甘い飲み物の摂取量と死亡リスクが相関

甘味飲料の摂取量が多いことと、全ての原因による死亡（全死亡）、および循環器疾患や心疾患による死亡リスクの高さが有意に関連していることが、日本人を対象とした研究から明らかになった。一方、がん死や消化器疾患、脳血管疾患などによる死亡リスクとは有意な関連がないことも分かった。国立がん研究センターなどによる多目的コホート研究（JPHC研究）によるもので、詳細は「Preventive Medicine」7月号に掲載された。

　甘味飲料の摂取量が多いことは、体重増加や糖尿病、がん、脳血管疾患のリスクと関連しており、さらに欧米からは死亡リスクとも関連することが報告されている。一方、アジアからは欧米と異なり、甘味飲料の摂取量と死亡リスクとの間に関連はないとの報告がある。また日本人対象の疫学研究の結果はこれまで報告されていない。

　今回発表された研究の対象は、1995年と1998年に、岩手県二戸、長野県佐久、茨木県水戸、東京都葛飾区、高知県中央東、沖縄県中部などの11保健所管内に居住していた45～74歳の男女7万486人。食事アンケート調査に基づき、清涼飲料水（コーラなど）、100％りんごジュース、100％オレンジジュース、缶コーヒー、乳酸菌飲料、β-カロテン含有飲料、カルシウム飲料、ドリンク剤の摂取量の合計を算出。その五分位で群分けして平均17.1年追跡し、全死亡やがん死、循環器疾患、消化器疾患などによる死亡リスクを比較検討した。

　追跡期間中に1万1,811人が死亡していた。死因は、がん4,713人、循環器疾患2,766人、心疾患1,412人、脳血管疾患1,088人、呼吸器疾患888人、消化器疾患433人だった。死亡リスクに影響を及ぼし得る因子（年齢、性別、BMI、喫煙・飲酒・運動習慣、摂取エネルギー量、コーヒーや緑茶の摂取量、高血圧の既往、居住地域）を統計学的に調整後、以下のような関連が明らかになった。

　甘味飲料摂取量の第1五分位群（摂取量が最も少ない下位20％）に比較して、第5五分位群（摂取量が最も多い上位20％）は全死亡リスクが1.15倍高く〔ハザード比（HR）1.15（95％信頼区間1.09～1.22）〕、甘味飲料摂取量が多いほど全死亡リスクが高いという有意な関連が認められた（傾向性P＜0.001）。また、第5五分位群は第1五分位群に比較して、循環器疾患による死亡がHR1.23（同1.09～1.38）であり（傾向性P＝0.02）、心疾患による死亡はHR1.35（同1.14～1.60）と（傾向性P＝0.01）、摂取量の多さがリスクの高さと関連していた。

　一方で、がん死や、脳血管疾患、呼吸器疾患、消化器疾患による死亡リスクについては、甘味飲料摂取量との有意な関連が見られなかった。

　これらの結果は欧米の先行研究と同様で、アジアの先行研究とは異なると言える。その理由として著者らは、甘味飲料を摂取している人の割合の違いが関係している可能性を考察している。すなわち本研究では、月に1度以上甘味飲料を摂取する人の割合が85％であり、アジアの先行研究での26％よりも欧米の先行研究での58～76％に近かった。

　また、甘味飲料の摂取が循環器疾患や心疾患による死亡リスクと関連していたことについては、「甘味飲料は血糖値やインスリン濃度を上昇させるグリセミックインデックスが高く、心血管系や代謝系の機能へ悪影響を及ぼす可能性がある」と述べている。

Association of sugary drink consumption with all-cause and cause-specific mortality: the Japan Public Health Center-based Prospective Study.

Hsi-Lan Huang, Sarah Krull Abe, Norie Sawada, Ribeka Takachi, Junko Ishihara, Motoki Iwasaki, Taiki Yamaji, Hiroyasu Iso, Tetsuya Mizoue, Mitsuhiko Noda, Masahiro Hashizume, Manami Inoue, Shoichiro Tsugane

Preventive medicine. 2021 07;148;106561. pii: S0091-7435(21)00145-6.

https://www.sciencedirect.com/science/article/abs/pii/S0091743521001456

Abstract

BACKGROUND :

Few epidemiologic studies have assessed the associations of sugary drink consumption with mortality outcomes among Asian populations.

METHODS :

This study included 70,486 participants in the Japan Public Health Center-based Prospective Study at the age of 45-74 years in 1995-1999. A validated food frequency questionnaire was used to assess the consumption of sugary drinks. We estimated the risk of total and cause-specific mortality associated with sugary drink consumption using Cox proportional hazards regression model.

