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

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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.


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.


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).


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.

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Fig. 1
Fig. 2



Breast cancer


Sugar-sweetened beverage


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


Hazard ratio


Odds ratio


Confidence interval


Body mass index


Metabolic equivalent index


Standard deviation


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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.


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.

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Correspondence to Estefania Toledo.

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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.

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

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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).

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