Sugar-containing beverages and their association with risk of breast, endometrial, ovarian and colorectal cancers among Canadian women
Introduction
Recent data from the Canadian Community Health Surveys have shown a decline in the consumption of sugar containing beverages (SCBs: i.e., drinks with added sugar [also known as sugar-sweetened beverages (SSBs)] and 100 % fruit juices) among Canadians [1,2]. Nevertheless, SCBs, principally sugar-sweetened beverages, remain the main source of energy and sugar from beverages within this population [1,2]. In view of this finding, several epidemiological studies have been conducted to evaluate the associations of SCBs with metabolic health, and there is some evidence to date to suggest that high intake of SCBs, principally those containing added sugars, is positively associated with obesity [[3], [4], [5]] and obesity-related disorders such as diabetes [6], cardiovascular disease (CVD) [7,8], insulin resistance [9,10], increased levels of leptin [10] and to a lesser extent, metabolic syndrome [[11], [12], [13]].
The aforementioned metabolic perturbations are also potential risk factors for breast, endometrial, ovarian and/or colorectal cancers [[14], [15], [16]], possibly through their role in enhancing tumor cell growth and cell proliferation and through other cancer-related processes [17]. However, epidemiological evidence regarding the associations of SCBs with risk of obesity-related cancers including breast, endometrial, ovarian and colorectal cancer is sparse and inconclusive. While a few studies have observed associations of SCBs with risk of breast [18,19], endometrial (specifically Type 1) [20], and colorectal cancer [21], thus far, there is no evidence for an association of SCBs with risk of ovarian cancer [22,23].
Given the paucity of data to date, in the study reported here, we examined the associations between SCBs and risk of breast, endometrial, ovarian and/or colorectal cancers among females in the Canadian Study of Diet Lifestyle and Health (CSDLH).
Section snippets
Study population and design
A detailed description of the study design can be found elsewhere [24,25]. In brief, the CSDLH comprised 73,909 Canadian participants (34,291 males and 39,618 females) who were primarily recruited from alumni of the Universities of Alberta, Toronto and Western Ontario between 1995 and 1998 [25] (A small contingent was also recruited through the Canadian Cancer Society, mostly in 1992). All participants provided written informed consent. The study was approved by the human research ethics
Results
A total of 870, 169, 98 and 247 incident breast, endometrial, ovarian and colorectal cancer cases were diagnosed during a median follow-up of approximately 12 years.
A summary of the study population characteristics is shown in Table 1. For each cancer site, the proportion of cases with graduate-level education was slightly higher than that for the corresponding subcohort group. Cases, however, had lower median physical activity levels and median energy intake (except for breast cancer) than the
Discussion
In this study, intake of SCBs was positively associated with risk of endometrial cancer (overall and Type 1 subtype) and ovarian cancer (overall). In the fully adjusted model, fruit juice intake was also observed to be positively associated with risk of Type 1 endometrial cancer. After excluding women with a history of diabetes and CVD, we also observed that SSBs were positively associated with risk of Type 1 endometrial cancer. However, none of the beverages was associated with risk of breast
Funding
This work was supported by the Breast Cancer Research Foundation (BCRF-16-140 to T.E.R).
Authors’ contribution
RSA contributed to the conception and design, analyses and interpretation of the data, writing the manuscript and final approval of the version to be published. VAK contributed to data collection, interpretation of data, reviewing the manuscript and final approval of the manuscript. YM contributed to interpretation of the data, reviewing the manuscript and final approval of the manuscript. XX contributed to analyses and interpretation of the data, reviewing the manuscript and final approval of
CRediT authorship contribution statement
Rhonda S. Arthur: Conceptualization, Methodology, Formal analysis, Writing - original draft, Writing - review & editing. Victoria A. Kirsh: Conceptualization, Methodology, Formal analysis, Writing - review & editing. Yasmin Mossavar-Rahmani: Conceptualization, Methodology, Writing - review & editing. Xiaonan Xue: Formal analysis, Writing - review & editing. Thomas E. Rohan: Conceptualization, Methodology, Formal analysis, Writing - review & editing.
Declaration of Competing Interest
The authors report no declarations of interest.
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