A new study looking at hundreds of thousands of individuals has linked higher consumption of soft drinks with greater risk of premature death. The researchers saw that the association held for both artificially and sugar sweetened drinks.

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Most soft drinks pose a health risk, and new research finds that two glasses of soft drinks per day may raise early death risk.

Because the findings are that of an observational study, they do not prove that regular soft drink consumption drives early death. However, the research team concludes that the results endorse health initiatives to reduce public consumption of such beverages.

A recent paper in JAMA Internal Medicine describes how the international study group analyzed data on 451,743 adults from 10 European countries.

The data came from the European Prospective Investigation into Cancer and Nutrition (EPIC).

EPIC is an ongoing cohort whose participants enlisted between 1992 and 2000 and who live in Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.

On enrolment, the participants gave information about their food and drink consumption, either by filling in questionnaires or in interviews. Their average age was 51 years old, and 71% were female. None had heart disease, cancer, diabetes, or stroke at the outset.

Of the participants taking part in the analysis, 41,693 died during a follow-up that averaged 16.4 years and ranged from 11.1 years in Greece to 19.2 years in France.

The researchers compared deaths during the follow-up in those who said that they drank soft drinks every day with those who said that they consumed hardly any — that is fewer than one glass per month.

The team defined one glass as 250 milliliters (8.5 fluid ounces). Soft drink consumption included drinking of fizzy soft drinks such as cola and lemonade; isotonic or energy drinks; diet and low-calorie soft fizzy drinks; and diluted syrups, such as fruit cordial or squash. Soft drink consumption did not include fruit juice.

Their analysis revealed that consuming two or more glasses per day of total, sugar sweetened, and artificially sweetened soft drinks was linked to a higher risk of death from all causes in comparison to consuming hardly any soft drinks. The team observed the link in both males and females.

At the study outset, the participants also answered questions about their health and lifestyle.

From this information, the researchers were able to rule out any influence from factors such as physical activity, body mass index (BMI), education, smoking, and diet.

A further analysis also revealed that in comparison to consuming hardly any, drinking two or more glasses per day of artificially sweetened soft drinks was tied to a higher risk of circulatory diseases.

In the cases of sugar sweetened soft drinks, the link was to a higher risk of death from digestive diseases.

“No association,” write the authors, “was observed between soft drink consumption and overall cancer death.”

In a discussion of the findings, the researchers note that regardless of whether they included or removed the potential influence of BMI, the results were unchanged.

They also found positive links between total, artificially, and sugar sweetened soft drinks with deaths from all causes, as well as deaths from circulatory and digestive diseases among participants whose BMI was in the healthy range.

Such results would suggest that the links that they observed were likely not related to body fat. They support the idea that the link between soft drinks and premature death occurs through other routes.

In a comment to the Reuters news organization, study co-author Neil Murphy, Ph.D., of the Section of Nutrition and Metabolism at the International Agency for Research on Cancer, in Lyon, France, suggests that “high soft drink consumption may be a marker of overall unhealth[ful] diet.”

According to the Centers for Disease Control and Prevention (CDC), there is an association between the consumption of sugar sweetened beverages and less healthful behaviors in the United States.