Association of sugary drink consumption with all-cause and cause-specific mortality: the Japan Public Health Center-based Prospective Study

The Relationship Between Major Food Sources of Fructose and Cardiovascular Outcomes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

There is emerging evidence of associations between intake of sugar-sweetened beverages (SSBs), those that include various forms of added sugar, and increased risk of cardiovascular disease (CVD) but whether consumption of other dietary sources of fructose affects CVD is unclear. In this study, we conducted a meta-analysis to examine potential dose-response relationships between such foods and CVD, coronary heart disease (CHD), and stroke morbidity and mortality. We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library from the inception of each database to February 10, 2022. We included prospective cohort studies analyzing the association between at least 1 dietary source of fructose and CVD, CHD, and stroke. Based on data from 64 included studies, summary HRs and 95% CIs were calculated for the highest intake category compared with the lowest, and dose-response analyses were performed. Of all fructose sources examined, only SSB intakes showed positive associations with CVD, giving summary HRs per 250 mL/d increase of 1.10 (95% CI: 1.02, 1.17) for CVD, 1.11 (95% CI: 1.05, 1.17) for CHD, 1.08 (95% CI: 1.02, 1.13) for stroke morbidity, and 1.06 (95% CI: 1.02, 1.10) for CVD mortality. Conversely, 3 dietary sources showed protective associations: between fruits and CVD morbidity (HR: 0.97; 95% CI: 0.96, 0.98), fruits and CVD mortality (HR: 0.94; 95% CI: 0.92, 0.97), yogurt and CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99), and breakfast cereals and CVD mortality (HR: 0.80; 95% CI: 0.70, 0.90). All these relationships were linear except for fruit, which was J-shaped: CVD morbidity was the lowest at 200 g/d and there was no protective association above 400 g/d. These findings indicate that the adverse associations between SSBs and CVD, CHD, and stroke morbidity and mortality do not extend to other dietary sources of fructose. The food matrix seemed to modify the association between fructose and cardiovascular outcomes.

Sugary drink consumption and the subsequent risk of gastric cancer: The Japan Public Health Center-based Prospective Study

BACKGROUND/OBJECTIVES

Evidence on the association between sugary drink consumption and gastric cancer (GC) risk is limited, especially in Asian populations. This study aimed to investigate the association between consumption of sugary drinks (sugar-sweetened beverages and 100% fruit juices) and GC risk in a Japanese population.

SUBJECTS/METHODS

This study included 74,455 Japanese individuals aged 45-74 years (35,102 males and 39,353 females) who participated in a population-based cohort study (Japan Public Health Center-based Prospective Study). Sugary drinks were assessed using a food frequency questionnaire. Cox proportional hazard regression was used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of GC incidence according to the quintile of sugary drink consumption.

RESULTS

We identified 2141 patients with GC cases during 16.7 years of follow-up. Sugary drink consumption was not associated with GC risk. The multivariate HR of total, cardia, and non-cardia GC in the highest vs. lowest quintile of sugary drinks consumption in males was 0.98 (95% CI: 0.82-1.17; p-trend 0.48), 0.48 (95% CI: 0.23-0.99; p-trend 0.03), and 1.03 (95% CI: 0.86-1.24; p-trend 0.88), respectively. In females, the respective multivariate HRs were 1.03 (95% CI: 0.79-1.33; p-trend 0.47), 1.28 (95% CI: 0.32-5.12; p-trend 0.53), and 1.01 (95% CI: 0.78-1.32; p-trend 0.56). The results did not change significantly after adjusting for Helicobacter pylori infection and atrophic gastritis status in the subgroup analysis.

CONCLUSIONS

In this Japanese prospective cohort study, sugary drink consumption was not associated with GC risk.

The Lifelong Health Support 10: a Japanese prescription for a long and healthy life

BACKGROUND

Although the age-adjusted incidence and mortality of cancer and cardiovascular disease (CVD) have been decreasing steadily in Japan, both diseases remain major contributors to morbidity and mortality along with the aging society. Herein, we aim to provide a prescription of 10 health tips for long and healthy life named the "Lifelong Health Support 10 (LHS10)."

METHOD

The LHS10 was developed by the preventive medicine specialists at the National Cerebral and Cardiovascular Center in Suita, where it has been used for health guidance to prevent CVD, cancer, and cognitive decline in addition to their major risk factors such as hypertension, diabetes, and obesity. It consisted of the lifestyle modification recommendations of the 2014 Japanese Society of Hypertension guidelines and the 2017 Japan Atherosclerosis Society Guidelines for preventing atherosclerotic CVD. Further, it came in line with other international lifestyle modification guidelines. In this narrative review, we summarized the results of several Japanese epidemiological studies investigating the association between the LHS10 items and the risk of cancer, CVD, and other chronic diseases including dementia, diabetes, and chronic kidney disease.

RESULTS

The LHS10 included avoiding smoking and secondhand smoke exposure, engaging in physical activity, refraining from excessive alcohol drinking, reducing fried foods and sugary soft drinks, cutting salt in food, consuming more vegetables, fruits, fish, soy foods, and fibers, and maintaining proper body weight. All items of the LHS10 were shown to reduce the risk of cancer, CVD, and other chronic diseases.

CONCLUSIONS

The LHS10 can be a helpful tool for health guidance.

Sugary drink consumption and risk of kidney and bladder cancer in Japanese adults

Globally, sugary drinks are widely consumed, however, few epidemiologic studies have investigated the association between sugary drink consumption and risk of kidney and bladder cancer. We examined the association of sugary drinks with risk of kidney and bladder cancer in 73,024 participants from the Japan Public Health Center-based Prospective Study who reported no history of cancer. Sugary drink consumption was assessed using a validated food frequency questionnaire at study baseline (1995–1999). Individuals were followed to December 31, 2013. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs). During 1,069,815 person years of follow-up, 169 kidney cancer and 297 bladder cancer cases were documented. After adjusting for potential confounders, no greater risk of kidney and bladder cancer was observed. However, sugary drink consumption was positively associated with the risk of kidney cancer (HR for 100 ml/day increase in consumption was 1.11 [95% CI 1.01–1.22]) and bladder cancer (HR for 100 ml/d increase in consumption was 1.11 [95% CI 1.01–1.22]) among women after exclusion of cases diagnosed in the first three years of follow-up. In this large prospective cohort, consumption of sugary drinks was significantly associated with a small increase in hazard ratio for kidney and bladder cancer among women after exclusion of cases diagnosed within the first three years.