One of the Largest Investigations of Beverage Consumption and Liver Cancer Risk Finds No Link Between Artificially Sweetened Beverages and Liver Cancer
A new study published in JAMA Network Open analyzed data from more than 1.5 million adults to examine whether beverage consumption is associated with liver cancer risk. Researchers found that higher intake of sugar-sweetened beverages was associated with increased risk of two liver cancer subtypes, while artificially sweetened beverage consumption was not associated with liver cancer risk overall or by subtype.
Key Takeaways
- The study analyzed data from more than 1.5 million adults across 11 prospective cohort studies, making it one of the largest investigations of beverage consumption and liver cancer risk to date.
- Sugar-sweetened beverage intake was associated with increased risk of two liver cancer subtypes: hepatocellular carcinoma (HCC), the most common form of liver cancer, and intrahepatic cholangiocarcinoma (ICC).
- Artificially sweetened beverage intake was not associated with liver cancer risk, either overall or for the individual liver cancer subtypes examined.
- Researchers identified 2,811 liver cancer cases during a median follow-up of nearly 18 years, including 1,699 HCC cases and 444 ICC cases.
- The findings were consistent regardless of diabetes status, as researchers found no evidence that diabetes modified the association between beverage intake and liver cancer risk.
- The authors concluded that the evidence did not support an independent association between artificially sweetened beverage consumption and liver cancer risk.
Key Points
Question
Are artificially sweetened beverage (ASB) and sugar-sweetened beverage (SSB) intakes associated with risk of liver cancer overall and by subtype (hepatocellular carcinoma [HCC] and intrahepatic cholangiocarcinoma [ICC])?
Findings
In this pooled analysis of 11 prospective cohort studies comprising 1,518, 411 adults, SSB intake per 1-beverage/day increment was associated with increased risk of HCC and ICC, whereas ASB intake was not associated with liver cancer overall or by subtype.
Meaning
This study found that SSB consumption was associated with increased risk of liver cancer subtypes, while the evidence did not support an independent association between ASB intake and liver cancer risk.
Abstract
Importance
Artificially sweetened beverages (ASBs) and sugar-sweetened beverages (SSBs) are widely consumed worldwide and have been linked to metabolic disorders, including obesity and type 2 diabetes, which are established risk factors associated with liver cancer. However, prospective evidence examining beverage consumption and liver cancer subtypes remains limited and inconsistent.
Objective
To examine associations between ASB and SSB consumption and risk of incident liver cancer overall and by subtype, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).
Design, Setting, and Participants
In this pooled analysis of 11 prospective cohort studies (10 US cohorts and 1 European cohort, comprising adults without a history of cancer at baseline), participants were enrolled across cohorts between 1980 and 2009 and followed up through end-of-study dates ranging from 2000 to 2019. The median (IQR) duration of follow-up was 11.4 (10.8-27.9) to 31.4 (27.6-31.5) years. This analysis was conducted between September 2024 and August 2025. Participants were followed up via linkage to state cancer registries or follow-up surveys for incident liver cancer.
Exposures
Self-reported intake of ASB and SSB assessed at baseline using validated food frequency questionnaires and analyzed per 1-beverage/day increment.
Main Outcomes and Measures
Incident liver cancer overall and by subtype (HCC and ICC) identified through cancer registries or medical record review. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence, adjusting for potential confounders, including demographics and lifestyle factors, and weighted-mean meta-analysis of estimates.
Results
A total of 1, 518, 411 participants (mean [SD] age, 57.8 [10.1] years; 883,832 female [58.2%]) were included in this analysis. During a median (IQR) of 17.8 (12.8–23.5) years of follow-up, 2811 incident liver cancer cases were identified, including 1699 HCC and 444 ICC cases. After multivariable adjustment, ASB intake per 1-beverage/day increase was not associated with liver cancer risk, HCC (10 cohorts), or ICC (6 cohorts). SSB intake per 1-beverage/day increase was not associated with overall liver cancer risk but was associated with increased risk of HCC (HR, 1.10; 95% CI, 1.03-1.18; 10 cohorts) and ICC (HR, 1.15; 95% CI, 1.00-1.32; 6 cohorts). There was no evidence of effect modification by diabetes status.
Conclusions and Relevance
In this study, increased SSB consumption was associated with increased risk of HCC and ICC. There was little evidence that ASB intake was associated with liver cancer risk overall or by subtype.
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