Association Between Sugar-Sweetened Beverage Intake and Mortality Risk in Women: The California Teachers Study

Background The evidence linking sugar-sweetened beverage (SSB) intake and mor-tality risk is conflicting, and associations between various SSB subtypes and mortality remain unclear. Objective To examine the association between baseline SSB intake, subtypes of SSB intake, and mortality risk in women. Design Prospective cohort study. Participants/setting Participants of the California Teachers Study (n = 100,314; me-dian age = 53 years) free of cardiovascular disease, cancer, and diabetes at baseline (1995-1996) were followed from 1995 to 2015. Baseline SSB intake was defined as caloric soft drinks (regular soft drinks, not diet soda), sweetened bottled waters or teas, and fruit drinks; and was derived from a self-administered food frequency questionnaire. Main outcome measure Mortality was ascertained via annual linkage with state-and nationwide mortality records and the National Death Index over 20 years. Statistical analysis Multivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% CIs for assessing associations between SSB intake and mortality. Rare/never consumers were the comparator group. Results There were a total of 14,143 deaths over 20 years (30.5% from cardiovascular disease; 29.2% from cancer). In women who consumed > 7 servings/week of SSBs at baseline (4% of participants), the multivariable-adjusted HRs were not significant for all-cause, cardiovascular disease-specific, or cancer-specific mortality. Consuming > 7 servings/week of baseline caloric soft drink was associated with a higher risk of all-cause (HR = 1.26, 95% CI 1.10 to 1.46; P for trend = 0.02) and cancer-specific (HR = 1.33, 95% CI 1.08 to 1.63; P for trend = 0.08) mortality. In secondary analyses, consuming > 1.5 c/day of baseline SSBs was associated with all-cause mortality (HR = 1.12, 95% CI 1.02 to 1.24; P for trend = 0.01). Conclusions Although the baseline frequency of total SSB intake was not significantly associated with mortality, consuming > 7 servings/week of caloric soft drinks was associated with higher risk of all-cause and cancer-specific mortality. Findings support public health efforts to reduce caloric soft drink consumption. J Acad Nutr Diet. 2022;122(2):320-333.