Sugar-sweetened beverage consumption and incidence of breast cancer: the Seguimiento Universidad de Navarra (SUN) Project

Abstract

Purpose

Breast cancer (BC) incidence is increasing worldwide. Higher insulin resistance may potentially lead to an increased risk of BC. Sugar-sweetened beverages (SSB) are an acknowledged dietary factor that increases insulin resistance. However, the association between SSB and BC has not been widely explored. We evaluated the association between baseline consumption of SSB and the incidence of BC among relatively young women in a cohort of Spanish university graduates.

Methods

We evaluated 10,713 middle-aged, Spanish female university graduates (median age 33) from the Seguimiento Universidad de Navarra (SUN) cohort, initially free of BC. SSB consumption was collected at baseline using a validated 136-item semi-quantitative food-frequency questionnaire. Incidence of BC was confirmed by a trained oncologist using medical records. We fitted Cox regression models to assess the relationship between baseline categories of SSB consumption and the incidence of BC during follow-up. We stratified the analyses by menopausal status.

Results

During 106,189 person-years follow-up, 100 incident cases of BC were confirmed. Among postmenopausal women, regular consumption of SSB was associated with a significantly higher incidence of BC (HR 2.12; 95% CI 1.02, 4.41) in the fully adjusted model, compared to women who never or seldom consumed SSB. No association was found among premenopausal women (HR 1.16; 95% CI 0.66, 2.07).

Conclusions

Even though the number of cases was small, in this Mediterranean cohort, we observed a direct association between SSB consumption and BC risk among postmenopausal women. Nonetheless further larger longitudinal studies are needed to support this association.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Abbreviations

BC:

Breast cancer

SSB:

Sugar-sweetened beverage

SUN:

Seguimiento Universidad de Navarra (University of Navarra Follow-up Study)

HR:

Hazard ratio

OR:

Odds ratio

CI:

Confidence interval

BMI:

Body mass index

MET:

Metabolic equivalent index

SD:

Standard deviation

References

  1. 1.

    World Health Organization (2012) GLOBOCAN. Cancer fact sheets: breast cancer. http://globocan.iarc.fr/old/FactSheets/cancers/breast-new.asp. Accessed 6 Jun 2018

  2. 2.

    World Cancer Research Fund, American Institute for Cancer Research (2017) Diet, nutrition, physical activity and breast cancer. http://www.aicr.org/continuous-update-project/reports/breast-cancer-report-2017.pdf. Accessed 6 Jun 2018

  3. 3.

    Global Burden of Disease Cancer Collaboration C, Fitzmaurice C, Allen C et al (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3:524–548. https://doi.org/10.1001/jamaoncol.2016.5688

    Article  Google Scholar 

  4. 4.

    Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT et al (2014) American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol 32:3568–3574. https://doi.org/10.1200/JCO.2014.58.4680

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Mørch LS, Skovlund CW, Hannaford PC et al (2017) Contemporary hormonal contraception and the risk of breast cancer. N Engl J Med 377:2228–2239. https://doi.org/10.1056/NEJMoa1700732

    Article  PubMed  Google Scholar 

  6. 6.

    Gartlehner G, Patel SV, Feltner C et al (2017) Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: evidence report and systematic review for the US preventive services task force. JAMA 318:2234–2249. https://doi.org/10.1001/jama.2017.16952

    Article  PubMed  Google Scholar 

  7. 7.

    Kobayashi S, Sugiura H, Ando Y, Shiraki N, Yanagi T, Yamashita H et al (2012) Reproductive history and breast cancer risk. Breast Cancer 19:302–308. https://doi.org/10.1007/s12282-012-0384-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Collaborative Group on Hormonal Factors in Breast Cancer (2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360:187–195

    Article  Google Scholar 

  9. 9.

    Petri AL, Tjønneland A, Gamborg M et al (2004) Alcohol intake, type of beverage, and risk of breast cancer in pre- and postmenopausal women. Alcohol Clin Exp Res 28:1084–1090

    Article  Google Scholar 

  10. 10.

