Association Between Sugar-Sweetened Beverage Intake and Liver Cancer Risk in the Women’s Health Initiative
Year: 2022
Type: article
Study design: Observational Study
Abstract: Intake of sugar-sweetened beverage (SSB), a postulated risk factor for obesity, diabetes, and cardiovascular disease, may drive insulin resistance and inflammation which are strongly implicated in liver carcinogenesis. However, evidence on the association between SSB intake and liver cancer is scarce. We hypothesized that higher SSB intake would be associated with a greater risk of liver cancer. We included 90,504 women aged 50–79 years from the Women's Health Initiative Observational Study and Clinical Trials excluding Dietary Modification Trial participants. SSB intake was defined as the sum of soft drinks and fruit drinks (1 serving = one 12 fl. oz can or 355 ml), which was assessed by a validated food frequency questionnaire administered at baseline between 1993 and 1998. Incident liver cancers were reported by self-administered questionnaires and further confirmed by medical record review. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for age, race and ethnicity, education, alcohol intake, smoking status, body mass index, non-steroidal anti-inflammatory drug use, physical activity, total caloric intake, and history of diabetes. After a median of 18.7 years follow-up, 205 women had confirmed liver cancer. Approximately 7.3% of women consumed ≥ 1 serving/day of SSB. Higher SSB intake was associated with a 78% greater risk of liver cancer (HR ≥1/day vs never to < 3/month = 1.78, 95%CI = 1.09–2.95, P linear trend = 0.007) as compared to intake of < 3 servings/month. Non-statistically significant positive associations with liver cancer were observed for fruit drinks (HR ≥1/day vs never to < 3/month = 1.55, 95%CI = 0.88–2.75) and soft drinks (HR ≥1/day vs never to < 3/month = 1.73, 95%CI = 0.76–3.94). Results were similar after further adjustment for coffee/tea intake, or history of liver diseases, or when liver cancer cases diagnosed within the first 2 years of follow-up or those with history of diabetes were excluded. Our findings suggest SSB as a potential modifiable risk factor for liver cancer in postmenopausal women. Studies in men and diverse populations are needed to examine these associations more comprehensively. The WHI study is funded by the National Institute of Health.
Authors: Longgang Zhao, Mace Coday, David Garcia, Xinyi Li, Melissa Lopez-Pentecost, JoAnn Manson, Katherine McGlynn, Yasmin Mossavar-Rahmani, Michelle Naughton, Nazmus Saquib, Howard Sesso, Aladdin Shadyab, Michael Simon, Linda Snetselaar, Fred Tabung, Lesley Tinker, Deirdre Tobias, Trang VoPham, Xuehong Zhang
Institutions: University of South Carolina, University of Tennessee Health Science Center, University of Arizona, Harvard University, Brigham and Women's Hospital, National Cancer Institute, Albert Einstein College of Medicine, The Ohio State University, Sulaiman Al Rajhi Colleges, University of California System, The Barbara Ann Karmanos Cancer Institute, University of Iowa, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Fred Hutch Cancer Center, University of Washington
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,750
OpenAlex ID: W4282833985