Sugar-sweetened drink intake tied to increased IBD risk

Consumption of sugar-sweetened beverages (SSBs) was associated with increased risk of inflammatory bowel disease (IBD), a large population-based study suggests. This association was not found with artificially sweetened beverages (ASBs) and natural juices.

“IBDs have been related to high-sugar dietary patterns, but the associations of different types of beverages with IBD risk are largely unknown,” said the researchers. Evidence has shown an association between SSBs and increased risks of systemic inflammation, obesity, metabolic syndrome, and diabetes. [Am J Clin Nutr 2011;94:479-485; Circulation 2012;125:1735-1741; Am J Clin Nutr 2006;84:274-288; Circulation 2010;121:1356-1364] “[I]n parallel, there has been evidence for the critical roles of these diseases in IBD.”

The researchers sought to evaluate the associations between intake of SSBs, ASBs, and natural juices*, and IBD risk using data from a population-based cohort (UK Biobank). Participants included in the study (n=121,490; mean age 56.2 years, 56 percent female) were IBD-free at recruitment. Beverage consumption was obtained from repeated 24-hour diet recalls between 2009 and 2012. [Aliment Pharmacol Ther 2022;56:1018-1029]

During a mean follow-up of 10.2 years, 510 incident IBD cases were documented. A majority of the cases were ulcerative colitis (UC; n=367), while the rest were Crohn’s disease (CD).

Compared with zero SSB intake, consumption of >1 unit**/day of SSBs was associated with an increased risk of IBD (fully adjusted model hazard ratio [HR], 1.51; p=0.009), which was stronger for CD (HR, 2.05; p=0.007) but nonsignificant for UC (HR, 1.31; p=0.172). The trend, however, was nonsignificant for the associations of SSBs with risk of IBD (p_trend=0.17), CD (p_trend=0.181), or UC (p_trend=0.432).

“In the restricted cubic splines, we did not find nonlinear relationship between beverage intake and risk of IBD, CD or UC, but we can observe an elevated risk of IBD and CD with excessive intake of SSBs,” the researchers explained.

The stronger association between SSB intake and CD risk aligns with evidence showing that diet is more associated with CD risk. “[This] may be partly explained by the different lesion location and imbalanced intestinal microbiota in patients with CD or UC,” they said.

Conversely, there were no associations between IBD risk and consumption of >1 unit/day of ASBs (fully adjusted model HR, 0.85; p=0.436) or natural juices (fully adjusted model HR, 1.08; p=0.664). The same was true for CD (HR, 0.42; p=0.091 [ASB] and HR, 1.24; p=0.489 [natural juices]) and UC (HR, 1.05; p=0.832 and HR, 1.01; p=0.954, respectively).

The lack of positive association between ASBs, natural juices, and IBD risk is worth noting, the researchers said. “The inflammatory role of artificial sweeteners is still on debate … [T]he effect of natural sugar in natural juices may be counteracted by dietary fibres and bioactive compounds.”

“In general, our findings pointed out that excessive consumption of SSBs, but not ASBs or natural juices, might be a potential risk factor for IBD,” said the researchers. “[I]f proven causal, our findings suggest reduced SSB consumption as a strategy for prevention of IBD, especially CD.”

“[F]urther studies are needed to confirm these findings and explore the underlying mechanism before public health policy could be carried out,” they added.

Associations between consumption of the examined beverages and younger-onset IBD would also be worth looking into in future studies, as the study was limited to an older age group owing to the participants’ baseline age (>40 years).