Sugary drink consumption and risk of cancer: results from NutriNet-Santé prospective cohortBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408 (Published 10 July 2019) Cite this as: BMJ 2019;366:l2408
- Eloi Chazelas, intern1,
- Bernard Srour, epidemiologist1,
- Elisa Desmetz, intern1,
- Emmanuelle Kesse-Guyot, senior researcher1,
- Chantal Julia, assistant professor12,
- Valérie Deschamps, epidemiologist3,
- Nathalie Druesne-Pecollo, operational coordinator1,
- Pilar Galan, senior researcher1,
- Serge Hercberg, professor12,
- Paule Latino-Martel, senior researcher1,
- Mélanie Deschasaux, post-doctoral researcher1,
- Mathilde Touvier, senior researcher1
- 1Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), 74 rue Marcel Cachin F-93017 Bobigny Cedex, France
- 2Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
- 3Santé Publique France, The French Public Health Agency, Nutritional Epidemiology Surveillance Team (ESEN), Bobigny, France
- Correspondence to: B Srour (or @BernardSrour on Twitter)
- Accepted 7 May 2019
Objective To assess the associations between the consumption of sugary drinks (such as sugar sweetened beverages and 100% fruit juices), artificially sweetened beverages, and the risk of cancer.
Design Population based prospective cohort study.
Setting and participants Overall, 101 257 participants aged 18 and over (mean age 42.2, SD 14.4; median follow-up time 5.1 years) from the French NutriNet-Santé cohort (2009-2017) were included. Consumptions of sugary drinks and artificially sweetened beverages were assessed by using repeated 24 hour dietary records, which were designed to register participants’ usual consumption for 3300 different food and beverage items.
Main outcome measures Prospective associations between beverage consumption and the risk of overall, breast, prostate, and colorectal cancer were assessed by multi-adjusted Fine and Gray hazard models, accounting for competing risks. Subdistribution hazard ratios were computed.
Results The consumption of sugary drinks was significantly associated with the risk of overall cancer (n=2193 cases, subdistribution hazard ratio for a 100mL/d increase 1.18, 95% confidence interval 1.10 to 1.27, P<0.0001) and breast cancer (693, 1.22, 1.07 to 1.39, P=0.004). The consumption of artificially sweetened beverages was not associated with the risk of cancer. In specific subanalyses, the consumption of 100% fruit juice was significantly associated with the risk of overall cancer (2193, 1.12, 1.03 to 1.23, P=0.007).
Conclusions In this large prospective study, the consumption of sugary drinks was positively associated with the risk of overall cancer and breast cancer. 100% fruit juices were also positively associated with the risk of overall cancer. These results need replication in other large scale prospective studies. They suggest that sugary drinks, which are widely consumed in Western countries, might represent a modifiable risk factor for cancer prevention.
Study registration ClinicalTrials.gov NCT03335644.
Contributors: EC, BS, and MT designed the study. SH, PG, MT, CJ, and EKG conducted the study. EC performed the statistical analysis. MT and BS supervised the statistical analysis. EC drafted the manuscript. BS and MT supervised the writing. All authors contributed to the data interpretation and revised each draft for important intellectual content. All authors read and approved the final manuscript. All authors had full access to the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. MT is the guarantor. The corresponding author (BS) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: The NutriNet-Santé study was supported by the following public institutions: Ministère de la Santé, Santé Publique France, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Conservatoire National des Arts et Métiers (CNAM), and Université Paris 13. BS was funded by the French National Cancer Institute (grant number INCa_8085) and the Fondation de France. Researchers were independent from funders. Funders had no role in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study is conducted according to the Declaration of Helsinki guidelines and was approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm n°0000388FWA00005831), the Commission Nationale de l’Informatique et des Libertés (CNIL n°908450/n°909216/n°1460707), and the Consultation Committee for the Protection of Participants in Biomedical Research (C09-42 on 5 May 2010). Electronic informed consent is obtained from each participant.
Data sharing: No additional data are available.
The guarantor (MT) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
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