Consumption of Sweet Beverages and Cancer Risk. A Systematic Review and Meta-Analysis of Observational Studies

Llaha, Fjorida; Gil-Lespinard, Mercedes; Unal, Pelin; Villasante, Izar; Castañeda, Jazmín; Zamora-Ros, Raúl

doi:10.3390/nu13020516

Cited by 57 publications

(40 citation statements)

References 102 publications

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“…Other studies did not investigate artificial sweeteners but the whole group of ASBs in millilitres or servings per day. A recent systematic review and meta-analysis of sweetened beverages and risk of cancer at different sites [40] stressed the lack of studies on ASBs and cancer risk except for pancreatic cancer, for which they found a positive, although non-significant, association. Likewise, previous analyses of the NutriNet-Sante ´cohort did not detect an association between ASBs and cancer risk [41], suggesting that measurements of ASBs might be inadequate to accurately characterise the overall dietary exposure to artificial sweeteners.…”

Section: Plos Medicinementioning

confidence: 99%

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

et al. 2022

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Background The food industry uses artificial sweeteners in a wide range of foods and beverages as alternatives to added sugars, for which deleterious effects on several chronic diseases are now well established. The safety of these food additives is debated, with conflicting findings regarding their role in the aetiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies, but robust epidemiological evidence is lacking. Thus, our objective was to investigate the associations between artificial sweetener intakes (total from all dietary sources, and most frequently consumed ones: aspartame [E951], acesulfame-K [E950], and sucralose [E955]) and cancer risk (overall and by site). Methods and findings Overall, 102,865 adults from the French population-based cohort NutriNet-Santé (2009–2021) were included (median follow-up time = 7.8 years). Dietary intakes and consumption of sweeteners were obtained by repeated 24-hour dietary records including brand names of industrial products. Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products. Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame). Limitations of this study include potential selection bias, residual confounding, and reverse causality, though sensitivity analyses were performed to address these concerns. Conclusions In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally. Trial registration ClinicalTrials.gov NCT03335644.

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Section: Plos Medicinementioning

confidence: 99%

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

et al. 2022

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“…Sugar-sweetened beverages have been proposed to increase the risk of PCa, where a meta-analysis of 27 studies reported a positive association between their consumption and PCa risk [72].…”

Section: Environmental and Occupational Exposurementioning

confidence: 99%

Epidemiology and Prevention of Prostate Cancer

Gandaglia

Leni

Bray

et al. 2021

European Urology Oncology

315

131

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Context: Worldwide, prostate cancer (PCa) represents the second most common solid tumor in men. Objective: To assess the geographical distribution of PCa, epidemiological differences, and the most relevant risk factors for the disease. Evidence acquisition: Estimated incidence, mortality, and prevalence of PCa for the year 2020 in 185 countries were derived from the IARC GLOBOCAN database. A review of English-language articles published between 2010 and 2020 was conducted using MEDLINE, EMBASE, and Scopus to identify risk factors for PCa. Evidence synthesis: In the year 2020, there were over 1 414 000 estimated new cases of PCa worldwide, with an age-standardized rate (ASR) incidence of 31 per 100 000 (lifetime cumulative risk: 3.9%). Northern Europe has the highest all-age incidence ASR (83), while the lowest ASR was in South-Central Asia (6.3). In the year 2020, there were over 375 000 estimated deaths worldwide, and the overall mortality ASR was 7.7 per 100 000, with the highest ASR in the Caribbean (28) and the lowest in South-Central Asia (3.1). Family history, hereditary syndromes, and race are the strongest risk factors for PCa. Metabolic syndrome was associated with the risk of developing PCa, high-grade disease, and adverse pathology. Diabetes and exposure to ultraviolet rays were found to be inversely associated to PCa incidence. Cigarette smoking and obesity may increase PCa-specific mortality, while regular physical activity may reduce disease progression. Although 5-alpha reductase inhibitors are known to be associated with a reduced incidence of PCa, available studies failed to show an effect on overall mortality. Conclusions: Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality. Patient summary: Prostate cancer (PCa) rates vary profoundly worldwide, with incidence and mortality rates being highest in Northern Europe and Caribbean, respectively. South-Central Asia has the lowest epidemiological burden. Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors

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“…• The sugar intake and its relationship to cancer is controversial. While few studies indicate no association, others indirectly indicate that it could impact recurrence and/or survival (29)(30)(31)(32)(33)(34)(35)…”

Section: Carbohydrate Sugar Intakementioning

confidence: 99%

IAPEN India : Nutrition Consensus Guidelines in Oncology Clinical Practice

Timmanpyati¹,

Parikh²,

Bajaj³

et al. 2021

JNUTRES

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Malnutrition is one of the most common and significant issue during the treatment of cancer. Poor nutritional management during the treatment may impede the progress in the treatment. Many international societies have nutritional recommendations published on their websites. India, being a multicultural population with varied nutritional habits and local beliefs have no cohesive evidence-based nutritional approach during and after treatment. The current guideline has been formulated jointly by oncologists, nutritionists, and multidisciplinary professionals with an aim to provide science based standard nutritional guidance to the community healthcare professionals across India. The committee referred to major international guidelines published in recent past. With intense deliberations adopted few selective recommendations which are compatible with Indian practice. Keywords: Cancer, Nutrition, Consensus guideline, nutrition in cancer, IAPEN guidelines, IAPEN cancer guidelines

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Consumption of Sweet Beverages and Cancer Risk. A Systematic Review and Meta-Analysis of Observational Studies

Cited by 57 publications

References 102 publications

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

Epidemiology and Prevention of Prostate Cancer

IAPEN India : Nutrition Consensus Guidelines in Oncology Clinical Practice

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