{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:34:50Z","timestamp":1789396490966,"version":"build-2803163510"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,8,8]]},"abstract":"\n Importance<\/jats:title>\n Approximately 65% of adults in the US consume sugar-sweetened beverages daily.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To study the associations between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A prospective cohort with 98\u202f786 postmenopausal women aged 50 to 79 years enrolled in the Women\u2019s Health Initiative from 1993 to 1998 at 40 clinical centers in the US and were followed up to March 1, 2020.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Sugar-sweetened beverage intake was assessed based on a food frequency questionnaire administered at baseline and defined as the sum of regular soft drinks and fruit drinks (not including fruit juice); artificially sweetened beverage intake was measured at 3-year follow-up.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were (1) liver cancer incidence, and (2) mortality due to chronic liver disease, defined as death from nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence and for chronic liver disease mortality, adjusting for potential confounders including demographics and lifestyle factors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n During a median follow-up of 20.9 years, 207 women developed liver cancer and 148 died from chronic liver disease. At baseline, 6.8% of women consumed 1 or more sugar-sweetened beverage servings per day, and 13.1% consumed 1 or more artificially sweetened beverage servings per day at 3-year follow-up. Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100\u202f000 person-years [\n P<\/jats:italic>\n value for trend\u2009=\u2009.02]; adjusted HR, 1.85 [95% CI, 1.16-2.96];\n P<\/jats:italic>\n \u2009=\u2009.01) and chronic liver disease mortality (17.7 vs 7.1 per 100\u202f000 person-years [\n P<\/jats:italic>\n value for trend\u2009&amp;lt;.001]; adjusted HR, 1.68 [95% CI, 1.03-2.75];\n P<\/jats:italic>\n \u2009=\u2009.04). Compared with intake of 3 or fewer artificially sweetened beverages per month, individuals who consumed 1 or more artificially sweetened beverages per day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100\u202f000 person-years [\n P<\/jats:italic>\n value for trend\u2009=\u2009.70]; adjusted HR, 1.17 [95% CI, 0.70-1.94];\n P<\/jats:italic>\n \u2009=\u2009.55) or chronic liver disease mortality (7.1 vs 5.3 per 100\u202f000 person-years [\n P<\/jats:italic>\n value for trend\u2009=\u2009.32]; adjusted HR, 0.95 [95% CI, 0.49-1.84];\n P<\/jats:italic>\n \u2009=\u2009.88).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In postmenopausal women, compared with consuming 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more sugar-sweetened beverages per day had a higher incidence of liver cancer and death from chronic liver disease. Future studies should confirm these findings and identify the biological pathways of these associations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.12618","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T11:19:33Z","timestamp":1691493573000},"page":"537","source":"Crossref","is-referenced-by-count":89,"title":["Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality"],"prefix":"10.1001","volume":"330","author":[{"given":"Longgang","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia"},{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mace","family":"Coday","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Mossavar-Rahmani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle J.","family":"Naughton","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Lopez-Pentecost","sequence":"additional","affiliation":[{"name":"Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazmus","family":"Saquib","sequence":"additional","affiliation":[{"name":"College of Medicine, Sulaiman Alrajhi University, Bukariyah, Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladdin H.","family":"Shadyab","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Simon","sequence":"additional","affiliation":[{"name":"Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan"},{"name":"Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda G.","family":"Snetselaar","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Public Health, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred K.","family":"Tabung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center-James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus"},{"name":"Division of Epidemiology, College of Public Health, The Ohio State University, Columbus"},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre K.","family":"Tobias","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Harvard T.H. 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