European Journal of Nutrition

, Volume 55, Issue 1, pp 7–20 | Cite as

Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort

  • Magdalena Stepien
  • Talita Duarte-Salles
  • Veronika Fedirko
  • Antonia Trichopoulou
  • Pagona Lagiou
  • Christina Bamia
  • Kim Overvad
  • Anne Tjønneland
  • Louise Hansen
  • Marie-Christine Boutron-Ruault
  • Guy Fagherazzi
  • Gianluca Severi
  • Tilman Kühn
  • Rudolf Kaaks
  • Krasimira Aleksandrova
  • Heiner Boeing
  • Eleni Klinaki
  • Domenico Palli
  • Sara Grioni
  • Salvatore Panico
  • Rosario Tumino
  • Alessio Naccarati
  • H. Bas Bueno-de-Mesquita
  • Petra H. Peeters
  • Guri Skeie
  • Elisabete Weiderpass
  • Christine L. Parr
  • José Ramón Quirós
  • Genevieve Buckland
  • Esther Molina-Montes
  • Pilar Amiano
  • Maria-Dolores Chirlaque
  • Eva Ardanaz
  • Emily Sonestedt
  • Ulrika Ericson
  • Maria Wennberg
  • Lena Maria Nilsson
  • Kay-Tee Khaw
  • Nick Wareham
  • Kathryn E. Bradbury
  • Heather A. Ward
  • Isabelle Romieu
  • Mazda Jenab
Original Contribution

Abstract

Purpose

The aim of the study was to assess associations between intake of combined soft drinks (sugar sweetened and artificially sweetened) and fruit and vegetable juices and the risk of hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBC) and biliary tract cancers (GBTC) using data from the European Prospective Investigation into Cancer and Nutrition cohort of 477,206 participants from 10 European countries.

Methods

After 11.4 years of follow-up, 191 HCC, 66 IHBC and 236 GBTC cases were identified. Hazard ratios and 95 % confidence intervals (HR; 95 % CI) were estimated with Cox regression models with multivariable adjustment (baseline total energy intake, alcohol consumption and intake pattern, body mass index, physical activity, level of educational attainment and self-reported diabetes status).

Results

No risk associations were observed for IHBC or GBTC. Combined soft drinks consumption of >6 servings/week was positively associated with HCC risk: HR 1.83; 95 % CI 1.11–3.02, ptrend = 0.01 versus non-consumers. In sub-group analyses available for 91 % of the cohort artificially sweetened soft drinks increased HCC risk by 6 % per 1 serving increment (HR 1.06, 95 % CI 1.03–1.09, ncases = 101); for sugar-sweetened soft drinks, this association was null (HR 1.00, 95 % CI 0.95–1.06; ncases = 127, pheterogeneity = 0.07). Juice consumption was not associated with HCC risk, except at very low intakes (<1 serving/week: HR 0.60; 95 % CI 0.38–0.95; ptrend = 0.02 vs. non-consumers).

Conclusions

Daily intake of combined soft drinks is positively associated with HCC, but a differential association between sugar and artificially sweetened cannot be discounted. This study provides some insight into possible associations of HCC with sugary drinks intake. Further exploration in other settings is required.

Keywords

Hepatocellular carcinoma Biliary tract cancers Soft drink Fruit and vegetable juice Prospective cohort 

