coffees and teas, and plain water might be optional alternatives for reducing SSB intakes.

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Data availability

The National Health and Nutrition Examination Survey is an open-access resource, data are available at https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/Default.aspx.

Code availability

All analyses were performed by SAS 9.4 (SAS Institute Inc.) and STATA version 14 (StataCorp), and codes were available from the corresponding author by request.

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Funding

Dr. An Pan is supported by the National Key Research and Development Program of China (2017YFC0907504) and National Nature Science Foundation of China (81930124).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan, 430030, China

    Yan-Bo Zhang, Jun-Xiang Chen, Yi-Wen Jiang, Peng-Fei Xia & An Pan

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Contributions

YBZ designed the study, conducted the statistical analyses, and wrote the paper; JC conducted the statistical analyses and contributed to the critical review of the manuscript; YWJ and PX contributed to data interpretation and the critical review of the manuscript; AP designed the study, supervised the study process, and contributed to data interpretation and the critical review of the manuscript; and all authors read and approved the final manuscript.

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Correspondence to An Pan.

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No potential conflicts of interests were disclosed.

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The study protocol was approved by the NHANES Institutional Review Board. Institutional review board approval for this analysis was waived because of the publicly available and de-identified data.

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All participants provided written informed consent.

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Zhang, YB., Chen, JX., Jiang, YW. et al. Association of sugar-sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US National Health and Nutrition Examination Survey. Eur J Nutr 60, 1945–1955 (2021). https://doi.org/10.1007/s00394-020-02387-x

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