Soft drinks of all types linked to all-cause mortality

Author: Louise Prime

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Consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in a large European study*, published this week in JAMA Internal Medicine. The authors said their results lend support to public health campaigns that aim to limit people’s consumption of soft drinks of any type.

A multinational research team conducted a population-based cohort study to examine the association between total, sugar-sweetened, and artificially sweetened soft drink consumption and subsequent total and cause-specific mortality. They used data on 451,743 participants in the ongoing European Prospective Investigation into Cancer and Nutrition (EPIC), from Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK. They did not include participants who had reported cancer, heart disease, stroke, or diabetes at baseline; with implausible dietary intake data; or those with missing soft drink consumption or follow-up information.

During a mean follow-up of 16.4 years, 41,693 participants died. The researchers reported significantly higher all-cause mortality among people who consumed at least two glasses per day (compared with consumers of less than 1 glass per month) of total soft drinks (hazard ratio, HR 1.17), sugar-sweetened soft drinks (HR 1.08), and artificially sweetened soft drinks (HR 1.26). They also reported positive associations between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR 1.52) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR 1.59). They added that artificially sweetened, and not sugar-sweetened, soft drinks were associated with deaths from circulatory diseases; whereas for digestive disease deaths, only sugar-sweetened soft drinks were associated with higher risk.

The study authors acknowledged that its observational nature meant it could not show cause and effect, and that there might also have been residual confounding, but they said its large size helped to combat limitations.

They concluded: “In this study, the high level of consumption of total, sugar-sweetened, and  artificially sweetened soft drinks was associated with elevated risks of death from all causes. Positive associations were observed between sugar-sweetened soft drinks and digestive disease deaths as well as between artificially sweetened soft drinks and circulatory disease deaths. Further studies are needed to investigate the possible adverse health effects of artificial sweeteners.

“The results of this study are supportive of ongoing public health campaigns aimed at reducing the consumption of soft drinks.”


*Mullee A, Romaguera D, Pearson-Stuttard J, et al. Association between soft drink consumption and mortality in 10 European countries. JAMA Intern Med. Published online September 03, 2019. doi:10.1001/jamainternmed.2019.2478

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