Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort

Magdalena Stepien, Talita Duarte-Salles, Veronika Fedirko, Antonia Trichopoulou, Pagona Lagiou, Christina Bamia, Kim Overvad, Anne Tjønneland, Louise Hansen, Marie Christine Boutron-Ruault, Guy Fagherazzi, Gianluca Severi, Tilman Kühn, Rudolf Kaaks, Krasimira Aleksandrova, Heiner Boeing, Eleni Klinaki, Domenico Palli, Sara Grioni, Salvatore PanicoRosario Tumino, Alessio Naccarati, H. Bas Bueno-de-Mesquita, Petra H. Peeters, Guri Skeie, Elisabete Weiderpass, Christine L. Parr, José Ramón Quirós, Genevieve Buckland, Esther Molina-Montes, Pilar Amiano, Maria Dolores Chirlaque, Eva Ardanaz, Emily Sonestedt, Ulrika Ericson, Maria Wennberg, Lena Maria Nilsson, Kay Tee Khaw, Nick Wareham, Kathryn E. Bradbury, Heather A. Ward, Isabelle Romieu, Mazda Jenab*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

49 Citations (Scopus)


Purpose: The aim of the study was to assess associations between intake of combined soft drinks (sugar sweetened and artificially sweetened) and fruit and vegetable juices and the risk of hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBC) and biliary tract cancers (GBTC) using data from the European Prospective Investigation into Cancer and Nutrition cohort of 477,206 participants from 10 European countries. Methods: After 11.4 years of follow-up, 191 HCC, 66 IHBC and 236 GBTC cases were identified. Hazard ratios and 95 % confidence intervals (HR; 95 % CI) were estimated with Cox regression models with multivariable adjustment (baseline total energy intake, alcohol consumption and intake pattern, body mass index, physical activity, level of educational attainment and self-reported diabetes status). Results: No risk associations were observed for IHBC or GBTC. Combined soft drinks consumption of >6 servings/week was positively associated with HCC risk: HR 1.83; 95 % CI 1.11–3.02, ptrend = 0.01 versus non-consumers. In sub-group analyses available for 91 % of the cohort artificially sweetened soft drinks increased HCC risk by 6 % per 1 serving increment (HR 1.06, 95 % CI 1.03–1.09, ncases = 101); for sugar-sweetened soft drinks, this association was null (HR 1.00, 95 % CI 0.95–1.06; ncases = 127, pheterogeneity = 0.07). Juice consumption was not associated with HCC risk, except at very low intakes (<1 serving/week: HR 0.60; 95 % CI 0.38–0.95; ptrend = 0.02 vs. non-consumers). Conclusions: Daily intake of combined soft drinks is positively associated with HCC, but a differential association between sugar and artificially sweetened cannot be discounted. This study provides some insight into possible associations of HCC with sugary drinks intake. Further exploration in other settings is required.

Original languageEnglish
Pages (from-to)7-20
Number of pages14
JournalEuropean Journal of Nutrition
Issue number1
Publication statusPublished - 1 Feb 2016
Externally publishedYes


  • Biliary tract cancers
  • Fruit and vegetable juice
  • Hepatocellular carcinoma
  • Prospective cohort
  • Soft drink


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