Consumption of sweetened beverages has been linked to several risk factors for liver cancer including diabetes. Studies investigating the role of sweetened beverage consumption and liver cancer, however, are limited. As persons with diabetes are advised against consumption of sugar, the objective of this study was to examine the role of sweetened beverage consumption and liver cancer risk by diabetes status.
Data from two U.S. cohorts: the NIH-AARP Diet and Health Study, and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial were harmonized and pooled. Hazard ratios and 95%CI were estimated using Cox proportional hazard models stratified by median follow-up time.
Among persons without diabetes, there were no statistical evidence of associations between liver cancer and consumption of sweetened beverages overall, sugar sweetened beverages (SSB), or artificially sweetened beverages (ASB). Sugar sweetened (SS) soda consumption, however, was associated with liver cancer in the first follow-up interval (HR:1.18. 95%CI: 1.03, 1.35). In contrast, among persons with diabetes, there were significant associations between liver cancer and consumption of sweetened beverages overall (HR: 1.12, 95%CI 1.01, 1.24), ASBs (HR: 1.13, 95% CI: 1.02, 1.25), soda overall (HR: 1.13, 95% CI: 1.00, 1.26) and artificially sweetened (AS) soda (HR: 1.13, 95% CI: 1.01, 1.27) in the first follow-up interval.
Increased soda consumption may be associated with risk of liver cancer. The results suggest that decreasing consumption of SS soda by persons without diabetes, and AS soda by persons with diabetes, could be associated with reduced liver cancer risk.
- • Sugar sweetened soda is associated with increased liver cancer risk among persons without diabetes.
- • Artificially sweetened soda is associated with increased liver cancer risk among persons with diabetes.
- • The risk of liver cancer was evident in the first 12 years of follow-up.
Worldwide, liver cancer is the sixth most frequently occurring cancer and the third largest contributor to cancer mortality . In the U.S., where 42,230 cases of liver cancer are predicted to occur in 2021 , a number of factors are known to increase risk. These factors include excessive alcohol consumption, hepatitis C virus (HCV), hepatitis B virus (HBV), cigarette smoking, non-alcoholic fatty liver disease, obesity, and type 2 diabetes . The combined population attributable fraction of these factors, however, is estimated at 59.5%, so 40.5% of risk remains poorly explained . It is possible that dietary factors such as sweetened beverages are linked to liver cancer, as sweetened beverage consumption has been linked to non-alcoholic fatty liver disease, obesity, and type 2 diabetes .
Beverages can be sweetened by either sugar or by artificial sweeteners such as aspartame, sucralose, and saccharin. It is unclear, however, if either sugar sweetened beverages (SSB) or artificially sweetened beverages (ASB) contribute to liver cancer risk. A recent meta-analysis of one ASB, artificially sweetened (AS) soda, and gastrointestinal cancers reported that consumption associated with a 28% increase in liver cancer risk . The literature on SSB consumption and liver cancer risk is also limited . In the U.S., where there is very high sweetened beverage consumption , only one prospective study of sweetened beverage consumption and liver cancer has been reported .
Many persons with diabetes are advised to limit SSB consumption, therefore consumption can vary widely between persons with and without diabetes . A U.S. national survey found that 34.7% of person without diabetes reported drinking sweetened beverages at least once per day, while only 22.0% of persons with diabetes reported drinking sweetened beverages at least once a day . Based on the likelihood of different sweetened beverage consumption exposure, the current study examined the relationship between sweetened beverage consumption and liver cancer risk by diabetes status.