Association between Soft Drink Consumption and Mortality in 10 European Countries

Amy Mullee, Dora Romaguera, Jonathan Pearson-Stuttard, Vivian Viallon, Magdalena Stepien, Heinz Freisling, Guy Fagherazzi, Francesca Romana Mancini, Marie Christine Boutron-Ruault, Tilman Kühn, Rudolf Kaaks, Heiner Boeing, Krasimira Aleksandrova, Anne Tjønneland, Jytte Halkjær, Kim Overvad, Elisabete Weiderpass, Guri Skeie, Christine L. Parr, J. Ramón QuirósAntonio Agudo, Maria Jose Sánchez, Pilar Amiano, Lluís Cirera, Eva Ardanaz, Kay Tee Khaw, Tammy Y.N. Tong, Julie A. Schmidt, Antonia Trichopoulou, Georgia Martimianaki, Anna Karakatsani, Domenico Palli, Claudia Agnoli, Rosario Tumino, Carlotta Sacerdote, Salvatore Panico, Bas Bueno-De-Mesquita, W. M.Monique Verschuren, Jolanda M.A. Boer, Roel Vermeulen, Stina Ramne, Emily Sonestedt, Bethany Van Guelpen, Pernilla Lif Holgersson, Konstantinos K. Tsilidis, Alicia K. Heath, David Muller, Elio Riboli, Marc J. Gunter, Neil Murphy*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

162 Citations (Scopus)


Importance: Soft drinks are frequently consumed, but whether this consumption is associated with mortality risk is unknown and has been understudied in European populations to date. Objective: To examine the association between total, sugar-sweetened, and artificially sweetened soft drink consumption and subsequent total and cause-specific mortality. Design, Setting, and Participants: This population-based cohort study involved participants (n = 451743 of the full cohort) in the European Prospective Investigation into Cancer and Nutrition (EPIC), an ongoing, large multinational cohort of people from 10 European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom), with participants recruited between January 1, 1992, and December 31, 2000. Excluded participants were those who reported cancer, heart disease, stroke, or diabetes at baseline; those with implausible dietary intake data; and those with missing soft drink consumption or follow-up information. Data analyses were performed from February 1, 2018, to October 1, 2018. Exposure: Consumption of total, sugar-sweetened, and artificially sweetened soft drinks. Main Outcomes and Measures: Total mortality and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models adjusted for other mortality risk factors. Results: In total, 521 330 individuals were enrolled. Of this total, 451743 (86.7%) were included in the study, with a mean (SD) age of 50.8 (9.8) years and with 321081 women (71.1%). During a mean (range) follow-up of 16.4 (11.1 in Greece to 19.2 in France) years, 41693 deaths occurred. Higher all-cause mortality was found among participants who consumed 2 or more glasses per day (vs consumers of <1 glass per month) of total soft drinks (hazard ratio [HR], 1.17; 95% CI, 1.11-1.22; P <.001), sugar-sweetened soft drinks (HR, 1.08; 95% CI, 1.01-1.16; P =.004), and artificially sweetened soft drinks (HR, 1.26; 95% CI, 1.16-1.35; P <.001). Positive associations were also observed between artificially sweetened soft drinks and deaths from circulatory diseases (≥2 glasses per day vs <1 glass per month; HR, 1.52; 95% CI, 1.30-1.78; P <.001) and between sugar-sweetened soft drinks and deaths from digestive diseases (≥1 glass per day vs <1 glass per month; HR, 1.59; 95% CI, 1.24-2.05; P <.001). Conclusions and Relevance: This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

Original languageEnglish
Pages (from-to)1479-1490
Number of pages12
JournalJAMA Internal Medicine
Issue number11
Publication statusPublished - Nov 2019
Externally publishedYes


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