Association Between Sugar-Sweetened Beverage Intake and Mortality Risk in Women: The California Teachers Study

J Acad Nutr Diet. 2022 Feb;122(2):320-333.e6. doi: 10.1016/j.jand.2021.08.099. Epub 2021 Aug 11.


Background: The evidence linking sugar-sweetened beverage (SSB) intake and mortality risk is conflicting, and associations between various SSB subtypes and mortality remain unclear.

Objective: To examine the association between baseline SSB intake, subtypes of SSB intake, and mortality risk in women.

Design: Prospective cohort study.

Participants/setting: Participants of the California Teachers Study (n = 100,314; median age = 53 years) free of cardiovascular disease, cancer, and diabetes at baseline (1995-1996) were followed from 1995 to 2015. Baseline SSB intake was defined as caloric soft drinks (regular soft drinks, not diet soda), sweetened bottled waters or teas, and fruit drinks; and was derived from a self-administered food frequency questionnaire.

Main outcome measure: Mortality was ascertained via annual linkage with state- and nationwide mortality records and the National Death Index over 20 years.

Statistical analysis: Multivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% CIs for assessing associations between SSB intake and mortality. Rare/never consumers were the comparator group.

Results: There were a total of 14,143 deaths over 20 years (30.5% from cardiovascular disease; 29.2% from cancer). In women who consumed ≥ 7 servings/week of SSBs at baseline (4% of participants), the multivariable-adjusted HRs were not significant for all-cause, cardiovascular disease-specific, or cancer-specific mortality. Consuming ≥ 7 servings/week of baseline caloric soft drink was associated with a higher risk of all-cause (HR = 1.26, 95% CI 1.10 to 1.46; P for trend = 0.02) and cancer-specific (HR = 1.33, 95% CI 1.08 to 1.63; P for trend = 0.08) mortality. In secondary analyses, consuming ≥ 1.5 c/day of baseline SSBs was associated with all-cause mortality (HR = 1.12, 95% CI 1.02 to 1.24; P for trend = 0.01).

Conclusions: Although the baseline frequency of total SSB intake was not significantly associated with mortality, consuming ≥ 7 servings/week of caloric soft drinks was associated with higher risk of all-cause and cancer-specific mortality. Findings support public health efforts to reduce caloric soft drink consumption.

Keywords: Caloric soft drink; Death; Mortality; Sugar-sweetened beverage; Sugary drink.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • California
  • Diet / mortality*
  • Drinking
  • Female
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Sugar-Sweetened Beverages*