Tracking decades of beverage habits in two major U.S. cohorts, researchers investigated whether what people drink could help explain differences in gastric cancer incidence.
Study: Association between sugar-sweetened and artificially sweetened beverage intake and gastric cancer incidence. Image Credit: Vintage Tone / Shutterstock
A recent study in the journal Gastro Hep Advances assessed whether sugar-sweetened beverage (SSB) or artificially sweetened beverage (ASB) intake was associated with gastric cancer incidence.
Gastric cancer remains the fourth leading cause of cancer-related mortality worldwide. Over the years, researchers have identified key risk factors including Helicobacter pylori infection, male sex, advancing age, alcohol use, and tobacco exposure. In addition, dietary habits also play a key role in gastric cancer; for example, diets high in salted fish, pickled vegetables, grilled or charcoaled meats, and low in fruits or vegetables have all been associated with higher gastric cancer risk.
SSBs, such as sodas, energy drinks, and juices with added sugars, are widely consumed and typically contain high fructose corn syrup. Although higher SSB intake has been linked to increased risk for certain cancers like colorectal, breast, and liver, its relationship with gastric cancer is not well established. Previous studies often yield limited or inconsistent evidence, potentially reflecting differences in beverage definitions, gastric cancer subtypes examined, or adjustment for important covariates.
The role of artificially sweetened beverages is similarly unclear, as debates about their safety continue. Consequently, a significant research gap remains regarding how both SSBs and artificially sweetened beverages may contribute to gastric cancer risk, underscoring the need for well-designed studies to address these uncertainties.
Examining the Risk of Gastric Cancer According to Beverage Type
The current prospective cohort study evaluated the association between sugar-sweetened and artificially sweetened beverage intake and gastric cancer incidence in two large U.S. cohorts: the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS), which originally enrolled 121,700 women and 51,529 men, respectively.
Participants who completed the 1986 baseline questionnaire, when beverage intake was first assessed, were included. Beverage consumption was measured every four years using validated food frequency questionnaires.
SSBs included carbonated drinks, punch, lemonade, and sports drinks. ASBs were defined as low-calorie carbonated drinks. Beverage intake, based on an 8-ounce serving, was categorized into five groups and adjusted for total caloric intake.
Gastric adenocarcinoma cases diagnosed from baseline through June 2021 (NHS) or January 2022 (HPFS) were identified via biennial questionnaires and the National Death Index, with diagnoses confirmed by medical records or cancer registries. Cox proportional hazards models were used to estimate hazard ratios, adjusting for potential confounders such as red and processed meat intake.
Higher Gastric Cancer Incidence Associated With Sugar-Sweetened, Not Artificially Sweetened, Beverages
Analysis included 68,311 women and 42,973 men who contributed over 3.2 million person-years of follow-up, during which 278 cases of gastric cancer were identified: 140 in the NHS and 138 in the HPFS. Individuals who consumed more than one serving of SSB per day had a significantly higher risk of developing gastric cancer compared to never users, with a hazard ratio of 2.45 and a 95 percent confidence interval from 1.49 to 4.04. The direction of the association was similar across both cohorts.
In cohort-specific analyses of participants consuming more than one SSB per day, the hazard ratio was 3.04 in the NHS and 1.99 in the HPFS. In contrast, consumption of ASBs showed no association with gastric cancer incidence in either age-adjusted or multivariable-adjusted models.
H. pylori serostatus was assessed in a subset of 616 NHS and 324 HPFS participants drawn from a nested case-control study of colorectal cancer, using IgG antibodies. H. pylori IgG seropositivity was present in 36.7% in the NHS and 34.0% in the HPFS. Neither sugar-sweetened nor artificially sweetened beverage intake was associated with H. pylori IgG seropositivity in multivariable-adjusted models for either cohort.
Further analysis of fructose intake, a major sweetener in SSBs, revealed a positive association between higher fructose intake and gastric cancer incidence in the total cohort and among women. Collectively, these findings indicate that high SSB consumption, particularly more than one serving per day, was associated with higher gastric cancer incidence.
Pathways Forward in SSB and Gastric Cancer Research
The current study found an association between higher SSB intake and increased incidence of gastric cancer. This association raises the possibility that SSB intake could represent a modifiable factor relevant to gastric cancer risk, although the observational findings require confirmation. While several mechanisms, such as weight gain, insulin resistance, steroid hormone imbalance, inflammation, DNA damage, and dysbiosis, have been proposed to potentially explain this relationship, further research is needed to elucidate the precise biological pathways involved.
This study has several limitations, including limited information regarding H. pylori infection status, anatomical location of gastric cancer, family history of gastric cancer, and history of upper endoscopy. Additionally, the cohort was predominantly White and comprised participants aged 30 to 75 years, limiting the ability to examine associations in racial-ethnic subgroups or among younger adults.
Future investigations should aim to confirm these findings in more diverse populations and explore the underlying biological mechanisms in greater depth. Expanding research to include younger individuals and those from a wider range of racial and ethnic backgrounds will enhance the generalizability and impact of these results.