Last Nail in the Coffin for Sugar-Sweetened Beverages

Now Let's Focus on the Hard Part

Alice H. Lichtenstein, DSc


Circulation. 2019;139(18):2126-2128. 

In This Article

Sugar-sweetened Beverages

The association between SSB intake and all-cause mortality is driven primarily by CVD rather than cancer. The positive associations were significant for all categories of age, body mass index, physical activity, estimation of diet quality, and types of SSB. Reporting this detailed assessment was particularly important because individuals who admit to consuming the highest amount of SSB tended to have a constellation of characteristics that covaried, raising the question of whether the effect of SSB was independent. The highest consumers of SSB tended to be younger; engage in less physical activity; be more likely to smoke; have higher rates of hypertension; be less likely to take multivitamins; have higher intakes of total energy and red and processed meat; have lower intakes of whole grains, vegetables, and alcohol; and have a higher dietary glycemic load and lower diet quality. Although each of these factors, in different ways, could have contributed to the findings of SSB intake and mortality, to the extent possible, the authors went to great lengths to limit this possibility. Although a cause-and-effect relationship cannot be definitively established, this should not detract from the general message that benefit will likely be derived from reducing the intake of SSB and that there are no signals for potential adverse effects of making this change that would lead to unanticipated consequences. The association of SSB and cancer mortality is more difficult to interpret, is attenuated or became nonsignificant after controlling for confounders, and was only significant in women. Cancers of different sites have different causes. Some, particularly endocrine cancers, have been linked to excess body fat.[7] Consistent with these data, the strongest relationship between SSB intake and cancer was for breast cancer. Body mass index tended to be higher in women reporting the highest intakes of SSB but not in men, perhaps explaining the sex differences.