UC San Diego

Background: Evidence of sugar-sweetened beverage (SSB) consumption and risk of cardiovascular disease (CVD), colorectal cancer (CRC), and mortality is limited and inconsistent, meriting further study.

Methods: This dissertation uses data from the California Teachers Study, a cohort of adult women teachers and administrators (n=133,477; mean ± SD age=54.1 ± 14.8), who were followed from 1995-1996 until incident CVD (myocardial infarction [MI], revascularization, and stroke), CRC, and mortality, through December 31, 2015. SSBs intake was derived from a self-administered food frequency questionnaire. Annual linkage with state- and nationwide records ascertained end points.

Results: Over 20 years of follow-up, 8,848 incident CVD events (stroke [n=5,258], revascularization [n=2,889], and MI [n=2,677]); 1,318 incident CRC cases; and 14,143 deaths (CVD deaths [n=4,313] and cancer deaths [n=3,457]) were documented. The SSBs and incident CVD results indicated that women who consumed ≥1 serving/day of SSBs had significantly elevated risk of CVD (hazard ratio (HR) [95% confidence interval (CI)]) (1.19 [1.06, 1.34]), revascularization (1.26 [1.04, 1.54]), and stroke (1.21 [1.04, 1.41]) as compared to rare/never consumers. A 42% (1.42 [1.00, 2.01]; P trend = 0.021) and 23% (1.23 [1.05, 1.44]; P trend = 0.0002) dose-dependent higher risk of CVD was observed in women that consumed ≥1 serving/day of fruit drinks and caloric soft drinks, respectively, versus rare/never consumers. The SSBs and incident CRC findings showed that SSBs were not significantly associated with CRC risk, though a non-significant modest association was suggested. The SSBs and mortality results indicated that compared to rare/never consumers, the multivariable-adjusted HRs [95% CI] were 1.04 [0.94, 1.15] for all-cause, 0.95 [0.75, 1.20] for CVD-specific, and 1.07 [0.90, 1.26] for cancer-specific mortality, in women who consumed ≥1 serving/day of SSBs. There was a dose-dependent increased in all-cause mortality (1.30 [1.14, 1.48]; P trend = 0.002) and cancer-specific mortality (1.38 [1.13, 1.69]; P trend = 0.029) risk in women who consumed ≥1 serving/day of caloric soft drink compared to rare/never consumers.

Conclusion: Frequent consumption of SSBs, primarily caloric soft drinks, significantly increased the risk of CVD and mortality in adult women, substantiating the evidence on the unfavorable effects of excessive SSB consumption. SSBs are a modifiable dietary component and public health target that can impact preventable CVD and death.