Association of sweetened beverages consumptions with all-cause mortality risk among Dutch adults: the Lifelines Cohort Study

Importance: Low/no-calorie beverages (LNCB) are considered heathier than sugar-sweetened beverages (SSB) including fruit juice (FJ), but evidence on their potential impact on mortality risk is inconclusive. 
Objective: To examine associations between SSB, LNCB and FJ consumption and all-cause mortality in Dutch adults.  
Design, setting, and participants: This prospective cohort included Dutch adults aged 18 years or older participating in the Lifelines Cohort Study. Vital status was followed up until February 2021 (median [IQR] 8.8 [7.9-9.7] years) via the National Personal Records Database. Data were analyzed from 2020 to 2021.
Exposure: SSB, LNCB and FJ consumptions were assessed at baseline using a validated 110-item food-frequency questionnaire.
Main outcome and measures: Associations between beverages of interest (serving size of 150 ml) and all-cause mortality risk were investigated using restricted cubic spline and Cox proportional hazard regression analyses, including substitution analyses, to estimate hazard ratios (HRs) and 95%CI while adjusting for demographics, lifestyle, and dietary factors. 
Result: A total of 118,582 adults were included (median [SD] age 45 [13] years; 60% was women). Median (IQR) of SSB, LNCB, and FJ consumptions were 0.1 (0.0-0.6), 0.1 (0.0-0.6), and 0.2 (0.0-0.6) serving/day, respectively. There were 2161 (2%) death during the follow-up period. Dose-response analyses showed linear associations between SSB and LNCB consumptions and mortality risk. Multivariable-adjusted HR of all-cause mortality risk for each additional serving of SSB and LNCB was 1.12 (95%CI: 1.06-1.19) and 1.05 (95%CI: 0.99-1.11), respectively. Replacing SSB with LNCB was associated with a lower mortality risk, which most pronounced in women (HR 0.88, 95%CI 0.78-0.99). Finally, an overall J-shaped association was observed between FJ consumption and all-cause mortality risk with HR of 0.81 (95%CI: 0.73-0.90) for >0-2 servings/week, HR of 0.87 (95%CI: 0.78-0.97) for in >2-<7 servings/week and HR of 1.11 ([95%CI: 0.94-1.31) for ≥1 servings/day compared to no consumption.
Conclusions and relevance: Substitution of each serving per day of SSB with the same amount of SSB was associated with lower mortality risk, notably in women. An overall J-shaped association between FJ consumption and all-cause mortality risk was observed.