Sugar-Sweetened Beverages, Fruit Juice, and Low-Calorie Beverages, and All-Cause Mortality Risk Among Dutch Adults: The Lifelines Cohort Study Within the SWEET Project

Abstract

ObjectivesTo examine prospective associations between intakes of sugar-sweetened beverages (SSB), fruit juice, and low-calorie beverages (LCB), and all-cause mortality among Dutch adults participating in the Lifelines Cohort Study. MethodsA total of 118,439 participants aged 45 ± 13 years (60% women) were included in a prospective cohort analysis. Dietary intake at baseline was assessed using an extensive semi-quantitative food frequency questionnaire (FFQ). Uni- and multivariate Cox proportional hazard regression analyses, including substitution analyses, were performed adjusted for demographics, self-reported diseases and lifestyle, and dietary factors. The association was modelled continuously in each 1 glass (or 150 mL)/day intake increment and in four categories of each beverages intake (no intake, ≤2 glass/week, >2--<7 glass/week, and ≥1 glass/day). ResultsOf the total participants, 63% were SSB consumers, 76% were fruit juice consumers, and 56% were LCB consumers. The median intake among consumers was 0.4 [0.2–1.0] glass/day for SSB, 0.3 [0.1–0.7] glass/day for fruit juice, and 0.5 [1.2–1.1] glass/day for LCB. During a follow-up period of 8.3 [7.5–9.3] y, 2,023 (1.8%) deaths were recorded. Compared to no intake, ≥1 glass SSB/day was associated with a higher risk of mortality (HR 1.24, 95% CI 1.05, 1.46), whereas LCB intake was not associated with all-cause mortality risk. Theoretical replacement of 1 glass/day of SSB with the same amount of LCB was associated with a lower risk of all-cause mortality (HR 0.90, 95% CI 0.83, 0.98). Finally, compared to no intake, moderate fruit juice intake (≤2 glass/week and >2--<7 glass/week) was inversely associated with all-cause mortality (HR 0.80, 95% CI 0.72, 0.90 and HR 0.85, 95% CI 0.76, 0.95 respectively). ConclusionsSSB intake was associated with a higher risk of all-cause mortality in the general Dutch adult population, whereas moderate fruit juice intake showed the opposite. Replacing SSB with LCB was associated with a lower risk of all-cause mortality Funding SourcesThis EU-project under the acronym “SWEET” has received funding from the European Union’s Horizon 2020 research and innovation programme. The material presented and views expressed here are the responsibility of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.