Sugar-sweetened drinks tied to increased liver cancer risk?

A high intake of sugar-sweetened beverages (SSBs) may be linked to an increased risk of liver cancer, according to an observational study on postmenopausal women presented at Nutrition 2022.

Participants were 98,418 postmenopausal women aged 50–79 years enrolled in the Women’s Health Initiative Observational Study and Clinical Trials. Information on SSB intake* was acquired through validated food frequency questionnaires that were distributed at baseline (1993–1998), while information on liver cancer incidence was obtained through questionnaires and medical records.

SSB consumption was categorized as never to <3 servings/month (reference arm), 1–6 servings/week, and ≥1 servings/day. At baseline, about 6.8 percent of women consumed ≥1 SSB serving/day. Women with higher SSB consumption were generally younger, less physically active, and had higher BMI and energy intake than those with lower consumption.

The mean age of the participants was 61–63 years and BMI ranged from 27.3–29.7 kg/m². Sixty-one to 64 percent had a family history of cancer, 4.1–5.5 percent a history of diabetes, and 2.3–2.5 percent a history of liver disease. Fifty-four to 62 percent were on hormone replacement therapy and 42–46 percent on oral contraceptives.

The women were followed up for a median 19.4 years during which time 207 women were diagnosed with liver cancer.

After adjusting for multiple confounding risk factors, a higher SSB intake was linked to a greater risk for liver cancer, with an almost twofold risk in those who consumed ≥1 servings/day compared with the reference arm (hazard ratio [HR], 1.97, 95 percent confidence interval [CI], 1.23–3.14). SSB consumption of 1–6 servings/week was also associated with an increased risk for liver cancer (HR, 1.14, 95 percent CI, 0.77–1.70; p_trend=0.005). [Nutrition 2022, abstract OR07-01-22]

The increased risk was consistent for intake of soft drinks (HRs, 1.77 and 0.98 for ≥1 servings/day and 1–6 servings/week, respectively; p_trend=0.08) and fruit juices (HRs, 1.81 and 1.42, respectively; p_trend=0.08) vs the reference arm. There was also a non-significant elevated liver cancer risk observed with intake of artificially-sweetened beverages (HRs, 1.19 and 1.04, respectively; p_trend=0.55).

Substituting one SSB per day with one serving of water led to a reduced risk of liver cancer (HR, 0.71), as did substitution with one serving per day of coffee or tea (HR, 0.80).

Sensitivity analysis excluding participants with diabetes or chronic liver disease at baseline and those who developed liver cancer in the first 2 years of observation did not affect the SSB consumption–liver cancer association.

Hepatitis infection, smoking, alcohol consumption, obesity, diabetes, metabolic syndrome, non-alcoholic fatty liver disease, and cirrhosis have been associated with an increased risk of liver cancer, said study lead author Longgang Zhao, a PhD candidate at the University of South Carolina, Columbia, South Carolina, US. “However, >40 percent of liver cancers cannot be explained by these risk factors,” he said.

“Our findings suggest SSB consumption is a potential modifiable risk factor for liver cancer. If our findings are confirmed, reducing SSB consumption might serve as a public health strategy to reduce liver cancer burden,” he said.

“[Additionally,] replacing SSBs with water and non-sugar-sweetened coffee or tea could significantly lower liver cancer risk,” he added.

According to Zhao, further research among diverse populations and men is needed to identify the mechanisms behind this link. One hypothesis is that “intake of SSBs, a postulated risk factor for obesity, diabetes, and cardiovascular disease, may drive insulin resistance and inflammation which are strongly implicated in liver carcinogenesis,” he suggested.