Aug. 9, 2023 – Drinking sugar-laden beverages on a regular basis may greatly increase the risk that postmenopausal women may develop liver cancer or die from chronic liver disease, new research suggests.
The study found that women who are beyond menopause who consumed at least one sugar-sweetened beverage daily had an 85% higher risk of developing liver cancer and a 68% higher risk of dying from chronic liver disease, compared with those who consumed three servings or fewer per month.
But when looking at consumption of artificially sweetened drinks, Longgang Zhao, PhD, with Brigham and Women’s Hospital and Harvard Medical School in Boston, said researchers found no strong link between intake and risk of liver cancer or death from chronic liver disease. But, Zhao said, the sample size for that comparison was small and should be “interpreted with caution.”
The new study was published online Tuesday in the American Medical Association’s journal.
About 40% of people with liver cancer do not have one of the well-known disease risk factors, such as chronic hepatitis B or C infection, type 2 diabetes, or obesity. In the current analysis, Zhao and colleagues wanted to find out if sugar-sweetened or artificially sweetened beverages could be a risk factor for liver cancer or chronic liver disease.
Two previous studies have found only a “potential association” between sugar-sweetened beverages and a person’s risk of liver cancer, the authors explained.
Last month, the International Agency for Research on Cancer (IARC) officially classified the artificial sweetener aspartame as a possible carcinogen, but cancer epidemiologist Paul Pharoah, MD, PhD, said “the evidence that aspartame causes primary liver cancer, or any other cancer in humans, is very weak.”
To provide greater clarity about a potential link, the study team used the Women’s Health Initiative (WHI) to evaluate sugary beverage consumption among nearly 100,000 postmenopausal women and artificially sweetened drink intake among nearly 65,000 and followed them for nearly 21 years. The study looked at cases of liver cancer and death from chronic liver disease, defined as nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis.
(The WHI is a series of long-term national studies funded by the National Heart, Lung, and Blood Institute.)
Among these women, nearly 7% consumed at least one sugar-sweetened beverage daily and 13% consumed one or more artificially sweetened beverage servings daily.
Over the follow-up period, 207 women got liver cancer and 148 died from chronic liver disease in the sugary beverage group, while 133 women got liver cancer and 74 died from chronic liver disease in the artificial sugar group.
Compared with women who drank three servings or fewer of sugar-sweetened beverages per month, those who consumed one or more per day had a significantly higher risk of liver cancer and of dying from a chronic liver disease.
There was no significant difference in the groups who only had artificially sweetened drinks.
One of the authors, Xuehong Zhang, a doctor of science who’s also with Brigham and Women’s Hospital and Harvard Medical School, said it’s not surprising that sugar-sweetened beverages may raise the risk of adverse liver outcomes.
Sugary drinks can cause obesity, diabetes, and diseases of the heart and blood vessels, and they may drive insulin resistance and inflammation, all of which can lead to cancer and liver problems, Zhang said.
For Nancy S. Reau, MD, who was not involved in the research, the most important finding is the link between daily consumption of sugar-sweetened beverages and liver health.
“Regardless of whether this is a surrogate marker for liver disease risk (such as fatty liver disease) or a consequence of the drink itself, it is an easy measure for clinicians to capture and an easy behavior for patients to modify,” said Reau, a hepatologist at Rush Medical College in Chicago.
But, she said, “I do not feel that this article can be used to advocate for artificially sweetened beverages as a substitute.”
It is possible, she explained, that this population was too small to see a significant signal between artificially sweetened beverages and liver health. Plus, “natural, low-caloric beverages as part of a healthy diet combined with exercise are always going to be ideal.”
Weighing in as well, Dale Shepard, MD, PhD, a medical oncologist at the Cleveland Clinic, said not drinking too many sugary or artificially sweetened drinks is the best course of action, but other things, such as smoking, excessive alcohol, sun exposure without adequate sunscreen, obesity, and inactivity, “are more likely to increase one’s risk for cancer.