Suitable drinks consumption and risk of death

Relation

Malik vs, Li Y, Pan a, et al. Long -term consumption of sweetener -sweetened and artificially sweetened drinks and risk of mortality in adults in the USA. (Link away). 2139 (18): 2113-2125.

Objective

To determine whether the consumption of sweetened drinks is associated with a risk of mortality.

Draft

The relationship between the consumption of sweetener -sweetened drinks (SSBS) or artificially sweetened drinks (ASBS) was examined to determine the association with the overall mortality risk and the cause -specific mortality in 2 large cohorts. COX-proportional hazards regression was used to estimate Hazard Ratios (HRS) and 95 % confidence intervals (CIS).

Participant

Data from 37,716 men in the Health Professional's Follow-up Study (HPFS; 1986 to 2014) and 80,647 women in the Nurses' Health Study (NHS; 1980 to 2014) were analyzed to determine an association.

Study parameters rated

Drink consumption data were derived from questionnaires completed by NHS and HPFS participants. Total SSBs were defined as caffeinated colas, caffeine-free colas, other (non-cola) carbonated sugar-sweetened beverages, and non-carbonated sugar-sweetened beverages (fruit punch, sodas, or other fruit drinks). Fruit juice was not considered SSB. Artificially sweetened beverages were defined as caffeinated, decaffeinated, and noncarbonated low-calorie or diet beverages.

Causes of death were tracked to distinguish between deaths from cardiovascular disease (CVD), cancer, breast cancer, lung cancer, and colorectal cancer mortality. Potential covariates were tracked to identify possible confounders related to lifestyle factors and medical history, including age, body weight, smoking status, physical activity, medication and supplement use, disease diagnoses, and family history of chronic diseases.

Target parameter

Death from any cause during the follow-up period (28 years for HPFS and 34 years for NHS).

Key insights

During the 34-year follow-up in the NHS, 23,432 deaths (4,139 CVD and 8,318 cancer) occurred, and during the 28-year follow-up in the HPFS there were 13,004 deaths (3757 CVD and 4062 cancer). During this period, the average consumption of SSBs decreased in both cohorts. The admission of ASBs initially increased and then decreased.

Men and women with higher intakes of SSBs tended to be younger, less physically active, less likely to take a multivitamin, and more likely to smoke than those with lower intakes. Consumption of sugar-sweetened beverages was also associated with higher intakes of total energy, red and processed meat, and glycemic load. At the same time, SSB consumption was associated with lower intake of whole grains and vegetables. People who drank more ASBs were also younger, more likely to have high blood pressure and more likely to be overweight. Drinking artificially sweetened beverages was associated with a lower glycemic load.

After adapting to age and ASB consumption, the intake of SSBS in both cohorts was associated with an increased risk of overall mortality. Compared to women who consumed less than once a month, women who consumed 2 portions of SSBs per day had a 63 % higher risk of death (HR: 1.63; 95 % AI: 1.52-1.75). In men, there was a 29 % increased risk (HR: 1.29; 95 %-KI: 1.15–1.44). In men and women, HR was 52 % higher (HR: 1.52; 95 %-KI: 1.43–1.61).

After adjusting for demographic and lifestyle factors (smoking, alcohol consumption, postmenopausal hormone use). [NHS], physical activity, family history of diabetes mellitus, family history of myocardial infarction, family history of cancer, multivitamin use, ethnicity and aspirin use), the association was only slightly attenuated (HR: 1.30; 95% CI: 1.22-1.38) . Additional adjustment for baseline hypertension and hypercholesterolemia, intake of whole grains, fruits, vegetables, red and processed meat, total energy, and BMI further attenuated the association, reducing it to a 21% increase in risk (HR: 1.21; 95% CI: 1.13-1.28;PTrend <0.001).

Compared to women who consumed less than once a month, women who consumed ≥2 portions of SSBs per day had a 63 % higher risk of death.

Each portion per day - increase in the SSB was associated with a 7 % higher risk of death (HR: 1.07; 95 % AI: 1.05–1.09). The association was stronger among those in the NHS than at HPFS (PInteraction=0.02). It didn't seem to matter what type of SSB a person drank; the same 7% higher risk of death per daily serving consumed.

The risk for CVD mortality was more pronounced than for cancer mortality.