Abbreviations

HCC

Hepatocellular carcinoma

IHBC

Intrahepatic bile duct

HBV

Hepatitis B

HCV

Hepatitis C

T2D

Type 2 diabetes

NAFLD

Non-alcoholic fatty liver disease

GBTC

Biliary tract cancer

EBD

Extrahepatic bile duct cancer

GB

Gallbladder

AmpV

Ampulla of Vater

EPIC

European Prospective Investigation into Cancer and Nutrition

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

GGT

Gamma-glutamyl tranferase

AP

Liver-specific alkaline phosphatase

BMI

Body mass index

Supplementary material

394_2014_818_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Magdalena Stepien
    • 1
  • Talita Duarte-Salles
    • 1
  • Veronika Fedirko
    • 1
    • 2
  • Antonia Trichopoulou
    • 3
    • 4
  • Pagona Lagiou
    • 4
    • 5
  • Christina Bamia
    • 4
  • Kim Overvad
    • 6
  • Anne Tjønneland
    • 7
  • Louise Hansen
    • 7
  • Marie-Christine Boutron-Ruault
    • 8
    • 9
    • 10
  • Guy Fagherazzi
    • 8
    • 9
    • 10
  • Gianluca Severi
    • 11
    • 12
  • Tilman Kühn
    • 13
  • Rudolf Kaaks
    • 13
  • Krasimira Aleksandrova
    • 14
  • Heiner Boeing
    • 14
  • Eleni Klinaki
    • 3
  • Domenico Palli
    • 15
  • Sara Grioni
    • 16
  • Salvatore Panico
    • 17
  • Rosario Tumino
    • 18
  • Alessio Naccarati
    • 19
  • H. Bas Bueno-de-Mesquita
    • 20
    • 21
    • 22
  • Petra H. Peeters
    • 23
  • Guri Skeie
    • 24
  • Elisabete Weiderpass
    • 24
    • 25
    • 26
    • 27
  • Christine L. Parr
    • 28
  • José Ramón Quirós
    • 29
  • Genevieve Buckland
    • 30
  • Esther Molina-Montes
    • 31
  • Pilar Amiano
    • 32
    • 33
  • Maria-Dolores Chirlaque
    • 31
    • 33
  • Eva Ardanaz
    • 33
    • 34
  • Emily Sonestedt
    • 35
  • Ulrika Ericson
    • 36
  • Maria Wennberg
    • 37
  • Lena Maria Nilsson
    • 37
  • Kay-Tee Khaw
    • 38
  • Nick Wareham
    • 39
  • Kathryn E. Bradbury
    • 40
  • Heather A. Ward
    • 41
  • Isabelle Romieu
    • 1
  • Mazda Jenab
    • 1
  1. 1.Section of Nutrition and MetabolismInternational Agency for Research on Cancer (IARC-WHO)LyonFrance
  2. 2.Rollins School of Public Health, Winship Cancer InstituteEmory UniversityAtlantaUSA
  3. 3.Hellenic Health FoundationAthensGreece
  4. 4.Department of Hygiene, Epidemiology, Medical Statistics, WHO Collaborating Center for Food and Nutrition PoliciesUniversity of Athens Medical SchoolAthensGreece
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  6. 6.Section for Epidemiology, Department of Public HealthAarhus UniversityAarhusDenmark
  7. 7.Danish Cancer Society Research CenterCopenhagenDenmark
  8. 8.INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018Nutrition, Hormones and Women’s Health TeamVillejuifFrance
  9. 9.University Paris Sud, UMRS 1018VillejuifFrance
  10. 10.Institut Gustave RoussyVillejuifFrance
  11. 11.Cancer Epidemiology CentreCancer Council VictoriaMelbourneAustralia
  12. 12.Centre for Molecular, Environmental, Genetic, and Analytic EpidemiologyThe University of MelbourneMelbourneAustralia
  13. 13.Department of Cancer EpidemiologyGerman Cancer Research CentreHeidelbergGermany
  14. 14.Department of EpidemiologyGerman Institute of Human Nutrition, Potsdam-RehbrueckeNuthetalGermany
  15. 15.Molecular and Nutritional Epidemiology UnitCancer Research and Prevention Institute – ISPOFlorenceItaly
  16. 16.Epidemiology and Prevention UnitFondazione IRCCS, Istituto Nazionale dei TumoriMilanItaly
  17. 17.Dipartamento di Medicina Clinicae ChirurgiasFederico II UniversityNaplesItaly
  18. 18.Cancer Registry and Histopathology Unit“Civile M.P. Arezzo” HospitalRagusaItaly
  19. 19.Molecular and Genetic Epidemiology UnitHuman Genetics Foundation (HuGeF)TorinoItaly
  20. 20.National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
  21. 21.Department of Gastroenterology and HepatologyUniversity Medical CentreUtrechtThe Netherlands
  22. 22.The School of Public HealthImperial College LondonLondonUK
  23. 23.Department of Epidemiology, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  24. 24.Department of Community Medicine, Faculty of Health SciencesUniversity of Tromso, The Arctic University of NorwayTromsøNorway
  25. 25.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  26. 26.Department of ResearchCancer Registry of NorwayOsloNorway
  27. 27.Samfundet FolkhälsanHelsinkiFinland
  28. 28.Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway
  29. 29.Public Health DirectorateAsturiasSpain
  30. 30.Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research ProgrammeCatalan Institute of Oncology (ICO-IDIBELL)BarcelonaSpain
  31. 31.Department of EpidemiologyMurcia Regional Health AuthorityMurciaSpain
  32. 32.Public Health Division of Gipuzkoa, Health Department of Basque RegionBioDonostia Research InstituteSan SebastianSpain
  33. 33.CIBER Epidemiology and Public Health CIBERESPMadridSpain
  34. 34.Navarre Public Health InstitutePamplonaSpain
  35. 35.Department of Clinical Sciences – MalmöLund UniversityMalmöSweden
  36. 36.Diabetes and Cardiovascular Disease, Genetic Epidemiology, Department of Clinical Sciences in MalmöLund UniversityMalmöSweden
  37. 37.Public Health and Clinical Medicine, Nutritional Research, and Arctic Research CenterUmeå UniversityUmeåSweden
  38. 38.School of Clinical Medicine, Clinical Gerontology UnitUniversity of CambridgeCambridgeUK
  39. 39.MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
  40. 40.Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
  41. 41.Department of Epidemiology and Biostatistics, School of Public HealthImperial CollegeLondonUK

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