This week JAMA published an epidemiological study of 451,743 Europeans from 10 countries which suggested there is an increased risk of myocardial infarction and ischemic stroke in persons who consume at least 1 glass of artificially sweetened soft drink per day (relative risk increase: 1.41). There was also an association with overall death rate (relative risk 1.26).
For a comparison, the risk of stroke in smokers is increased by a relative risk of about 2.34 in a prior German study (PROCAM). So, smoking increases the risk of stroke only about two and a half times more than artificially sweetened soft drinks usage may do.
The effect was robust and did not go away when factors such as BMI / obesity were taken into account, lessening the effect of any correlation of use of diet drinks in those who wish to lose weight.
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ABSTRACT
Association Between Soft Drink Consumption and Mortality in 10 European Countries
Amy Mullee, PhD; Dora Romaguera, PhD; Jonathan Pearson-Stuttard, BMBCh; et al Vivian Viallon, PhD3; Magdalena Stepien, PhD3; Heinz Freisling, PhD3; Guy Fagherazzi, PhD; Francesca Romana Mancini, PhD; Marie-Christine Boutron-Ruault, MD; Tilman Kühn, PhD; Rudolf Kaaks, PhD; Heiner Boeing, PhD; Krasimira Aleksandrova, PhD; Anne Tjønneland, MD; Jytte Halkjær, PhD; Kim Overvad, MD; Elisabete Weiderpass, MD; Guri Skeie, PhD; Christine L. Parr, PhD; J. Ramón Quirós, MD; Antonio Agudo, PhD; Maria-Jose Sánchez, MD, PhD; Pilar Amiano, MS; Lluís Cirera, MD; Eva Ardanaz, MD; Kay-Tee Khaw, MB; Tammy Y. N. Tong, PhD; Julie A. Schmidt, PhD; Antonia Trichopoulou, MD; Georgia Martimianaki, MSc; Anna Karakatsani, MD; Domenico Palli, MD; Claudia Agnoli, MSc; Rosario Tumino, MD; Carlotta Sacerdote, MD; Salvatore Panico, MD; Bas Bueno-de-Mesquita, MD7,; W. M. Monique Verschuren, PhD; Jolanda M. A. Boer, PhD; Roel Vermeulen, PhD; Stina Ramne, MSc; Emily Sonestedt, PhD; Bethany van Guelpen, MD; Pernilla Lif Holgersson, PhD; Konstantinos K. Tsilidis, PhD; Alicia K. Heath, PhD; David Muller, PhD; Elio Riboli, MD; Marc J. Gunter, PhD; Neil Murphy, PhD
JAMA Intern Med. Published online September 3, 2019. doi:10.1001/jamainternmed.2019.2478
Importance Soft drinks are frequently consumed, but whether this consumption is associated with mortality risk is unknown and has been understudied in European populations to date.
Objective To examine the association between total, sugar-sweetened, and artificially sweetened soft drink consumption and subsequent total and cause-specific mortality.
Design, Setting, and Participants This population-based cohort study involved participants (n = 451 743 of the full cohort) in the European Prospective Investigation into Cancer and Nutrition (EPIC), an ongoing, large multinational cohort of people from 10 European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom), with participants recruited between January 1, 1992, and December 31, 2000. Excluded participants were those who reported cancer, heart disease, stroke, or diabetes at baseline; those with implausible dietary intake data; and those with missing soft drink consumption or follow-up information. Data analyses were performed from February 1, 2018, to October 1, 2018.
Exposure Consumption of total, sugar-sweetened, and artificially sweetened soft drinks.
Main Outcomes and Measures Total mortality and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models adjusted for other mortality risk factors.
Results In total, 521 330 individuals were enrolled. Of this total, 451 743 (86.7%) were included in the study, with a mean (SD) age of 50.8 (9.8) years and with 321 081 women (71.1%). During a mean (range) follow-up of 16.4 (11.1 in Greece to 19.2 in France) years, 41 693 deaths occurred. Higher all-cause mortality was found among participants who consumed 2 or more glasses per day (vs consumers of <1 glass per month) of total soft drinks (hazard ratio [HR], 1.17; 95% CI, 1.11-1.22; P < .001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P = .004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P < .001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P < .001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P < .001).
Conclusions and Relevance This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.
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