by Jenna Koroly, MS, RD, CSOWM, CDN
Sugar-sweetened products contain added sugars such as white sugar, brown sugar, honey, maple syrup, and agave. You may also see added sugar listed on ingredients lists as: cane juice, corn sweetener, high-fructose corn syrup, fruit juice concentrate and nectar, malt, and molasses [i]. Artificially-sweetened products are often labeled as “diet” or “sugar-free” and contain ingredients such as sucralose, aspartame, and saccharin. In the below study, the authors look at the association between sugar-sweetened beverages (SSBs) and artificially-sweetened beverages (ASBs) and cancer risk and mortality [ii].
Study
Sugar- and artificially-sweetened beverages and cancer mortality in a large U.S. prospective cohort
Journal: Cancer Epidemiology, Biomarkers & Prevention
Participants were women and men from the Cancer Prevention Study II prospective cohort. In 1982, over 900,000 participants reported SSB and ASB intake, and were followed through 2016. The authors looked at SSB and ASB intake and cancer mortality, obesity-related cancer risk, and 20 cancer types [ii].
Findings
The authors found:
- SSB intake of 2 or more drinks per day versus none was not associated with cancer mortality
- SSB intake of 2 or more drinks per day versus none was associated with increased risk of obesity-related cancers, which was not significant after controlling for BMI
- SSBs were associated with increased mortality from colorectal and kidney cancers
- ASBs were associated with obesity-related cancers, which was not significant after controlling for BMI, apart from pancreatic cancer [ii]
For the Patient and Caregiver
The recommendation for added sugar intake is no more than 6 teaspoons (25 grams) per day for females and no more than 9 teaspoons (36 grams) per day for males. You will be lower than this recommendation when eating mostly whole, unprocessed foods such as vegetables, fruit, whole grains, nuts and seeds, and lean meats, and beverages such as water, homemade brewed tea, and your own fruit-infused water. However, it is very easy to consume more added sugar, which can lead to overweight and obesity, when eating more packaged and processed snacks and beverages such as cookies, candy, soda, and juice. For example, one 12 ounce can of soda typically contains 38-41 grams of added sugar! If you are looking to add some flavor to your water, tea, or coffee, you may consider making a homemade fruit-infused water, using a flavorful tea bag such as ginger turmeric, or trying cinnamon in your coffee.
For the Healthcare Team
This study brings to light the relationship between sweetened beverages (both sugar and artificial sugar), weight, and cancer and cancer mortality risk. Obesity-related cancers include gastrointestinal, postmenopausal breast, endometrial, and kidney cancers. Educating patients on the relationship between excess consumption of sugar, obesity, and cancer risk is crucial. Encourage patients to drink more water and unsweetened tea in place of soda, juice, and energy drinks. Because evidence is inconclusive on artificial sweeteners, you may consider recommending flavoring water with lime, lemon, cucumber, or even ginger instead.
References:
[i] Mayo Clinic Staff. Artificial sweeteners and other sugar substitutes. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936
[ii] McCullough ML, Hodge RA, Campbell PT, Guinter MA, Patel AV (2022). Sugar- and artificially-sweetened beverages and cancer mortality in a large U.S. prospective cohort. Cancer Epidemiol Biomarkers Prev, OF1-OF12. https://doi.org/10.1158/1055-9965.EPI-22-0392