    Romieu I, Scoccianti C, Chajès V et al (2015) Alcohol intake and breast cancer in the European prospective investigation into cancer and nutrition. Int J Cancer 137:1921–1930. https://doi.org/10.1002/ijc.29469

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Smith-Warner SA, Spiegelman D, Yaun SS et al (1998) Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA 279:535–540

    CAS  Article  Google Scholar 

  12. 12.

    Fortner RT, Katzke V, Kúhn T et al (2016) Obesity and breast cancer. Recent Results Cancer Res 208:43–65

    CAS  Article  Google Scholar 

  13. 13.

    Lahmann PH, Friedenreich C, Schuit AJ et al (2007) Physical activity and breast cancer risk: the european prospective investigation into cancer and nutrition. Cancer Epidemiol Biomark Prev 16:36–42

    Article  Google Scholar 

  14. 14.

    Wu Y, Zhang D, Kang S (2013) Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat 137:869–882. https://doi.org/10.1007/s10549-012-2396-7

    Article  PubMed  Google Scholar 

  15. 15.

    Doll R, Peto R (1981) The causes of cancer: quantitative estimates of avoidable risks of cancer in the united states today. J Natl Cancer Inst 66:1192–1308

    Article  Google Scholar 

  16. 16.

    World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: a global perspective. Continuous update project expert report 2018. Available at https://www.wcrf.org/dietandcancer. Accessed 6 June 2018

  17. 17.

    Eccles S, Aboagye EO, Ali S, Anderson a S, Armes J, Berditchevski F et al (2013) Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. Breast Cancer Res 15:92. https://doi.org/10.1186/bcr3493

    Article  Google Scholar 

  18. 18.

    Hodge AM, Bassett JK, Milne RL, English DR, Giles GG (2018) Consumption of sugar-sweetened and artificially sweetened soft drinks and risk of obesity-related cancers. Public Health Nutr 21:1618–1626

    Article  Google Scholar 

  19. 19.

    Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB (2010) Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 33:2477–2481. https://doi.org/10.2337/dc10-1079

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Hu FB, Malik VS (2010) Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav 100:47–54. https://doi.org/10.1016/j.physbeh.2010.01.036

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Barrio-Lopez MT, Martinez-Gonzalez M, Fernandez-Montero A, Beunza JJ, Zazpe I, Bes-Rastrollo M (2013) Prospective study of changes in sugar-sweetened beverage consumption and the incidence of the metabolic syndrome and its components: the SUN cohort. Br J Nutr 110:1722–1731. https://doi.org/10.1017/S0007114513000822

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Carwile JL, Willett WC, Spiegelman D, Hertzmark E, Rich-Edwards J, Frazier a L et al (2015) Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls. Hum Reprod 30:675–683. https://doi.org/10.1093/humrep/deu349

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Duchaine CS, Dumas I, Diorio C (2014) Consumption of sweet foods and mammographic breast density: a cross-sectional study. BMC Public Health 14:554. https://doi.org/10.1186/1471-2458-14-554

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Seguí-Gómez M, de la Fuente C, Vázquez Z, de Irala J, Martínez-González MA (2006) Cohort profile: the “Seguimiento Universidad de Navarra” (SUN) study. Int J Epidemiol 35:1417–1422. https://doi.org/10.1186/1475-2891-10-121

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Willett WC (2013) Issues in analysis and presentation of dietary data. In: Willett WC (ed) Nutritional epidemiology, 3rd edn. Oxford University Press, New York, pp 305–333

    Google Scholar 

  26. 26.

    Martin-Moreno JM, Boyle P, Gorgojo L et al (1993) Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 22:512–519

    CAS  Article  Google Scholar 

  27. 27.

