Sugary drinks and cancer risk: more to diet than just sugar

Chazelas and colleagues report that sugar intake, including fruit juice, is associated with a higher incidence of cancer.1 A fundamental question is whether examining a single nutritional villain in isolation is meaningful, rather than acknowledging the need for a wide ranging, varied, and balanced diet?

Fruit juice is a valuable source of bioactive molecules with health related anti-inflammatory and anti-oxidant properties. A meta-analysis of 22 studies found that a high intake of flavonoids reduced all cause mortality (relative risk 0.74).2 Since 2003 the World Health Organization has recommended the consumption of fruit and vegetables to improve health—given that intact and juiced fruit have similar molecular compositions, fruit juice can be predicted to have health giving properties. The most extensive meta-analysis of the benefits of fruit and vegetable intake found that consumption of 100% fruit juice (not extrinsically sweetened) reduced all cause mortality (0.76) as well as the incidence of coronary heart disease (0.79) and ischaemic stroke (0.65).3

Chazelas and colleagues considered only sugar, but diet is too complex to consider only form of one nutrient. The Global Burden of Disease study found that disease was associated with diets high in sodium, low in fruit and vegetables, and low in whole grain, nuts, and seeds. The study notes that “a policy focus on the sugar and fat components of diets might have a comparatively smaller effect than that of promotion of increased uptake of vegetables, fruits, whole grains, nuts, and seeds.”4

An unintended consequence of examining only one nutrient is that it promotes the myth of good and bad foods, when we must emphasise the range and balance of the many foods that will make up a healthy diet.