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期刊来源：JAMA

文献发表时间：2023-08-08

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2807987

关键点内容如下：

问题

摄入更多的含糖饮料是否与更高的肝癌或慢性肝病死亡率风险相关？

调查结果

在98786名绝经后妇女中，随访时间中位数为20.9年，与每月饮用3份或更少含糖饮料的妇女相比，每天饮用1份或更多含糖饮料的妇女患肝癌的比率显著更高，（每年18.0 vs 10.3/10万人；调整后的风险比[HR]为1.85）和慢性肝病死亡率（每年17.7 vs 7.1/10万人；调整后的HR，1.68）。

意义

与每月饮用3杯或更少的含糖饮料相比，每天饮用1杯或更多的含糖饮料与肝癌和慢性肝病死亡的发病率显著升高相关。

摘要内容如下：

重要性

大约65%的美国成年人每天饮用含糖饮料。

目标

研究含糖饮料、人工加糖饮料的摄入与肝癌发病率和慢性肝病死亡率之间的关系。

研究设计和参与者

从1993年到1998年，在美国的40个临床中心，98786名年龄在50到79岁的绝经后妇女参加了妇女健康倡议，并随访至2020年3月1日。

暴露因素

根据基线时的食物频率问卷评估含糖饮料的摄入量，并将其定义为常规软饮料和果汁饮料（不包括果汁）的总和。在3年的随访中测量了人工加糖饮料的摄入量。

主要结果和措施

主要转归是（1）肝癌发病率，（2）慢性肝病死亡率，定义为非酒精性脂肪性肝病、肝纤维化、肝硬化、酒精性肝病和慢性肝炎引起的死亡。使用Cox比例风险回归模型估计肝癌发病率和慢性肝病死亡率的多变量风险比（HR）和95%CI，调整包括人口统计学和生活方式因素在内的潜在混杂因素。

次要结果

在中位数为20.9年的随访期间，207名女性患上了肝癌，148名死于慢性肝病。基线时，6.8%的女性每天饮用1份或更多份含糖饮料，13.1%的女性在3年随访时每天饮用1份或更多份人工加糖饮料。与每月摄入3份或更少份含糖饮料的人相比，每天摄入1份或更多份含糖饮料的人患肝癌的风险显著更高（每10万人年18.0比10.3[趋势P值=0.02]；校正HR，1.85[95%CI，1.16-2.96]；P=0.01）和慢性肝病死亡率（17.7 vs 7.1/10万人-年[趋势P值.001]；校正HR，1.68[95%CI，1.03-2.75]；P=.04）。与每月摄入3种或更少人工甜味饮料相比，每天摄入1种或更多人工甜味饮料的个体，其肝癌发病率并未显著增加（11.8比10.2/10万人-年[趋势P值=0.70]；校正HR，1.17[95%CI，0.70-1.94]；P=0.55）或慢性肝病死亡率（7.1 vs 5.3/10万人-年[趋势P值=0.32]；校正HR，0.95[95%CI，0.49-1.84]；P=.88）。

结论和相关性

在绝经后妇女中，与每月饮用3份或更少份含糖饮料的妇女相比，每天饮用1份或更多份含糖饮料的妇女患肝癌和死于慢性肝病的几率更高。未来的研究应该证实这些发现，并确定这些关联的生物学途径。

英文原文如下：

Key Points

Question  Is greater intake of sugar-sweetened beverages associated with greater risk of liver cancer or chronic liver disease mortality?

Findings  In 98 786 postmenopausal women followed up for a median of 20.9 years, compared with consuming 3 servings or less of sugar-sweetened beverages per month, women consuming 1 or more servings per day had significantly higher rates of liver cancer (18.0 vs 10.3 per 100 000 person-years; adjusted hazard ratio [HR], 1.85) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years; adjusted HR, 1.68).

Meaning  Compared with 3 or fewer sugar-sweetened beverages per month, consuming 1 or more sugar-sweetened beverages per day was associated with a significantly higher incidence of liver cancer and death from chronic liver diseases.

Abstract

Importance  Approximately 65% of adults in the US consume sugar-sweetened beverages daily.

Objective  To study the associations between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality.

Design, Setting, and Participants  A prospective cohort with 98 786 postmenopausal women aged 50 to 79 years enrolled in the Women’s Health Initiative from 1993 to 1998 at 40 clinical centers in the US and were followed up to March 1, 2020.

Exposures  Sugar-sweetened beverage intake was assessed based on a food frequency questionnaire administered at baseline and defined as the sum of regular soft drinks and fruit drinks (not including fruit juice); artificially sweetened beverage intake was measured at 3-year follow-up.

Main Outcomes and Measures  The primary outcomes were (1) liver cancer incidence, and (2) mortality due to chronic liver disease, defined as death from nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence and for chronic liver disease mortality, adjusting for potential confounders including demographics and lifestyle factors.

Results  During a median follow-up of 20.9 years, 207 women developed liver cancer and 148 died from chronic liver disease. At baseline, 6.8% of women consumed 1 or more sugar-sweetened beverage servings per day, and 13.1% consumed 1 or more artificially sweetened beverage servings per day at 3-year follow-up. Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100 000 person-years [P value for trend = .02]; adjusted HR, 1.85 [95% CI, 1.16-2.96]; P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years [P value for trend <.001]; adjusted HR, 1.68 [95% CI, 1.03-2.75]; P = .04). Compared with intake of 3 or fewer artificially sweetened beverages per month, individuals who consumed 1 or more artificially sweetened beverages per day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100 000 person-years [P value for trend = .70]; adjusted HR, 1.17 [95% CI, 0.70-1.94]; P = .55) or chronic liver disease mortality (7.1 vs 5.3 per 100 000 person-years [P value for trend = .32]; adjusted HR, 0.95 [95% CI, 0.49-1.84]; P = .88).

Conclusions and Relevance  In postmenopausal women, compared with consuming 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more sugar-sweetened beverages per day had a higher incidence of liver cancer and death from chronic liver disease. Future studies should confirm these findings and identify the biological pathways of these associations.