Sugar-sweetened beverages linked to colon cancer, mortality
Key Takeaways
Sugar-sweetened beverages (SSBs) represent the single largest source of added sugar in the American diet. Excess intake of added sugar is linked to several health risks, including type 2 diabetes and cardiovascular disease.
New research suggests excess sugar intake from SSBs is associated with an increased risk of proximal colon cancer and related mortality.
Clinicians should educate and counsel patients to understand the risks associated with SSBs and how to reduce intake of added sugars in foods and beverages.
In the US, sugar-sweetened beverages (SSBs) represent the single largest source of added sugar.[][] Intakes of added sugar are above the recommended cutoff levels in the US population, potentially contributing to certain health risks such as type 2 diabetes, hypertension, and even some forms of cancer.[][]
Epidemiological data on the association between the intake of SSBs and cancer risk are conflicting.[]
Consumption of fructose–a simple sugar found alongside glucose in SSBs–has been implicated in the risk of colon cancer recurrence and death associated with the disease.[][] However, there is limited evidence to suggest a significant association between SSB intake and CRC development.
In exclusive interviews with MDLinx, prominent US- and Korea-based researchers discussed the impact of SSB intake on colorectal cancer (CRC) incidence and mortality and the potential actions clinicians can take to reduce further risks associated with sugar consumption in their patients with the disease.
Effects on CRC incidence and mortality
Excess fructose extends to the proximal colon and declines along the colorectum.
Given that preclinical research demonstrates that high-fructose corn syrup consumption can enhance tumor growth in the intestines, researchers have hypothesized that SSBs may impact cancer growth in the proximal colon.[]
Research published in the American Journal of Clinical Nutrition shows that the consumption of SSBs and fructose is associated with a significant increase in the incidence and mortality of proximal colon cancer.[] The most pronounced risk of proximal colon cancer incidence was observed with SSBs and fructose intakes in the past 10 years.
The study was a retrospective analysis that included a total of 121,111 participants from the US-based Nurses' Health Study (1984-2014) and Health Professionals Follow-Up Study (1986-2014). While proximal colon cancer was reported, no association was found between the intake of SSBs and fructose with distal colon or rectum cancer incidence or mortality.
While patients in the study were followed from the 1980s to 2014, the treatment paradigm for CRC has transformed significantly during this period. Given this shift in the treatment landscape, mortality outcomes may be different in the modern era, but the researchers of the study did not discuss this in their paper.
Everyday impacts
In an MDLinx interview, lead study author Chen Yuan, ScD, explained that the study findings “offer convincing justification for the reduction or replacement of” SSB intake “as a strategy for the prevention of CRC incidence and mortality” in individuals of all ages.
"Added sugar intake has markedly increased during the past several decades."
— Chen Yuan, ScD
Yuan, who serves as an instructor in the department of medical oncology at the Dana-Farber Cancer Institute and Harvard Medical School, explained that insulin resistance, obesity, and type 2 diabetes are not only consequences of excess sugar intake, but they are also established risk factors for CRC.
"In our study, we have well controlled these factors, so our findings suggest an independent association between SSB intake and colorectal carcinogenesis."
— Chen Yuan, ScD
She suggested that nutritional assessment and counseling on SSBs and added sugar intake should be incorporated into CRC prevention strategies, given that current dietary guidelines primarily only recommend reduced sugar intake for the prevention of obesity, diabetes, and cardiovascular disease.
Informing management of patients with CRC
Corresponding study author Hee-Kyung Joh, MD, MPH, PhD, an associate professor at the Seoul National University College of Medicine, suggested in an MDLinx interview that clinicians can take an active role in counseling their patients with CRC in reducing sugar intake and that this action may have important implications for patient outcomes.
Joh noted that while not relevant to the study itself, the findings suggest clinicians educate their patients with CRC on how to read nutrition labels and identify the amount of added sugar in any given product.
She added that patients should aim for less than 10% of total daily calories coming from sugar and should choose unsweetened beverages such as water, unsweetened tea and coffee, sparkling water, and diet soda.
"As they consistently reduce their total sugar intake, they may notice their sweets cravings lessen or that certain foods now taste too sweet."
— Hee-Kyung Joh, MD, MPH, PhD
What this means for you
Studies show that consumption of SSBs is associated with potentially negative health consequences, including type 2 diabetes, hypertension, and some forms of cancer Now, new research suggests SSB intake may increase the risk of proximal colon cancer and proximal CRC-related mortality. Until further research confirms these findings, clinicians can counsel their patients on how to reduce added sugar intake from beverages and processed foods as a measure for disease prevention and better overall health—a habit that can positively affect change later in life, too.