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

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European Journal of Nutrition Aims and scope Submit manuscript

A Correction to this article was published on 17 April 2024

This article has been updated

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, p trend = 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, n cases = 101); for sugar-sweetened soft drinks, this association was null (HR 1.00, 95 % CI 0.95–1.06; n cases = 127, p heterogeneity = 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; p trend = 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.

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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

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Acknowledgments

The authors’ responsibilities were as follows—ER: is the overall PI of the EPIC study which is jointly coordinated from ICL and IARC; MS, VF and MJ: conceptualised, designed, obtained funding for and carried out the present research; MS: performed the statistical analysis; and MS, VF, and MJ: contributed to the writing of the manuscript and data interpretation. Contributing authors from each collaborating centres provided the original data and biological samples, information on the respective populations, advice on study design/analysis, and interpretation of the results and approval of the final version of the manuscript for publication. This work was supported by the French National Cancer Institute (L’Institut National du Cancer; INCA) (Grant Number 2009-139). The coordination of EPIC is financially supported by the European Commission (DG-SANCO); and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer; Institut Gustave Roussy; Mutuelle Générale de l’Education Nationale; and Institut National de la Santé et de la Recherche Médicale (INSERM) (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum (DKFZ); and Federal Ministry of Education and Research (Germany); Stavros Niarchos Foundation; Hellenic Health Foundation; and Ministry of Health and Social Solidarity (Greece); Italian Association for Research on Cancer (AIRC); National Research Council; and AIRE-ONLUS Ragusa, AVIS Ragusa, Sicilian Government (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS); Netherlands Cancer Registry (NKR); LK Research Funds; Dutch Prevention Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); and Statistics Netherlands (the Netherlands); European Research Council (ERC) (Grant Number ERC-2009-AdG 232997) and Nordforsk; and Nordic Center of Excellence Programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS); Regional Governments of Andalucía, Asturias, Basque Country, Murcia (No. 6236) and Navarra; and ISCIII RETIC (RD06/0020) and the Catalan Institute of Oncology. (Spain); Swedish Cancer Society; Swedish Scientific Council; and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK; Medical Research Council; Stroke Association; British Heart Foundation; Department of Health; Food Standards Agency; and Wellcome Trust (UK). Reagents for the hepatitis infection determinations were kindly provided by Abbott Diagnostics Division, Lyon, France. The funding sources had no influence on the design of the study; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication.

Conflict of interest

None of the authors had a conflict of interest.

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Authors and Affiliations

  1. Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France

    Magdalena Stepien, Talita Duarte-Salles, Veronika Fedirko, Isabelle Romieu & Mazda Jenab

  2. Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Veronika Fedirko

  3. Hellenic Health Foundation, Athens, Greece

    Antonia Trichopoulou & Eleni Klinaki

  4. Department of Hygiene, Epidemiology, Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece

    Antonia Trichopoulou, Pagona Lagiou & Christina Bamia

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Pagona Lagiou

  6. Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark

    Kim Overvad

  7. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anne Tjønneland & Louise Hansen

  8. INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health Team, 94805, Villejuif, France

    Marie-Christine Boutron-Ruault & Guy Fagherazzi

  9. University Paris Sud, UMRS 1018, 94805, Villejuif, France

    Marie-Christine Boutron-Ruault & Guy Fagherazzi

  10. Institut Gustave Roussy, 94805, Villejuif, France

    Marie-Christine Boutron-Ruault & Guy Fagherazzi

  11. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, 3053, Australia

    Gianluca Severi

  12. Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, 3010, Australia

    Gianluca Severi

  13. Department of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany

    Tilman Kühn & Rudolf Kaaks

  14. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany

    Krasimira Aleksandrova & Heiner Boeing

  15. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy

    Domenico Palli

  16. Epidemiology and Prevention Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy

    Sara Grioni

  17. Dipartamento di Medicina Clinicae Chirurgias, Federico II University, Naples, Italy

    Salvatore Panico

  18. Cancer Registry and Histopathology Unit, “Civile M.P. Arezzo” Hospital, Ragusa, Italy

    Rosario Tumino

  19. Molecular and Genetic Epidemiology Unit, Human Genetics Foundation (HuGeF), Torino, Italy

    Alessio Naccarati

  20. National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    H. Bas Bueno-de-Mesquita

  21. Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands

    H. Bas Bueno-de-Mesquita

  22. The School of Public Health, Imperial College London, London, UK

    H. Bas Bueno-de-Mesquita

  23. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Petra H. Peeters

  24. Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway

    Guri Skeie & Elisabete Weiderpass

  25. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Elisabete Weiderpass

  26. Department of Research, Cancer Registry of Norway, Oslo, Norway

    Elisabete Weiderpass

  27. Samfundet Folkhälsan, Helsinki, Finland

    Elisabete Weiderpass

  28. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

    Christine L. Parr

  29. Public Health Directorate, Asturias, Spain

    José Ramón Quirós

  30. Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain

    Genevieve Buckland

  31. Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain

    Esther Molina-Montes & Maria-Dolores Chirlaque

  32. Public Health Division of Gipuzkoa, Health Department of Basque Region, BioDonostia Research Institute, San Sebastian, Spain

    Pilar Amiano

  33. CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain

    Pilar Amiano, Maria-Dolores Chirlaque & Eva Ardanaz

  34. Navarre Public Health Institute, Pamplona, Spain

    Eva Ardanaz

  35. Department of Clinical Sciences – Malmö, Lund University, Malmö, Sweden

    Emily Sonestedt

  36. Diabetes and Cardiovascular Disease, Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden

    Ulrika Ericson

  37. Public Health and Clinical Medicine, Nutritional Research, and Arctic Research Center, Umeå University, Umeå, Sweden

    Maria Wennberg & Lena Maria Nilsson

  38. School of Clinical Medicine, Clinical Gerontology Unit, University of Cambridge, Cambridge, UK

    Kay-Tee Khaw

  39. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

    Nick Wareham

  40. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Kathryn E. Bradbury

  41. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK

    Heather A. Ward

Authors
  1. Magdalena Stepien
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  2. Talita Duarte-Salles
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  3. Veronika Fedirko
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  4. Antonia Trichopoulou
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Corresponding author

Correspondence to Mazda Jenab.

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Stepien, M., Duarte-Salles, T., Fedirko, V. et al. Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort. Eur J Nutr 55, 7–20 (2016). https://doi.org/10.1007/s00394-014-0818-5

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  • DOI: https://doi.org/10.1007/s00394-014-0818-5

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