Regularly drinking sugar-sweetened beverages was associated with a significantly increased incidence of liver cancer and death from chronic liver disease, according to a prospective cohort study involving nearly 100,000 postmenopausal women.

Compared with consuming three or fewer sugar-sweetened beverages a month, women who drank at least one of these beverages per day had significantly higher rates of liver cancer (18.0 vs 10.3 per 100,000 person-years; adjusted HR 1.85, 95% CI 1.16-2.96, P=0.01), reported Xuehong Zhang, MBBS, ScD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues.

This was also true for chronic liver disease mortality (17.7 vs 7.1 per 100,000 person-years; aHR 1.68, 95% CI 1.03-2.75, P=0.04), they noted in JAMA.

However, results differed for artificially sweetened beverages, the authors said.

Compared with the consumption of three or fewer artificially sweetened beverages per month, women who consumed at least one of these beverages a day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100,000 person-years; aHR 1.17, 95% CI 0.70-1.94, P=0.55) or chronic liver disease mortality (7.1 vs 5.3, respectively; HR 0.95, 95% CI 0.49-1.84, P=0.88).

“Even though sugar-sweetened beverage intake has declined steadily in the U.S. from 2003 through 2018, the overall intake remains high, with 65.3% of white adults who reported consuming at least some sugar-sweetened beverages on a given day in 2017-2018,” Zhang and co-author Longgang Zhao, PhD, of the University of South Carolina in Columbia, told MedPage Today in an email.

“Our findings suggest sugar-sweetened beverages as a potential modifiable risk factor for liver cancer and chronic liver disease mortality,” they added. “If our findings are confirmed, reducing sugar-sweetened beverage consumption might serve as a public health strategy to reduce liver disease burden.”

While the study was not designed to evaluate the biologic pathways through which sugar-sweetened beverage consumption was associated with adverse liver outcomes, Zhang and team suggested some possible interactions underlying the association.

For example, drinks with high sugar concentrations influence obesity, which is a strong risk factor for liver diseases. “However, adjustments for body mass index did not alter the estimates materially in our study,” Zhang and Zhao said.