Association of sugar-sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US Na
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ORIGINAL CONTRIBUTION
Association of sugar‑sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US National Health and Nutrition Examination Survey Yan‑Bo Zhang1 · Jun‑Xiang Chen1 · Yi‑Wen Jiang1 · Peng‑Fei Xia1 · An Pan1 Received: 15 June 2020 / Accepted: 10 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Current evidence on the associations between sugar-sweetened beverage (SSB) intakes and mortality is inconsistent, whereas the evidence on artificially sweetened beverages (ASBs) was sparse. We aimed to investigate the associations of SSB and ASB intakes with mortality in a nationally representative sample of US adults. Methods Participants from the National Health and Nutrition Examination Survey (NHANES, 1999–2014; n = 31,402) were linked to the US mortality registry by the end of 2015. SSB and ASB intakes were collected using 24-h dietary recalls. Cox proportional hazard regression models were used to assess the associations of intakes of SSBs, ASBs, and added sugar from SSBs with mortality with adjustment for demographic, lifestyle, comorbidity, and dietary factors. Results After a mean follow-up of 7.9 years, 3878 deaths were identified. The multivariate-adjusted hazard ratios (95% confidence intervals) associated with each additional serving/d of SSB were 1.05 (1.01–1.09) for all-cause mortality and 1.11 (1.03–1.21) for heart disease mortality. Hazard ratios (95% confidence intervals) comparing the extreme quintiles of added sugar intakes from SSBs were 1.22 (1.05–1.42) for all-cause mortality and 1.45 (1.06–1.97) for heart disease mortality. No significant relationship was found between SSB intakes and cancer mortality or between high ASB intakes and mortality. Substituting one serving/d of SSB by an equivalent amount of ASBs, unsweetened coffees and teas, and plain water was associated with a 4–7% lower risk of all-cause mortality. Conclusion Higher SSB intakes were associated with higher risks of all-cause mortality and heart disease mortality. High ASB intakes were not significantly associated with mortality. ASBs, unsweetened coffees and teas, and plain water might be optional alternatives for reducing SSB intakes. Keywords Sugar-sweetened beverage · Artificially sweetened beverage · Mortality · Heart disease · National health and nutrition examination survey
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00394-020-02387-x) contains supplementary material, which is available to authorized users. * An Pan [email protected] 1
Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan 430030, China
Sugar-sweetened beverages (SSBs) include soft drinks, fruit drinks, vitamin wate
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