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Association of sugar-sweetened beverages with the risk of colorectal cancer: a systematic review and meta-analysis

European Journal of Clinical Nutrition volume 77, pages 941–952 (2023)Cite this article

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Abstract

The association between sugar-sweetened beverages intake and colorectal cancer (CRC) remains controversial. A metaanalysis was performed to clarify the correlation between sugar-sweetened beverages and CRC risk/mortality. A systematic literature search was conducted in PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Sinomed (CBM), Wanfang Data Knowledge Service Platform, and China Science and Technology Journal VIP database. Articles were restricted to be available in any language until March 31, 2022. The highest exposed categories were used to calculate the pooled relative risks (RR) values. Pooled relative risks (RR) and 95% confidence intervals (CI) were used to estimate the association of sugar-sweetened beverages with CRC risk and mortality. Heterogeneity was assessed with the Cochran Q statistic and quantified with the I2 statistic. A total of 17 studies (6 case–control and 11 cohort) involving 557,391 subjects were included in this meta-analysis. The pooled RRs for CRC incidence and mortality among people taking sugar-sweetened beverages were 1.17 (95% CI: 1.07–1.28) and 1.13 (95% CI: 0.99–1.29), respectively. In subgroup analysis, a correlation was found in the distal colon with a pooled RR of 1.41 (95% CI: 1.10–1.80). There was no correlation in the proximal colon with a pooled RR of 1.58 (95% CI: 0.79–3.17). We found statistically significant associations between CRC incidence and sugar-sweetened beverages intake in North America and Oceania, with pooled RRs of 1.16 (95% CI: 1.00–1.33) and 1.32 (95% CI: 1.13–1.55), respectively. In sensitivity analysis, after excluding each study and calculating heterogeneity and effect sizes, there was still a correlation between sugar-sweetened beverages intake and CRC risk. This meta-analysis suggests that sugar-sweetened beverages intake may increase CRC risk, independent of CRC mortality. Whether CRC risk increases with increased sugar-sweetened beverage intake needs further investigation in the future.

This meta-analysis aimed to indicate the relationship between sugar-sweetened beverages intake and the risk and mortality of colorectal cancer. A total of 17 studies involving 557,391 subjects were included. The results showed that sugar-sweetened beverages may increase the risk of colorectal cancer but may not be associated with colorectal cancer mortality.

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Fig. 1: Flow diagram of the study search and selection process.
Fig. 2: Forest plot for sugar-sweetened beverages intake and CRC incidence [20,21,22,23,24, 31,32,33,34,35,36,37,38,39].
Fig. 3: Forest plot for sugar-sweetened beverages intake and CRC mortality [40,41,42].
Fig. 4
Fig. 5: For the sensitivity analysis graph of 14 studies [20,21,22,23,24, 31,32,33,34,35,36,37,38,39].
Fig. 6: Funnel plot of 14 studies.
Fig. 7
Fig. 8: Funnel plot of three studies.
Fig. 9

Data availability

All data generated or analyzed during this study are included in this published article (and its Supplementary Information files).

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Author notes

  1. These authors contributed equally: Linya Feng, Juan Gao, Weihang Xia.

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui, 230032, PR China

    Linya Feng, Juan Gao, Weihang Xia, Shaodi Ma, Birong Wu, Peng Xie & Haixia Liu

  2. Internal Medicine, Swedish Hospital, 5140 N California Ave, Chicago, IL, 60625, USA

    Yaru Li

  3. College of Osteopathic Medicine, Des Moines University, 3200 Grand Ave, Des Moines, IA, 50312, USA

    Yaru Li

  4. College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA

    Scott Lowe & Rachel Bentley

  5. Department of Oral and Maxillofacial Surgery, University at Buffalo, 320 Hayes Rd, Buffalo, New York, NY, 14215, USA

    Vicky Yau

  6. Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia

    Zhen Zhou

  7. The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China

    Ping’an Ding

  8. Hematology and Medical Oncology, St. Joseph Mercy Ann Arbor Hospital, 5301 McAuley Dr, Ypsilanti, MI, 48197, USA

    Ce Cheng

  9. Mercy Internal Medicine Service, Trinity Health of New England, 271 Carew St, Springfield, MA, 01104, USA

    Yichen Wang

  10. Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Qin Zhou

  11. Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu, 221006, China

    Kai Wang

  12. Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Hefei, Anhui, 230601, China

    Chenyu Sun

  13. Department of Thyroid and Breast Surgery, the Second Affiliated Hospital of Anhui Medical University, Furong Road 678, Hefei, Anhui, 230601, China

    Chenyu Sun

  14. AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, Illinois, 60657, USA

    Chenyu Sun

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  1. Linya Feng
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Contributions

LF, JG, and WX: study conceptualization, study design, methodology, investigation, data acquisition, data curation, writing—original draft, writing—reviewing and editing, visualization. YL and VY: investigation, writing—reviewing and editing. SM: visualization, advising, revisions. SL, RB, ZZ, PD, CC, YW, and QZ: advising, writing—review and editing. KW, HL, BW, and PX: writing—review and editing. CS: study conceptualization, study design, validation, supervision, investigation, writing—review and editing.

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Correspondence to Chenyu Sun.

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Feng, L., Gao, J., Xia, W. et al. Association of sugar-sweetened beverages with the risk of colorectal cancer: a systematic review and meta-analysis. Eur J Clin Nutr 77, 941–952 (2023). https://doi.org/10.1038/s41430-023-01302-x

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