长期饮用含糖饮料和人工甜味饮料与美国成年人的死亡率风险。
Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults.
机构信息
Departments of Nutrition (V.S.M., Y.L., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA.
Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (A.P.).
出版信息
Circulation. 2019 Apr 30;139(18):2113-2125. doi: 10.1161/CIRCULATIONAHA.118.037401.
BACKGROUND
Whether consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) is associated with risk of mortality is of public health interest.
METHODS
We examined associations between consumption of SSBs and ASBs with risk of total and cause-specific mortality among 37 716 men from the Health Professional's Follow-up study (from 1986 to 2014) and 80 647 women from the Nurses' Health study (from 1980 to 2014) who were free from chronic diseases at baseline. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals.
RESULTS
We documented 36 436 deaths (7896 cardiovascular disease [CVD] and 12 380 cancer deaths) during 3 415 564 person-years of follow-up. After adjusting for major diet and lifestyle factors, consumption of SSBs was associated with a higher risk of total mortality; pooled hazard ratios (95% confidence intervals) across categories (<1/mo, 1-4/mo, 2-6/week, 1-<2/d, and ≥2/d) were 1.00 (reference), 1.01 (0.98, 1.04), 1.06 (1.03, 1.09), 1.14 (1.09, 1.19), and 1.21 (1.13, 1.28; P trend <0.0001). The association was observed for CVD mortality (hazard ratio comparing extreme categories was 1.31 [95% confidence interval, 1.15, 1.50], P trend <0.0001) and cancer mortality (1.16 [1.04, 1.29], P trend =0.0004). ASBs were associated with total and CVD mortality in the highest intake category only; pooled hazard ratios (95% confidence interval) across categories were 1.00 (reference), 0.96 (0.93, 0.99), 0.97 (0.95, 1.00), 0.98 (0.94, 1.03), and 1.04 (1.02, 1.12; P trend = 0.01) for total mortality and 1.00 (reference), 0.93 (0.87, 1.00), 0.95 (0.89, 1.00), 1.02 (0.94, 1.12), and 1.13 (1.02, 1.25; P trend = 0.02) for CVD mortality. In cohort-specific analysis, ASBs were associated with mortality in NHS (Nurses' Health Study) but not in HPFS (Health Professionals Follow-up Study) ( P interaction, 0.01). ASBs were not associated with cancer mortality in either cohort.
CONCLUSIONS
Consumption of SSBs was positively associated with mortality primarily through CVD mortality and showed a graded association with dose. The positive association between high intake levels of ASBs and total and CVD mortality observed among women requires further confirmation.
背景
糖饮料（SSBs）或人工甜味饮料（ASBs）的消费与死亡率的关系是公共卫生关注的问题。
方法
我们研究了 SSBs 和 ASBs 的消费与来自健康专业人员随访研究（1986 年至 2014 年）的 37716 名男性和来自护士健康研究（1980 年至 2014 年）的 80647 名女性的全因和死因特异性死亡率风险之间的关联，这些人在基线时没有慢性疾病。使用 Cox 比例风险回归来估计危险比和 95%置信区间。
结果
在 3415564 人年的随访中，我们记录了 36436 例死亡（7896 例心血管疾病[CVD]和 12380 例癌症死亡）。在调整主要饮食和生活方式因素后，SSBs 的消费与总死亡率的风险增加相关；跨类别（<1/月、1-4/月、2-6/周、1-<2/天和≥2/天）的汇总危险比（95%置信区间）分别为 1.00（参考）、1.01（0.98，1.04）、1.06（1.03，1.09）、1.14（1.09，1.19）和 1.21（1.13，1.28；P 趋势<0.0001）。这种关联在 CVD 死亡率（极端类别之间的比较危险比为 1.31 [95%置信区间，1.15，1.50]，P 趋势<0.0001）和癌症死亡率（1.16 [1.04，1.29]，P 趋势=0.0004）中均有观察到。ASBs 仅在最高摄入类别中与全因和 CVD 死亡率相关；跨类别的汇总危险比（95%置信区间）分别为 1.00（参考）、0.96（0.93，0.99）、0.97（0.95，1.00）、0.98（0.94，1.03）和 1.04（1.02，1.12；P 趋势=0.01）用于全因死亡率和 1.00（参考）、0.93（0.87，1.00）、0.95（0.89，1.00）、1.02（0.94，1.12）和 1.13（1.02，1.25；P 趋势=0.02）用于 CVD 死亡率。在队列特异性分析中，ASBs 与 NHS（护士健康研究）中的死亡率相关，但与 HPFS（健康专业人员随访研究）无关（P 交互作用，0.01）。ASBs 与两个队列中的癌症死亡率均无关联。
结论
SSBs 的消费与死亡率呈正相关，主要通过 CVD 死亡率，且与剂量呈梯度相关。在女性中观察到高摄入量的 ASBs 与全因和 CVD 死亡率之间的正相关关系需要进一步证实。
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