RESULTS :

Mean follow-up was 17.1 years, during which 11,811 deaths were documented. Sugary drink consumption was associated with higher total mortality, with multivariate HR of 1.06 (95% CI 1.00-1.13) for quintile 3, 1.07 (95% CI 1.01-1.13) for quintile 4, and 1.15 (95% CI 1.09-1.22) for quintile 5, compared with quintile 1 (P < 0.001 for trend). Additionally, positive associations with cause-specific mortality were observed, including death from circulatory system diseases (quintile 5 vs quintile 1; HR, 1.23; 95% CI 1.09-1.38) and heart disease (quintile 5 vs quintile 1; HR, 1.35; 95% CI 1.14-1.60).

CONCLUSION :

In this large Japanese prospective study, sugary drink consumption was associated with all-cause and cause-specific mortality.

アメリカの成人では以下のような論文があります。

アメリカ人の飲むドリンクのサイズは凄いので、日本人にはそのままに当て嵌めることはできませんが、概ね同様でしょう。

Association of Sugary Beverage Consumption With Mortality Risk in US Adults

A Secondary Analysis of Data From the REGARDS Study

Lindsay J. Collin, MPH; Suzanne Judd, PhD; Monika Safford, MD, PhD; et al

Viola Vaccarino, MD, PhD; Jean A. Welsh, RN, MPH, PhD

JAMA Netw Open. 2019;2(5):e193121. doi:10.1001/jamanetworkopen.2019.3121

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733424

Findings

In this cohort study of 13 440 black and white adults 45 years and older observed for a mean of 6.0 years, each additional 12-oz serving/d of sugary beverages was associated with an 11% higher all-cause mortality risk, and each additional 12-oz serving/d of fruit juice was associated with a 24% higher all-cause mortality risk. Similar associations were not observed for sugary beverage consumption and coronary heart disease mortality.

Meaning

These results suggest higher consumption of sugary beverages, including fruit juice, is associated with increased mortality.

Abstract

Importance

Research has linked sugar-sweetened beverage (SSB) consumption to coronary heart disease (CHD) risk, but the role of nutritionally similar fruit juice and the association of these beverages with mortality risk is unknown.

Objective

To assess the association of SSBs and 100% fruit juices, alone and in combination (sugary beverages), with mortality.

Design, Setting, and Participants

This cohort study is a secondary analysis of data obtained from 30 183 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The REGARDS study was designed to examine modifiers of stroke risk. Enrollment took place from February 2003 to October 2007, with follow-up every 6 months through 2013. Overall, 30 183 non-Hispanic black and white adults 45 years and older were enrolled in the REGARDS study. Those with known CHD, stroke, or diabetes at baseline (12 253 [40.6%]) and those lacking dietary data (4490 [14.9%]) were excluded from the current study, resulting in a sample size of 13 440. Data were analyzed from November 2017 to December 2018.

Exposures

Sugar-sweetened beverage and 100% fruit juice consumption was estimated using a validated food frequency questionnaire and examined using categories of consumption that align with recommended limits for added sugar intake as a percentage of total energy (TE; <5%, 5%-<10%, and ≥10%) and 12-oz serving increments.

Main Outcomes and Measures

All-cause and CHD-specific mortality were determined from cause of death records and family interviews and adjudicated by a trained team. Multivariable adjusted hazard ratios (HRs) were estimated using regression models.

Results

Overall, 13 440 participants had a mean (SD) age of 63.6 (9.1) years at baseline, 7972 (59.3%) were men, 9266 (68.9%) were non-Hispanic white, and 9482 (70.8%) had overweight or obesity. There were 1000 all-cause and 168 CHD-related deaths during follow-up (mean [SD] follow-up, 6.0 [1.8] years). Mean (SD) sugary beverage consumption was 8.4% (8.3%) of TE/d (4.4% [6.8%] TE/d from SSBs; 4.0% [6.8%] TE/d from 100% fruit juice). Among high (≥10% of TE) vs low (<5% of TE) sugary beverage consumers, risk-adjusted HRs were 1.44 (95% CI, 0.97-2.15) for CHD mortality and 1.14 (95% CI, 0.97-1.33) for all-cause mortality. Risk-adjusted all-cause mortality HRs were 1.11 (95% CI, 1.03-1.19) for each additional 12 oz of sugary beverage consumed and 1.24 (95% CI, 1.09-1.42) for each additional 12 oz of fruit juice consumed. In risk-adjusted models, there was no significant association of sugary beverage consumption with CHD mortality.

Conclusions and Relevance

These findings suggest that consumption of sugary beverages, including fruit juices, is associated with all-cause mortality. Well-powered and longer-term studies are needed to inform their association with CHD mortality risk.