Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, No. 199 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
Int J Behav Nutr Phys Act. 2023 May 15;20(1):58. doi: 10.1186/s12966-023-01459-5.
Studies of the associations between soft drinks and the risk of cancer showed inconsistent results. No previous published systematic reviews and meta-analysis has investigated a dose-response association between exposure dose and cancer risk or assessed the certainty of currently available evidence. Therefore, we aim to demonstrate the associations and assessed the certainty of the evidence to show our confidence in the associations.
We searched Embase, PubMed, Web of Science, and the Cochrane Library from inception to Jun 2022, to include relevant prospective cohort studies. We used a restricted cubic spline model to conduct a dose-response meta-analysis and calculated the absolute effect estimates to present the results. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence.
Forty-two articles including on 37 cohorts enrolled 4,518,547 participants were included. With low certainty evidence, increased consumption of sugar-sweetened beverages (SSBs) per 250 mL/day was significantly associated with a 17% greater risk of breast cancer, a 10% greater risk of colorectal cancer, a 30% greater risk of biliary tract cancer, and a 10% greater risk of prostate cancer; increased consumption of artificially sweetened beverages (ASBs)re per 250 mL/day was significantly associated with a 16% greater risk of leukemia; increased consumption of 100% fruit juice per 250 mL/day was significantly associated with a 31% greater risk of overall cancer, 22% greater risk of melanoma, 2% greater risk of squamous cell carcinoma, and 29% greater risk of thyroid cancer. The associations with other specific cancer were no significant. We found linear dose-response associations between consumption of SSBs and the risk of breast and kidney cancer, and between consumption of ASBs and 100% fruit juices and the risk of pancreatic cancer.
An increment in consumption of SSBs of 250 mL/day was positively associated with increased risk of breast, colorectal, and biliary tract cancer. Fruit juices consumption was also positively associated with the risk of overall cancer, thyroid cancer, and melanoma. The magnitude of absolute effects, however, was small and mainly based on low or very low certainty of evidence. The association of ASBs consumption with specific cancer risk was uncertain.
PROSPERO: CRD42020152223.
关于软饮料与癌症风险之间关联的研究结果并不一致。此前尚无发表的系统评价和荟萃分析调查过暴露剂量与癌症风险之间的剂量-反应关联，也没有评估当前可用证据的确切性。因此，我们旨在展示这些关联，并评估证据的确切性，以表明我们对这些关联的信心。
我们从建库至 2022 年 6 月在 Embase、PubMed、Web of Science 和 Cochrane Library 中进行了检索，以纳入相关的前瞻性队列研究。我们使用限制立方样条模型进行了剂量-反应荟萃分析，并计算了绝对效应估计值来呈现结果。采用推荐评估、制定与评价（GRADE）方法来评估证据的确切性。
共纳入 42 篇文章中的 37 项队列研究，共纳入 4518547 名参与者。基于低确定性证据，每天每增加 250 毫升含糖饮料（SSB）的摄入量与乳腺癌风险增加 17%、结直肠癌风险增加 10%、胆道癌风险增加 30%和前列腺癌风险增加 10%显著相关；每天每增加 250 毫升人工甜味饮料（ASB）的摄入量与白血病风险增加 16%显著相关；每天每增加 250 毫升 100%纯果汁的摄入量与总体癌症风险增加 31%、黑色素瘤风险增加 22%、鳞状细胞癌风险增加 2%和甲状腺癌风险增加 29%显著相关。其他特定癌症的相关性无统计学意义。我们发现 SSB 的摄入量与乳腺癌和肾癌风险之间以及 ASB 和 100%纯果汁的摄入量与胰腺癌风险之间存在线性剂量-反应关系。
每天增加 250 毫升 SSB 的摄入量与乳腺癌、结直肠癌和胆道癌风险的增加呈正相关。果汁的摄入量也与总体癌症、甲状腺癌和黑色素瘤的风险呈正相关。然而，绝对效应的幅度较小，且主要基于低或极低确定性的证据。ASB 摄入量与特定癌症风险的关联尚不确定。
PROSPERO：CRD42020152223。
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