Assessing the Link Between Sugary Drinks and Cancer

Over the past 2 decades, there has been an increase in the consumption of sugar worldwide, partly because of beverage marketing and growing urbanization.¹ This lifestyle is deeply rooted in western countries. Data from the United States National Health and Nutrition Examination Survey showed that the intake of sugar in the US population surpassed the recommended calorie intake, with the average intake of men and women aged 18 years and older being 1.5 and 2.8 greater, respectively.²

On average, half of the US population consumes sugary drinks on a given day, with data showing 1 in 4 people get at least 200 calories daily from sugary drinks.³ Consumption of sugary drinks regularly may be a major contributory factor to the epidemic of cancer, according to a study published by the British Medical Journal.⁴

According to the study, a sugary drink is more than 5% sugar, which includes sugar-sweetened beverages, soft drinks (carbonated or non-carbonated), fruit drinks, sports drinks, energy drinks, and 100% fruit juices. These beverages are the single most significant sources of calories in the United States.⁵

The study assessed the correlation between the consumption of sugary drinks and artificially sweetened beverages, plus the risk of overall cancer, breast cancer, prostate cancer, and colorectal cancers.

The result of the study found that a 100 mL/day increase in the consumption of sugary drinks is associated with an 18% increased risk of overall cancer and 22% increased risk of breast cancer. Surprisingly, the consumption of 100% fruit juice, despite the natural and overall healthy image in the population, was also significantly associated with the risk of overall cancer. Although the sample study was large, an even larger-scale replication is still required, according to the study authors.

Possible risk factors for cancer, including sex, age, family history of cancer, smoking status, and physical activity level, were taken into consideration; however, the connection between sugary drinks and cancer remained the same.

Sugary drinks promote the accumulation of fats in the visceral area through changes in the adipokine secretion and cell signal pathways. The increased visceral deposit plays a role in the development of cancer, independent of the body weight.

In the study, obesity and weight gain were not the only driving pointers for the association between sugary drinks and cancer. High simple sugar consumption is not only associated with obesity, but is also linked to type 2 diabetes, and insulin resistance, which are positive risk factors for the development of cancer.

Although it is necessary to carefully interpret the study, the findings add to the evidence showing that a reduction in the consumption of sugary drinks decreases the risk of overall cancer. The research team found no correlation between sugary drinks and prostate or colon cancer because few people in the study developed these cancers, making the findings less definitive.

According to the study authors, another possible link between sugar and cancer is the high glycemic index. Several sugary drinks contain advanced glycation end products, which can impair the epithelial function in patients with or without diabetics.

The increase in glycemic index raises postprandial blood glucose, which in turn increases the risk of cancer by stimulating the synthesis of insulin-like growth factor. A high glycemic index is associated with hyperinsulinemia and type 2 diabetes, which are both risk factors for the development of breast cancer.

Furthermore, the research team observed high sugar contents served as the driving link between sugar and cancer, with daily intake of sugar from drinks largely associated with cancer. Sugary drinks with low sugar contents that were consumed in higher amounts were also positively associated with cancer.

In contrast, the research found no link between the risk of cancer and consumption of coffee, artificially sweetened beverages, diet soda, and unsweetened tea.

In addition, sugary drinks contain an additive, 4-methylimidazole, found in drinks that contain caramel coloring, or artificial sweeteners such as aspartame, which may also play a role in carcinogenesis.⁵

Consuming sugar-sweetened beverages regularly is not healthy, as it is associated with diseases such as heart diseases, diabetes, and obesity. Interestingly, the metabolic alterations caused by the consumption of sugar has also been linked to the development of hepatocellular carcinoma.¹

REFERENCES

• Malik V., Willet W., Hu F. Global obesity: trends, risk factors, and policy implications. Nature Reviews Endocrinology. 2013; 9(1):13.
• Natasha T., Li J., and Nancy P. Sugars in diet and risk of cancer in the NIH-AARP Diet and Health Study. International Journal of Cancer. 2012; 130(1): 159-169.
• Ogden C., Kit B., Caroll M., Park S. Consumption of sugar drinks in the United States. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. 2011.
• Malik V., Matthas B., Frank B. Intake of sugar-sweetened beverages and weight gain: a systematic review. The American Journal of Clinical Nutrition. 2006; 84(2): 274-288.
• Eloi C., Bernard S., Elisa D., Mathilde T. et al. Sugary drink consumption and risk of cancer: results from NutriNet- Sante prospective cohort. BMJ, 2019;I2 408 DOI: 10. 1136/bmj.I2408