Beigrezaei Sara, Raeisi-Dehkordi Hamidreza, Hernández Vargas Juliana Alexandra, Amiri Mojgan, Artola Arita Vicente, van der Schouw Yvonne T, Salehi-Abargouei Amin, Muka Taulant, Chatelan Angeline, Franco Oscar H
Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands.
Department of Epidemiology, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands.
Nutr Rev. 2025 Apr 1;83(4):663-674. doi: 10.1093/nutrit/nuae135.
Several effects of non-sugar-sweetened beverage (NSSBs) intake on health outcomes have been reported; however, the evidence on the association between NSSBs intake and chronic diseases and mortality risk is still inconclusive.
This umbrella review aimed to summarize the evidence on the association between NSSBs intake and the risk of chronic diseases and mortality.
Embase, ISI Web of Science, Cochrane Central, and PubMed were searched up to September 2023 for relevant meta-analyses of observational prospective cohort studies.
Two groups of researchers independently extracted study data and assessed the risk of bias for meta-analyses and primary studies.
Six meta-analyses, reporting 74 summary hazard ratios (HRs) for different outcomes obtained from 50 primary studies, were included. The summary HRs, 95% CIs, and certainty of evidence on the association of NSSBs intake with risk of chronic diseases and mortality were as follows: all-cause mortality (per 355 mL/d: 1.06 [1.01 to 1.10]; moderate certainty); stroke (per 250 mL/d: 1.09 [1.04 to 1.13]; high certainty); coronary heart disease (CHD) (per 250 mL/d: 1.06 [1.02 to 1.11]; high certainty); hypertension (HTN) (high vs low intake: 1.14 [1.09 to 1.18]; moderate certainty); type 2 diabetes (T2D) (high vs low intake: 1.16 [1.08 to 1.26]; low certainty); metabolic syndrome (MetS) (high vs low intake: 1.32 [1.22 to 1.43]; low certainty); colorectal cancer (high vs low intake: 0.78 [0.62 to 0.99]; moderate certainty); and leukemia (high vs low intake: 1.35 [1.03 to 1.77]; moderate certainty). For other outcomes, including the risk of cardiovascular and cancer mortality, chronic kidney diseases, breast cancer, prostate cancer, endometrial cancer, pancreatic cancer, multiple myeloma, and non-Hodgkin lymphoma, no association was found.
This study provides further evidence that NSSBs are associated with increased risk of all-cause mortality, stroke, CHD, HTN, T2D, MetS, and leukemia. Moreover, a higher intake of NSSBs was associated with a lower risk of colorectal cancer. However, it should be noted that the magnitudes of the associations are not large. Further studies are needed to clarify the long-term effects of different NSSBs intakes on health.
PROSPERO no. CRD42023429981.
已有报告指出非糖甜味饮料（NSSB）摄入对健康结局有多种影响；然而，关于NSSB摄入与慢性病及死亡风险之间关联的证据仍不确凿。
本系统评价旨在总结NSSB摄入与慢性病及死亡风险之间关联的证据。
截至2023年9月，检索了Embase、ISI科学网、Cochrane中心和PubMed，以获取观察性前瞻性队列研究的相关荟萃分析。
两组研究人员独立提取研究数据，并评估荟萃分析和原始研究的偏倚风险。
纳入了六项荟萃分析，报告了从50项原始研究中获得的74个不同结局的汇总风险比（HR）。NSSB摄入与慢性病及死亡风险之间关联的汇总HR、95%置信区间（CI）和证据确定性如下：全因死亡率（每355毫升/天：1.06[1.01至1.10]；中等确定性）；中风（每250毫升/天：1.09[1.04至1.13]；高确定性）；冠心病（CHD）（每250毫升/天：1.06[1.02至1.11]；高确定性）；高血压（HTN）（高摄入量与低摄入量相比：1.14[1.09至1.18]；中等确定性）；2型糖尿病（T2D）（高摄入量与低摄入量相比：1.16[1.08至1.26]；低确定性）；代谢综合征（MetS）（高摄入量与低摄入量相比：1.32[1.22至1.43]；低确定性）；结直肠癌（高摄入量与低摄入量相比：0.78[0.62至0.99]；中等确定性）；以及白血病（高摄入量与低摄入量相比：1.35[1.03至1.77]；中等确定性）。对于其他结局，包括心血管和癌症死亡风险、慢性肾脏病、乳腺癌、前列腺癌、子宫内膜癌、胰腺癌、多发性骨髓瘤和非霍奇金淋巴瘤，未发现关联。
本研究提供了进一步证据表明NSSB与全因死亡率、中风、CHD、HTN、T2D、MetS和白血病风险增加有关。此外，较高的NSSB摄入量与较低的结直肠癌风险有关。然而，应注意的是，这些关联的程度不大。需要进一步研究以阐明不同NSSB摄入量对健康的长期影响。
PROSPERO编号CRD42023429981。
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