Soft drinks consumption and mortality in 10 European countries: a multinational cohort study

IMPORTANCE: Soft drinks are frequently consumed but if they are associated with mortality risk in European populations is unknown. OBJECTIVE: To examine the association between total, sugar-sweetened, and artificially-sweetened soft drinks consumption and subsequent total and cause-specific mortality. DESIGN: Population based prospective cohort study. SETTING: 10 European countries. PARTICIPANTS: 451,743 men and women from the European Prospective Investigation into Cancer and Nutrition. EXPOSURE: Soft drinks consumption (total, sugar-sweetened, artificially-sweetened). MAIN OUTCOMES AND MEASURES: Total and cause-specific mortality. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using multivariable Cox proportional hazards models adjusted for other mortality risk factors. RESULTS: During a mean follow up of 16.4 years, 41,693 deaths occurred. Higher all-cause mortality was found for participants consuming ≥2 glasses/day (versus consumers of <1 glass/ month) of total soft drinks (hazard ratio [HR]=1.17; 95%CI 1.11-1.22; P-trend<.0001), sugar-sweetened soft drinks (HR=1.08; 95%CI, 1.01-1.16; P-trend=0.004), and artificially-sweetened soft drinks (HR=1.26; 95%CI, 1.16-1.35; P-trend<.0001). Positive associations were also observed for artificially-sweetened soft drinks with deaths from circulatory diseases (≥2 glasses/day versus <1 glass/ month, HR=1.52; 95%CI, 1.30-1.78; P-trend<.0001), and for sugar-sweetened soft drinks with deaths from digestive diseases (≥1 glass/day versus <1 glass/month, HR=1.59; 95%CI, 1.24-2.05; P-trend<.0001). CONCLUSION AND RELEVANCE: In this large prospective European cohort, consumption of total, sugar-sweetened, and artificially-sweetened soft drinks was positively associated with all-cause deaths. These results support public health campaigns aimed at limiting the consumption of soft drinks.