Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort.
Stepien M., Duarte-Salles T., Fedirko V., Trichopoulou A., Lagiou P., Bamia C., Overvad K., Tjønneland A., Hansen L., Boutron-Ruault M-C., Fagherazzi G., Severi G., Kühn T., Kaaks R., Aleksandrova K., Boeing H., Klinaki E., Palli D., Grioni S., Panico S., Tumino R., Naccarati A., Bueno-de-Mesquita HB., Peeters PH., Skeie G., Weiderpass E., Parr CL., Quirós JR., Buckland G., Molina-Montes E., Amiano P., Chirlaque M-D., Ardanaz E., Sonestedt E., Ericson U., Wennberg M., Nilsson LM., Khaw K-T., Wareham N., Bradbury KE., Ward HA., Romieu I., Jenab M.
PURPOSE: The aim of the study was to assess associations between intake of combined soft drinks (sugar sweetened and artificially sweetened) and fruit and vegetable juices and the risk of hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBC) and biliary tract cancers (GBTC) using data from the European Prospective Investigation into Cancer and Nutrition cohort of 477,206 participants from 10 European countries. METHODS: After 11.4 years of follow-up, 191 HCC, 66 IHBC and 236 GBTC cases were identified. Hazard ratios and 95% confidence intervals (HR; 95% CI) were estimated with Cox regression models with multivariable adjustment (baseline total energy intake, alcohol consumption and intake pattern, body mass index, physical activity, level of educational attainment and self-reported diabetes status). RESULTS: No risk associations were observed for IHBC or GBTC. Combined soft drinks consumption of >6 servings/week was positively associated with HCC risk: HR 1.83; 95% CI 1.11-3.02, p trend = 0.01 versus non-consumers. In sub-group analyses available for 91% of the cohort artificially sweetened soft drinks increased HCC risk by 6% per 1 serving increment (HR 1.06, 95% CI 1.03-1.09, n cases = 101); for sugar-sweetened soft drinks, this association was null (HR 1.00, 95% CI 0.95-1.06; n cases = 127, p heterogeneity = 0.07). Juice consumption was not associated with HCC risk, except at very low intakes (<1 serving/week: HR 0.60; 95% CI 0.38-0.95; p trend = 0.02 vs. non-consumers). CONCLUSIONS: Daily intake of combined soft drinks is positively associated with HCC, but a differential association between sugar and artificially sweetened cannot be discounted. This study provides some insight into possible associations of HCC with sugary drinks intake. Further exploration in other settings is required.