Soft drinks: are they associated with increased mortality?

Are soft drinks associated with increased mortality? This study is trying to tell me that soft drinks, whether they are diet or sweetened by sugar are associated with higher mortality? I honestly can’t say I’m surprised. Glad I’m not investing in the Coca Cola company. I personally do not drink sodas but I do indulge on a Diet Dr Pepper every now and then. Guess I’ll be cutting that out soon. But you’re here for the data. I am omitting some of the data because I can’t analyze and cover it all. Let’s take a good look at this study. They started off by stating that sugar sweetened drinks could cause approximately 184000 deaths due to cardiovascular issues, cancer, and diabetes. To look at the numbers in Europe, where this study took place, they used the European Prospective Investigation into Cancer and Nutrition cohort that has followed up patients from the general population of 10 European countries which include Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and the UK. In America we tend to think that these countries are healthier than ours. This “EPIC” cohort, pun intended, had 521330 patients in it. They ruled out a number of patients for reasons specified in the paper and ended up with 451743 patients. The famously large Framingham heart study has been going on for 70 years now and doesn’t have anything remotely close to that many patients involved. 451743 to be exact. WOW!

They figured out if and how many soft drinks these people consumed by different methods including interviews and questionnaires. People lie. That’s a limitation of the study in my opinion but with almost half a million patients, the liars could be mitigated. They also asked many other questions, like smoking and exercise habits, in the questionnaires, etc, so this data isn’t only for soft drink consumption. They used ICD-10 codes to figure out for what reasons the 41693 patients died. The researchers did a bunch of statistical jumping jacks that I am not going to go through. I’m am honestly going to lump together the patients who were drinking both soft drinks with sugar and soft drinks without sugar for the sake of simplicity. Again, read the article for yourself.

Here are the results that I find interesting about the groups:
1. Amongst all the patients, 43.2% of patients died from cancer.
2. Women made up 76.5% of the group that drinks less than 1 glass per months vs 60.9% of the group that drinks greater than or equal to 2 glasses per day.
3. The BMI is 1 point higher in those who drink greater than or equal to 2 glasses per day (median)
4. People who drink greater than or equal to 2 glasses per day claimed to be more physically active than with 27.8% of them saying they are physically active versus 15.5% in the
5. The greater than or equal to 2 glasses per day group also ate more red meat, fewer fruits and vegetables, more coffee, and more fruit and vegetable juices. No notable difference in alcohol consumption in my humble opinion.

Let’s talk mortality
Higher all cause mortality with greater than or equal to glasses per day of soft drinks. That includes sugar sweetened and artificially sweetened. That also includes if you’re male or female.

Regarding circulatory diseases
Same thing here. Higher circulatory mortality risks for those consuming greater than or equal to 2 glasses of soft drinks per day. If you break it down between the sugar vs artificial sweetener groups, however, the sugar group was not statistically significant. I guess that can be interpreted as don’t drink the diet stuff.

Regarding Cancer
This was interesting because they only found an association in colorectal cancer deaths. I expected them to find a risk with overall cancer.

There was an association with soft drinks, both types, and risk of Parkinson disease mortality.

All in all, the researchers found that higher risks were observed when people would consume more than 125ml (that’s just half a glass!!) of diet stuff and 250ml (just one glass!!) of the not diet stuff. I wonder what they considered high fructose corn syrup to be? They were also perplexed as to why artificial sweeteners caused the increase in mortality despite being “zero calorie”. They don’t have an answer to that and are seeking more data.

As with every other study, this one has some notable limitations such as the fact that it is an observational study. There’s no other way, honestly, to be able to perform a study of this scale. They also cannot identify causality. They also only asked the people in the study only once (upon enrollment) if they consumed soft drinks. That means that patients could have changed their habits, either started consuming soft drinks or stopped. Or switched to diet or switched to regular. No way of knowing.

Overall I know the media is on a frenzy right now with this study and I thought it was pretty cool so I hope that you all gained something from it.

As always, a big hat tip to the authors!

Mullee A, Romaguera D, Pearson-Stuttard J, et al. Association between soft drink consumption and mortality in 10 European countries [published online September 3, 2019]. JAMA Intern Med.
Link to Abstract