含糖饮料摄入与女性死亡风险的关联：加州教师研究。
Association Between Sugar-Sweetened Beverage Intake and Mortality Risk in Women: The California Teachers Study.
机构信息
Department of Family Medicine and Public Health in the School of Medicine at University of California San Diego, La Jolla; School of Public Health at San Diego State University, San Diego, CA.
Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA.
出版信息
J Acad Nutr Diet. 2022 Feb;122(2):320-333.e6. doi: 10.1016/j.jand.2021.08.099. Epub 2021 Aug 11.
BACKGROUND
The evidence linking sugar-sweetened beverage (SSB) intake and mortality risk is conflicting, and associations between various SSB subtypes and mortality remain unclear.
OBJECTIVE
To examine the association between baseline SSB intake, subtypes of SSB intake, and mortality risk in women.
DESIGN
Prospective cohort study.
PARTICIPANTS/SETTING: Participants of the California Teachers Study (n = 100,314; median age = 53 years) free of cardiovascular disease, cancer, and diabetes at baseline (1995-1996) were followed from 1995 to 2015. Baseline SSB intake was defined as caloric soft drinks (regular soft drinks, not diet soda), sweetened bottled waters or teas, and fruit drinks; and was derived from a self-administered food frequency questionnaire.
MAIN OUTCOME MEASURE
Mortality was ascertained via annual linkage with state- and nationwide mortality records and the National Death Index over 20 years.
STATISTICAL ANALYSIS
Multivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% CIs for assessing associations between SSB intake and mortality. Rare/never consumers were the comparator group.
RESULTS
There were a total of 14,143 deaths over 20 years (30.5% from cardiovascular disease; 29.2% from cancer). In women who consumed ≥ 7 servings/week of SSBs at baseline (4% of participants), the multivariable-adjusted HRs were not significant for all-cause, cardiovascular disease-specific, or cancer-specific mortality. Consuming ≥ 7 servings/week of baseline caloric soft drink was associated with a higher risk of all-cause (HR = 1.26, 95% CI 1.10 to 1.46; P for trend = 0.02) and cancer-specific (HR = 1.33, 95% CI 1.08 to 1.63; P for trend = 0.08) mortality. In secondary analyses, consuming ≥ 1.5 c/day of baseline SSBs was associated with all-cause mortality (HR = 1.12, 95% CI 1.02 to 1.24; P for trend = 0.01).
CONCLUSIONS
Although the baseline frequency of total SSB intake was not significantly associated with mortality, consuming ≥ 7 servings/week of caloric soft drinks was associated with higher risk of all-cause and cancer-specific mortality. Findings support public health efforts to reduce caloric soft drink consumption.
背景
含糖饮料（SSB）摄入与死亡率之间的关联证据相互矛盾，各种 SSB 亚类与死亡率之间的关联仍不清楚。
目的
研究基线 SSB 摄入量、SSB 摄入量的不同类型与女性死亡率之间的关系。
设计
前瞻性队列研究。
参与者/设置：加州教师研究（n=100314；中位年龄 53 岁）的参与者在基线时（1995-1996 年）无心血管疾病、癌症和糖尿病，从 1995 年随访至 2015 年。基线 SSB 摄入量定义为含热量软饮料（普通软饮料，不包括无糖苏打水）、加糖瓶装水或茶、和果汁饮料；并来自自我管理的食物频率问卷。
主要观察指标
死亡率通过每年与州和全国死亡率记录以及国家死亡索引的联系来确定，随访 20 年。
统计分析
多变量调整的 Cox 比例风险模型用于评估 SSB 摄入量与死亡率之间的关联，并生成风险比（HR）和 95%置信区间。罕见/从不消费的人群作为比较组。
结果
20 年内共有 14143 人死亡（30.5%死于心血管疾病；29.2%死于癌症）。在基线时每天饮用≥7 份 SSB（占参与者的 4%）的女性中，所有原因、心血管疾病特异性和癌症特异性死亡率的多变量调整 HR 均无显著差异。饮用≥7 份/周的基线含热量软饮料与全因（HR=1.26，95%CI 1.10-1.46；P 趋势=0.02）和癌症特异性（HR=1.33，95%CI 1.08-1.63；P 趋势=0.08）死亡率升高有关。在二次分析中，每天饮用≥1.5 杯 SSB 与全因死亡率有关（HR=1.12，95%CI 1.02-1.24；P 趋势=0.01）。
结论
尽管基线 SSB 总摄入量的频率与死亡率无显著关联，但每天饮用≥7 份含热量软饮料与全因和癌症特异性死亡率升高有关。研究结果支持减少含热量软饮料消费的公共卫生努力。
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