Postmenopausal Women at Higher Liver Cancer Risk from Sodas

Credit: Unsplash / Lee B. Vining

Older, postmenopausal women are at a higher risk of developing liver cancer and even dying from chronic liver disease when they drink at least one sugar-sweetened beverage daily.

According to new data from a team of US investigators, the rate of liver cancer was nearly doubled among postmenopausal women who drank at least one serving of beverage with sugar sweetener daily versus those who drank three or fewer every. The findings from the Women’s Health Initiative (WHI) cohort suggest there may be a biological pathway in postmenopausal that put them at higher risk of dangerous liver disease based on modifiable risk factors.

A team of investigators analyzed the link between sweetened beverage intake and the incidence of liver cancer and chronic liver disease deaths among postmenopausal women enrolled in the WHI from 1993 – 1998.

The incidence of annual liver cancer cases had increased three-fold among Americans from 1985 – 2015, investigators noted, with the increase of premeditating diseases including hepatitis B and C, type 2 diabetes, obesity, alcohol use disorder and aflatoxin contamination.

“Epidemiological studies on dietary factors and liver cancer and chronic liver disease mortality are limited,” they noted. “Therefore, it is important to identify dietary risk factors for liver cancer and chronic liver disease mortality.”

What’s more, sugar-sweetened beverages have been previously linked to heightened risk of breast, colorectal and prostate cancers. The impact of both sugar-sweetened and artificial-sweetened beverages on liver diseases remains poorly understood among humans—and what does exist in prior research has excluded the burden of disease in women.

The team conducted a prospective cohort analysis of nearly 100,000 postmenopausal women aged 50 – 79 years old from the WHI across 40 US clinical centers; participants were followed up to March 1, 2020. The original WHI excluded women participants with implausible total energy intake, a history of cancer at baseline, and those missing sugar-sweetened beverage intake or covariate data.

Investigators measured sugar-sweetened beverage intake based on a food frequency questionnaire administered to participants at baseline; relevant beverages included soft drinks and fruit drinks not including juice. They additionally measured artificially sweetened beverages at the three-year follow-up period.

The study’s primary outcomes were incidence of liver cancer and mortality due to chronic liver diseases including nonalcoholic fatty liver disease (NAFLD), liver fibrosis, cirrhosis, alcoholic liver diseases and chronic hepatitis.

The final cohort included 98,786 women; median follow-up was 20.9 years. In the observed time period, 207 women developed liver cancer and 148 died from chronic liver disease. Just 6.8 percent of women consumed at least one daily serving of sugar-sweetened beverage at baseline; 13.1 percent consumed at least one daily serving of artificially sweetened beverage at three-years follow-up.

Investigators observed 18.0 cases of liver cancer per 100,000 person-years among women who consumed at least one daily serving of sugar-sweetened beverages, versus 10.3 cases per 100,000 among women who consumed three or fewer servings of sugar-sweetened beverages monthly—indicating an 85 percent increased risk of liver cancer in the former group.

For chronic liver disease mortality, investigators observed 17.7 cases per 100,000 person-years among women who consumed at least one daily serving of sugar-sweetened beverages, versus 7.1 per 100,000 among women who consumed three or fewer servings of sugar-sweetened beverages monthly—indicating a 68 percent increased risk of death from chronic liver disease in the former group.

Women who consumed daily artificially sweetened beverages did not report significantly increased risks for neither liver cancer nor chronic liver disease mortality compared to those who consumed three or fewer artificially sweetened beverages monthly.

“Chronic liver disease was the fourth leading cause of death for women aged 45 to 54 years and the fifth leading cause of death for men aged 45 to 64 years in 2019 in the US,” investigators wrote. “However, evidence for the associations between diet and chronic liver disease mortality is limited. To our knowledge, this is the first study to report a positive association between sugar-sweetened beverage intake and chronic liver disease mortality.”

Investigators stressed their findings did not discern biologic pathways associating regular sugar-sweetened beverages with adverse liver outcomes—though the link of such beverages to obesity, blood glucose, liver fat accumulation and more biomarkers of liver disease risk may be explored.

“In postmenopausal women, compared with consuming three or fewer servings of sugar-sweetened beverages per month, people who consumed one or more sugar-sweetened beverages per day had higher rates of liver cancer and higher rates of death due to chronic liver disease,” they concluded. “Future studies should confirm these findings and identify the biological pathways of these associations.”

This article was originally published on sister site HCPLive.