In the pooled, fully adapted analysis, those who consumed ≥ 2 portions of SSBs per day had a share of 31 % compared to occasional consumers (HR: 1.31; 95 % AI: 1.15–1.50;PTrend <0.0001) Higher risk of death from cardiovascular diseases. The estimates were higher in the NHS than in the HPFS, but no interaction with the gender was observed (PInteraction = 0.70). Each portion of SSBs per day was associated with a 10 % higher risk of cardiovascular death (HR: 1.10; 95 % AI: 1.06–1.14).

In women there was a positive relationship between taking SSB and a 34 % increased risk of breast cancer mortality (HR: 1.34; 95 % AI: 1.00–1.80;PTrend = 0.02), the highest compared to the lowest consumers.

The ASBs seem to have a much lower influence. In the highest income category of the NHS, taking ASBs was positive with the risk of overall mortality and cardiovascular mortality: 2 or more portions per day were associated with a 10% increase in risk for the overall mortality and 15% for cardiovascular mortality. Although the risk of lower consumption tended to be steadily higher, the data did not achieve statistical significance.

After taking the occurrence of intermediary diseases (hypertension, hypercholesterolemia, type 2-diabetes mellitus, KHK and stroke) during the follow-up, the connection between ASSBs and the overall mortality in the NHS was no longer significant (HR in comparison of extreme categories: 1.00; 95% KI: 0.94-1.06).

Use of ASBs was not associated with cancer mortality in any cohort. In the NHS, there was a positive association between ASB and all-cause and CVD mortality at high intake levels (≥4 servings per day), with a 30% increase in the risk of all-cause mortality and a 43% increase in CVD mortality. Again, this was only seen in the NHS data; no associations were observed for HPFS.

Practice implications

We should first point out that some of the biggest names of the Harvard Channing School of Public Health are among the authors of this article. While the association does not show any causality, the associations between SSBs and mortality found in this study are probably real; Therefore, these results deserve some attention. According to this study, the consumption of moderate quantities of sweetened drinks (at 2 per day) and higher amounts of artificially sweetened drinks (4 per day) were associated with poor results.

Current government dietary advice suggests that added sugars should make up no more than 10% of total energy in the diet.¹Among young adults, SSBs contribute 9.3% of daily calories in men and 8.2% in women.²Sweetened drinks alone exceed the recommended overall sugar intake. The situation could be worse worldwide than in the United States.³

The results of this study are of particular relevance and current. In April 2019, the American Academy of Pediatrics approved a number of guidelines for containing sugar consumption in children, including the controversial guideline for taxing SSB.⁴Children and adolescents in the United States consume, on average, about 150 calories per day from SSBs, which equates to about 12 ounces per day.⁵

In November 2014, Berkeley, California became the first place in the United States to approve a tax on SSBs. The tax came into effect on January 1, 2015.⁶Other cities have copied Berkeley's example. It appears that imposing these taxes reduces consumption. One in the April 2019 issue ofAmerican Journal of Public Healthreports a significant 52% reduction in sugar-sweetened soda consumption in Berkeley after the law went into effect.⁷

The National Bureau of Economic Research reports that the soda tax in Philadelphia was associated with a 10.4-fold reduction per month in the frequency of regular soda consumption among adults.⁸On the other hand, a close examination of the sales documents suggests that the response was more complicated. Unpublished research suggests that while soda sales fell within city limits, they increased outside the tax area—people were simply buying soda in the suburbs. After the calculation, consumption may have only decreased by 20%.⁹

The soda industry is dissatisfied with measures limiting consumption of its products and is funding lobbying efforts to prevent the passage of these soda tax laws.¹⁰

Four cities in California now have soda taxes. The beverage industry in California has successfully stopped all new laws that could restrict their sale and prompted the legislator to adopt a 12-year moratorium for further soda taxes.¹¹

Boulder, Colorado, introduced a soda tax of 2 cents per ounce in 2016. By August 2018, the city was on its way to taking $ 5.8 million. Boulder's challenge was what he should do with the millions of dollars of income. The Colorado's Bill of Rights (Tabor change in the state constitution) requires the city to ask the voters whether they can keep the additional money.¹²

This study provides the most comprehensive data to quantify the risks of sugar -sweetened drinks for public health. The results indicate that reducing the consumption of sugar -containing drinks could literally be a question of life and death.