Magdalena Stepien1, Talita Duarte-Salles1, Veronika Fedirko1,2, Antonia Trichopoulou3,4, Pagona Lagiou4,5, Christina Bamia4, Kim Overvad6, Anne Tjønneland7, Louise Hansen7, Marie-Christine Boutron-Ruault8,9,10, Guy Fagherazzi8,9,10, Gianluca Severi11,12, Tilman Kühn13, Rudolf Kaaks13, Krasimira Aleksandrova14, Heiner Boeing14, Eleni Klinaki3, Domenico Palli15, Sara Grioni16, Salvatore Panico17, Rosario Tumino18, Alessio Naccarati19, H Bas Bueno-de-Mesquita20,21,22, Petra H Peeters23, Guri Skeie24, Elisabete Weiderpass24,25,26,27, Christine L Parr28, José Ramón Quirós29, Genevieve Buckland30, Esther Molina-Montes31, Pilar Amiano32,33, Maria-Dolores Chirlaque31,33, Eva Ardanaz33,34, Emily Sonestedt35, Ulrika Ericson36, Maria Wennberg37, Lena Maria Nilsson37, Kay-Tee Khaw38, Nick Wareham39, Kathryn E Bradbury40, Heather A Ward41, Isabelle Romieu1, Mazda Jenab42. 1. Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France. 2. Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 3. Hellenic Health Foundation, Athens, Greece. 4. Department of Hygiene, Epidemiology, Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece. 5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. 6. Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark. 7. Danish Cancer Society Research Center, Copenhagen, Denmark. 8. INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, 94805, Villejuif, France. 9. University Paris Sud, UMRS 1018, 94805, Villejuif, France. 10. Institut Gustave Roussy, 94805, Villejuif, France. 11. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, 3053, Australia. 12. Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, 3010, Australia. 13. Department of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany. 14. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany. 15. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy. 16. Epidemiology and Prevention Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy. 17. Dipartamento di Medicina Clinicae Chirurgias, Federico II University, Naples, Italy. 18. Cancer Registry and Histopathology Unit, "Civile M.P. Arezzo" Hospital, Ragusa, Italy. 19. Molecular and Genetic Epidemiology Unit, Human Genetics Foundation (HuGeF), Torino, Italy. 20. National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. 21. Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands. 22. The School of Public Health, Imperial College London, London, UK. 23. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 24. Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway. 25. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 26. Department of Research, Cancer Registry of Norway, Oslo, Norway. 27. Samfundet Folkhälsan, Helsinki, Finland. 28. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. 29. Public Health Directorate, Asturias, Spain. 30. Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain. 31. Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain. 32. Public Health Division of Gipuzkoa, Health Department of Basque Region, BioDonostia Research Institute, San Sebastian, Spain. 33. CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain. 34. Navarre Public Health Institute, Pamplona, Spain. 35. Department of Clinical Sciences - Malmö, Lund University, Malmö, Sweden. 36. Diabetes and Cardiovascular Disease, Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. 37. Public Health and Clinical Medicine, Nutritional Research, and Arctic Research Center, Umeå University, Umeå, Sweden. 38. School of Clinical Medicine, Clinical Gerontology Unit, University of Cambridge, Cambridge, UK. 39. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. 40. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 41. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK. 42. Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France. jenabm@iarc.fr.
Abstract
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.
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.
Entities:
Keywords:
Biliary tract cancers; Fruit and vegetable juice; Hepatocellular carcinoma; Prospective cohort; Soft drink
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