Daily Sugar-Sweetened Beverage Intake Linked to Higher Risk of Liver and Gastric Cancers
核心洞察
A pooled analysis of 1.5 million individuals found one sugar-sweetened beverage per day raised hepatocellular carcinoma (搜索) risk by 10% and intrahepatic cholangiocarcinoma (搜索) risk by 15%.
A Mass General Brigham study of 112,284 adults found daily sugar-sweetened beverage consumption associated with a 2.45-fold higher risk of gastric cancer (搜索).
Artificially sweetened beverages (搜索) showed no significant increase in risk for liver or gastric cancer (搜索) after adjusting for confounders such as diabetes and BMI.
Consuming sugar-sweetened beverages (搜索) on a daily basis may significantly increase the risk for specific types of liver and gastric cancer (搜索), according to two large prospective analyses, while artificially sweetened beverages (搜索) showed no significant association with increased risk.
A pooled analysis of 11 prospective cohort studies including more than 1.5 million participants found that individuals who drank one sugar-sweetened beverage per day had a 10% greater risk for hepatocellular carcinoma (搜索) (HCC) and a 15% greater risk for intrahepatic cholangiocarcinoma (搜索) (ICC). Separately, a Mass General Brigham study analyzing data from 112,284 participants found that consuming at least one sugar-sweetened beverage per day was associated with a 2.45-fold higher risk of gastric cancer (搜索) compared with consuming less than one serving per month.
Sugar-Sweetened Beverages and Liver Cancer
The pooled analysis, led by Cody Z. Watling, DPhil, a postdoctoral fellow in the division of cancer epidemiology and genetics at the National Cancer Institute (NCI), examined associations between intake of artificially sweetened and sugar-sweetened beverages (搜索) and the risk of total liver cancer, HCC, and ICC.
The study included 1,518,411 participants with no history of cancer (mean age, 57.8 years; standard deviation, 10.1; 58.2% women; mean BMI, 26.5 kg/m², standard deviation, 5). Enrollment across cohorts stretched from 1980 to 2009, with a median follow-up of 17.8 years. Incident liver cancer, HCC, and ICC served as the primary endpoint.
Watling and colleagues found sugar-sweetened beverages (搜索) had a significant association with both HCC (HR per 1 drink/day intake = 1.1; 95% CI, 1.03–1.18) and ICC (HR per 1 beverage/day intake = 1.15; 95% CI, 1–1.32), but not overall liver cancer.
In contrast, researchers did not observe a significant association between artificially sweetened beverages (搜索) and liver cancer, HCC, or ICC. "In models not adjusted for diabetes or BMI, we observed positive associations between artificially sweetened beverage consumption and liver cancer risk, but after adjustment for these confounders was made, outcomes were attenuated and there were no longer associations," the researchers wrote. They noted that participants who consumed one or more artificially sweetened beverages per day were more likely to have been diagnosed with diabetes and have a higher BMI at baseline than those who never or rarely consumed such beverages.
"The overall evidence for an association in humans between artificially sweetened beverages (搜索) and liver cancer, and more specifically aspartame and HCC, is not strongly supported by these analyses," Watling and colleagues wrote. "Based on this study and prior research associating sugar-sweetened beverages (搜索) with adverse outcomes, individuals may benefit from reducing their intake of sugar-sweetened beverages."
Sugar-Sweetened Beverages and Gastric Cancer
The Mass General Brigham study, published in the journal Gastro Hep Advances, analyzed data from 112,284 participants in the Nurses' Health Study and Health Professionals Follow-Up Study. During the follow-up period, which spanned decades, 278 participants developed gastric cancer (搜索).
"This is the first study to demonstrate an association between sugar-sweetened beverage intake and gastric cancer (搜索) in a U.S. population," said senior author Andrew T. Chan, MD, MPH, a gastroenterologist and epidemiologist with the Mass General Brigham Cancer Institute (搜索). "Gastric cancer is the fifth leading cause of cancer death worldwide, but we've known very little about how diet might contribute to this cancer."
After accounting for other potential risk factors, participants who consumed at least one serving of a sugar-sweetened beverage per day had a 2.45 times higher risk of gastric cancer (搜索) compared with those who consumed less than one serving per month. The association was observed in both women and men. Higher total fructose intake—fructose being the main sweetener in these drinks—was also associated with greater gastric cancer incidence. Among women in the Nurses' Health Study, consuming more than one such beverage per day was associated with a 3.04-fold higher risk of gastric cancer compared with those who very rarely consumed sugar-sweetened beverages (搜索).
Researchers defined sugar-sweetened beverages (搜索) as carbonated beverages, punch, lemonade, and sports drinks, while artificially sweetened beverages (搜索) were defined as low-calorie carbonated beverages. After controlling for other factors, higher consumption of artificially sweetened beverages was not associated with a higher incidence of gastric cancer (搜索).
Context and Unmet Need
Global liver cancer diagnoses are projected to increase 55% by 2040, according to study background. In the U.S., more than 42,000 individuals are expected to be diagnosed in 2026, and nearly 31,000 will die from the disease, according to the American Cancer Society's Cancer Statistics 2026 report.
Common risk factors for HCC, the most diagnosed form of the disease, include chronic hepatitis B or C virus infection, excessive alcohol use, smoking, metabolic dysfunction-associated steatotic liver disease (MASLD), obesity, and diabetes. "However, an estimated 35% of HCC cases are not explained by known risk factors," the researchers wrote.
Approximately 65% of U.S. adults report consuming one or more sugar-sweetened beverages (搜索) every day, according to the Mass General Brigham study. Previous studies have linked sugar-sweetened beverages with an increased risk of colorectal, breast, and liver cancers, but evidence on gastric cancer (搜索) had been limited.
Study Limitations
Both studies acknowledged important limitations. The liver cancer analysis relied on self-reported consumption of artificially sweetened and sugar-sweetened beverages (搜索) and could not stratify for underlying liver disease, including MASLD. "It remains unclear whether increased consumption of sugar-sweetened beverages contributes to increased risk of HCC independent of obesity and diabetes," the researchers wrote.
The gastric cancer (搜索) study noted its observational design, limited information on Helicobacter pylori (H. pylori) status and family history of gastric cancer, and a predominantly white participant population that limited the ability to examine differences across racial and ethnic groups. In a subset of 940 participants assessed for H. pylori status, just over one third had evidence of infection, but there was no association between sugar-sweetened beverage consumption and infection.
"To our knowledge, this is the largest study to date to assess the association of artificially sweetened beverage and sugar-sweetened beverage intake with liver cancer risk," Watling and colleagues wrote. The Mass General Brigham researchers said further studies are needed to confirm the findings and investigate why these beverages might increase gastric cancer (搜索) risk.