    De la Fuente-Arrillaga C, Vázquez Ruiz Z, Bes-Rastrollo M, Sampson L, Martinez-González MA (2010) Reproducibility of an FFQ validated in Spain. Public Health Nutr 13:1364–1372. https://doi.org/10.1017/S1368980009993065

    Article  PubMed  Google Scholar 

  28. 28.

    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608

    Article  Google Scholar 

  29. 29.

    Bes-Rastrollo M, Pérez Valdivieso JR, Sánchez-Villegas A, Alonso Á, Martínez-González M (2005) Validación del peso e índice de masa corporal auto-declarados de los participantes de una cohorte de graduados universitarios. Rev Esp Obes 3:352–358. https://doi.org/10.3305/nh.2013.28.5.6671

    Article  Google Scholar 

  30. 30.

    Martínez-González MA, López-Fontana C, Varo JJ et al (2005) Validation of the Spanish version of the physical activity questionnaire used in the Nurses’ Health Study and the Health Professionals’ Follow-up Study. Public Health Nutr 8:920–927

    Article  Google Scholar 

  31. 31.

    Shivappa N, Sandin S, Löf M et al (2015) Prospective study of dietary inflammatory index and risk of breast cancer in Swedish women. Br J Cancer 113:1099–1103. https://doi.org/10.1038/bjc.2015.304

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Augustin LS, Dal Maso L, La Vecchia C, Parpinel M, Negri E, Vaccarella S et al (2001) Dietary glycemic index and glycemic load, and breast cancer risk: a case–control study. Ann Oncol 12:1533–1538

    CAS  Article  Google Scholar 

  33. 33.

    Potischman N, Coates RJ, Swanson CA, Carroll RJ, Daling JR, Brogan DR et al (2002) Increased risk of early-stage breast cancer related to consumption of sweet foods among women less than age 45 in the United States. Cancer Causes Control 13:937–946. https://doi.org/10.1023/A:1021919416101

    Article  PubMed  Google Scholar 

  34. 34.

    Bradshaw PT, Sagiv SK, Kabat GC, Satia JA, Britton JA, Teitelbaum SL et al (2009) Consumption of sweet foods and breast cancer risk: a case–control study of women on Long Island, New York. Cancer Causes Control 20:1509–1515. https://doi.org/10.1007/s10552-009-9343-x

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Chandran U, McCann SE, Zirpoli G, Gong Z, Lin Y, Hong CC et al (2014) Intake of energy-dense foods, fast foods, sugary drinks, and breast cancer risk in African American and European American women. Nutr Cancer 66:1187–1199. https://doi.org/10.1080/01635581

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Witte JS, Ursin G, Siemiatycki J, Thompson WD, Paganini-Hill A, Haile RW (1997) Diet and premenopausal bilateral breast cancer: a case–control study. Breast Cancer Res Treat 42:243–251. https://doi.org/10.1023/A:1005710211184

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Monzavi-Karbassi B, Hine RJ, Stanley JS, Ramani VP, Carcel-Trullols J, Whitehead TL et al (2010) Fructose as a carbon source induces an aggressive phenotype in MDA-MB-468 breast tumor cells. Int J Oncol 37:615–622

    CAS  Article  Google Scholar 

  38. 38.

    Liu H, Heaney AP (2011) Refined fructose and cancer. Expert Opin Ther Targets 15:1049–1059. https://doi.org/10.1517/14728222.2011

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Ludwig DS (2003) Diet and development of the insulin resistance syndrome. Asia Pac J Clin Nutr 12:4

    Google Scholar 

  40. 40.

    Kaaks R (1996) Nutrition, hormones, and breast cancer: is insulin the missing link? Cancer Causes Control 7:605–625

    CAS  Article  Google Scholar 

  41. 41.

