"Sugar-Sweetened Beverages" Is an Independent Risk From Pancreatic Cancer: Based on Half a Million Asian Cohort Followed for 25 Years

Chien Hua Chen; Min Kuang Tsai; June Han Lee; Ro-Ting Lin; Chung Y Hsu; Christopher Wen; Xifeng Wu; Ta-Wei Chu; Chi Pang Wen

doi:10.3389/fonc.2022.835901

"Sugar-Sweetened Beverages" Is an Independent Risk From Pancreatic Cancer: Based on Half a Million Asian Cohort Followed for 25 Years

Front Oncol. 2022 Apr 7:12:835901. doi: 10.3389/fonc.2022.835901. eCollection 2022.

Authors

Chien Hua Chen^{1

2

3}, Min Kuang Tsai⁴, June Han Lee⁴, Ro-Ting Lin⁵, Chung Y Hsu⁶, Christopher Wen⁷, Xifeng Wu^{8

9}, Ta-Wei Chu^{10

11}, Chi Pang Wen^{4

6}

Affiliations

¹ Digestive Disease Center, Changbing Show-Chwan Memorial Hospital, Lukang, Taiwan.
² Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
³ Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan.
⁴ Institue of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
⁵ College of Public Health, China Medical University, Taichung, Taiwan.
⁶ Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
⁷ Long Beach VAMC Hospital, University of Irvine Medical Center, Irvine, CA, United States.
⁸ Center for Biostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
⁹ National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China.
¹⁰ Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹¹ Taipei MJ Health Screening Center, Taipei, Taiwan.

Abstract

Although the link between sugar-sweetened beverages (SSB) and pancreatic cancer has been suggested for its insulin-stimulating connection, most epidemiological studies showed inconclusive relationship. Whether the result was limited by sample size is explored. This prospective study followed 491,929 adults, consisting of 235,427 men and 256,502 women (mean age: 39.9, standard deviation: 13.2), from a health surveillance program and there were 523 pancreatic cancer deaths between 1994 and 2017. The individual identification numbers of the cohort were matched with the National Death file for mortality, and Cox models were used to assess the risk. The amount of SSB intake was recorded based on the average consumption in the month before interview by a structured questionnaire. We classified the amount of SSB intake into 4 categories: 0-<0.5 serving/day, ≥0.5-<1 serving per day, ≥1-<2 servings per day, and ≥2 servings per day. One serving was defined as equivalent to 12 oz and contained 35 g added sugar. We used the age and the variables at cohort enrolment as the reported risks of pancreatic cancers. The cohort was divided into 3 age groups, 20-39, 40-59, and ≥60. We found young people (age <40) had higher prevalence and frequency of sugar-sweetened beverages than the elderly. Those consuming 2 servings/day had a 50% increase in pancreatic cancer mortality (HR = 1.55, 95% CI: 1.08-2.24) for the total cohort, but a 3-fold increase (HR: 3.09, 95% CI: 1.44-6.62) for the young. The risk started at 1 serving every other day, with a dose-response relationship. The association of SSB intake of ≥2 servings/day with pancreatic cancer mortality among the total cohort remained significant after excluding those who smoke or have diabetes (HR: 2.12, 97% CI: 1.26-3.57), are obese (HR: 1.57, 95% CI: 1.08-2.30), have hypertension (HR: 1.90, 95% CI: 1.20-3.00), or excluding who died within 3 years after enrollment (HR: 1.67, 95% CI: 1.15-2.45). Risks remained in the sensitivity analyses, implying its independent nature. We concluded that frequent drinking of SSB increased pancreatic cancer in adults, with highest risk among young people.

Keywords: cohort; incidence; mortality; pancreatic cancer; sugar-sweetened beverages.