Simple sugar intake and cancer incidence, cancer mortality and all-cause mortality: A cohort study from the PREDIMED trial

Clin Nutr. 2021 Oct;40(10):5269-5277. doi: 10.1016/j.clnu.2021.07.031. Epub 2021 Aug 10.


Objective: To examine associations between intake of simple sugars and cancer incidence, cancer mortality, and total mortality in a prospective cohort study based on the PREDIMED trial conducted from 2003 to 2010.

Methods: Participants were older individuals at high cardiovascular risk. Exposures were total sugar, glucose and fructose from solid or liquid sources, and fructose from fruit and 100% fruit juice. Cancer incidence was the primary outcome; cancer mortality and all-cause mortality were secondary outcomes. Multivariable-adjusted, time-dependent Cox proportional hazard models were used.

Results: Of 7447 individuals enrolled, 7056 (94.7%) were included (57.6% women, aged 67.0 ± 6.2 years). 534 incident cancers with 152 cancer deaths and 409 all-cause deaths were recorded after a median follow-up of 6 years. Intake of simple sugars in solid form was unrelated to outcomes. Higher cancer incidence was found per 5 g/day increase in intake of liquid sugars, with multivariable-adjusted HR of 1.08 (95% CI, 1.03-1.13) for total liquid sugar, 1.19 (95% CI, 1.07-1.31) for liquid glucose, 1.14 (95% CI, 1.05-1.23) for liquid fructose, and 1.39 (95% CI, 1.10-1.74) for fructose from fruit juice. Cancer and all-cause mortality increased to a similar extent with intake of all sugars in liquid form. In categorical models, cancer risk was dose-related for all liquid sugars.

Conclusions: Simple sugar intake in drinks and fruit juice was associated with an increased risk of overall cancer incidence and mortality and all-cause mortality. This suggests that sugary beverages are a modifiable risk factor for cancer and all-cause mortality.

Keywords: Dietary sugar; Fructose; Fruit juice; Glucose; Liquid form; Observational study.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Beverages
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality
  • Cohort Studies
  • Diet
  • Dietary Sugars / administration & dosage*
  • Eating
  • Female
  • Fructose / administration & dosage
  • Fruit and Vegetable Juices
  • Glucose / administration & dosage
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Monosaccharides / administration & dosage*
  • Mortality
  • Neoplasms / epidemiology*
  • Neoplasms / mortality*
  • Proportional Hazards Models
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Sucrose / administration & dosage


  • Dietary Sugars
  • Monosaccharides
  • Fructose
  • Sucrose
  • Glucose