    Kaaks R (2001) Plasma insulin, IGF-I and breast cancer. Gynecol Obstet Fertil 29:185–191. https://doi.org/10.1016/S1297-9589(00)00047-3

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Christopoulos PF, Msaouel P, Koutsilieris M (2015) The role of the insulin-like growth factor-1 system in breast cancer. Mol Cancer 14:43. https://doi.org/10.1186/s12943-015-0291-7

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Gunter MJ, Hoover DR, Yu H, Wassertheil-Smoller S, Rohan TE, Manson JE et al (2009) Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 101:48–60. https://doi.org/10.1093/jnci/djn415

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Iyengar NM, Hudis CA, Dannenberg AJ (2015) Obesity and cancer: local and systemic mechanisms. Annu Rev Med 66:297–309. https://doi.org/10.1146/annurev-med-050913-022228

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Bhandari R, Kelley G, Hartley T, Rockett I (2014) Metabolic syndrome is associated with increased breast cancer risk: a systematic review with meta-analysis. Int J Breast Cancer 2014:1–13. https://doi.org/10.1155/2014/189384

    Article  Google Scholar 

  46. 46.

    Shapira N (2017) The potential contribution of dietary factors to breast cancer prevention. Eur J Cancer Prev 26:385–395. https://doi.org/10.1097/CEJ.0000000000000406

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E et al (2010) Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr 103:1808–1816. https://doi.org/10.1017/S0007114509993837

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    U.S. Department of Health and Human Services and U.S. Department of Agriculture (2015) 2015–2020 dietary guidelines for Americans, 8th edn. https://health.gov/dietaryguidelines/2015/guidelines/. Accessed 6 Jun 2018

Download references

Acknowledgements

The authors thank the implication and collaboration of the participants in the SUN Project. ARN was supported by the Fundación Científica Asociación Española Contra el Cáncer (AECC) (Scientific Foundation of the Spanish Association Against Cancer). We thank the other members of the SUN Group: Alonso A, Barrio López MT, Basterra-Gortari FJ, Benito Corchón S, Bes-Rastrollo M, Beunza JJ, Carlos Chillerón S, Carmona L, Cervantes S, de Irala Estévez J, de la Fuente Arrillaga C, de la Rosa PA, Delgado Rodríguez M, Dominguz LJ, Donat Vargas CL, Donázar M, Eguaras S, Fernández Montero A, Galbete Ciáurriz C, García López M, Goñi Ochandorena E, Guillén Grima F, Hernández-Hernandez A, Llorca J, López del Burgo C, Marí Sanchís A, Martí del Moral A, Martín Calvo N, Martínez JA, Molero P, Núñez-Córdoba JM, Pimenta AM, Rico A, Ruiz-Canela M, Ruiz Zambrana A, Sánchez Adán D, Sayón Orea C, Vázquez Ruiz Z. All authors revised the manuscript and read and approved the final version of it.

Funding

The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795, and G03/140), the Navarra Regional Government (45/2011, 122/2014, 41/2016), and the University of Navarra.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Estefania Toledo.

Ethics declarations

Ethical standards

The present study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving participants were approved by the Institutional Review Board of the University of Navarra. All potential participants were duly informed of their right to refuse to participate in the SUN study or to withdraw their consent to participate at any time without reprisal. Special attention was given to the specific information needs of individual potential candidates as well as to the methods used to deliver their information and the feedback that may receive in the future from the research team. After ensuring that the candidate had understood the information, we sought their potential freely given informed consent through their voluntary completion of the baseline questionnaire. These methods were accepted by our Institutional Review Board as to imply an appropriately-obtained informed consent.

Conflict of interest

On behalf of all authors, the corresponding author declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Romanos-Nanclares, A., Toledo, E., Gardeazabal, I. et al. Sugar-sweetened beverage consumption and incidence of breast cancer: the Seguimiento Universidad de Navarra (SUN) Project. Eur J Nutr 58, 2875–2886 (2019). https://doi.org/10.1007/s00394-018-1839-2

Download citation

Keywords

  • Sugar-sweetened beverage
  • Breast cancer
  • Cohort
  • Primary prevention