Comment on a study correlating sugary beverages to mortality

I am occasionally asked to comment on new studies that appear.  Practice Update: Diabetes asked for a comment on this study:

VS Malik, et al.  Long-Term Consumption of Sugar Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139:00–00. DOI: 10.1161/CIRCULATIONAHA.118.037401

The study concluded: “Consumption of SSBs [sugar-sweetened beverages] was positively associated with mortality primarily through CVD [cardiovascular disease] mortality and showed a graded association with dose. The positive association between high intake levels of ASBs [artificially sweetened beverages] and total and CVD mortality observed among women requires further confirmation.”

Here’s what I said:

This study is based on analyses of data from two remarkably large and long-standing investigations of diet and disease risk. The investigators looked for correlations between mortality and consumption of sugar-sweetened beverages (SSB) and found them. More than two SSB servings a day was associated with higher mortality, particularly from cardiovascular disease, and, to a lesser extent, cancer.

Thus, this study adds to the increasing body of evidence associating SSBs with poor health. SSBs provide calories, but nothing of nutritional value. Other studies correlate SSBs with obesity, type 2 diabetes, and heart disease. A further correlation with increased mortality is not surprising, but it is good to have it confirmed.

These results associate high intake of SSBs with disease risk, but cannot prove that SSBs causedisease. Epidemiological studies like these, based on self-reported dietary data, require careful interpretation. In part, this is because intake of SSBs tracks closely with other lifestyle characteristics. Heavy SSB users tend to be more sedentary, more likely to smoke, to consume more meat and calories, but to eat fewer vegetables than light users—overall, to have less healthy dietary habits in general. Still, reducing or eliminating SSB intake is harmless and could well improve health.