TABLE 2.
Risk of total breast cancer according to cumulative average intake of SSBs and ASBs in the NHS, NHSII, and pooled cohorts1
| <1/month | ≥1 to ≤4/month | >1 to <7/week | ≥1/day | P trend2 | Per 1 serving/day increase | ||
|---|---|---|---|---|---|---|---|
| Sugar-sweetened beverage category | |||||||
| NHS | Number of cases, n | 2141 | 1947 | 2864 | 543 | — | |
| Person years | 691,530 | 608,056 | 901,755 | 195,256 | — | ||
| Age-adjusted model | 1.00 | 1.01 (0.95–1.07) | 1.00 (0.94–1.06) | 1.04 (0.95–1.15) | 0.53 | 1.01 (0.97–1.06) | |
| Multivariable model 13 | 1.00 | 1.01 (0.94–1.07) | 1.01 (0.95–1.07) | 1.11 (1.00–1.22) | 0.06 | 1.05 (1.00–1.10) | |
| Multivariable model 24 | 1.00 | 1.00 (0.94–1.07) | 1.00 (0.94–1.06) | 1.09 (0.98–1.21) | 0.10 | 1.04 (0.99–1.09) | |
| NHS II | Number of cases, n | 928 | 984 | 1,507 | 465 | — | |
| Person years | 557,608 | 540,283 | 848,158 | 312,506 | — | ||
| Age-adjusted model | 1.00 | 1.10 (1.00–1.20) | 1.02 (0.94–1.11) | 0.96 (0.85–1.08) | 0.08 | 0.98 (0.93–1.03) | |
| Multivariable model 13 | 1.00 | 1.06 (0.97–1.17) | 0.96 (0.88–1.06) | 0.94 (0.83–1.08) | 0.14 | 1.00 (0.94–1.05) | |
| Multivariable model 24 | 1.00 | 1.06 (0.97–1.16) | 0.96 (0.87–1.05) | 0.93 (0.82–1.07) | 0.12 | 0.99 (0.94–1.05) | |
| Pooled5 | Number of cases, n | 3069 | 2931 | 4371 | 1008 | — | |
| Person years | 1,249,138 | 1,148,340 | 1,749,913 | 507,762 | — | ||
| Age-adjusted model | 1.00 | 1.03 (0.98–1.09) | 1.00 (0.96–1.05) | 1.00 (0.93–1.08) | 0.53 | 1.00 (0.96–1.03) | |
| Multivariable model 13 | 1.00 | 1.03 (0.98–1.08) | 1.00 (0.95–1.05) | 1.05 (0.97–1.14) | 0.49 | 1.03 (0.99–1.06) | |
| Multivariable model 24 | 1.00 | 1.02 (0.97–1.08) | 0.99 (0.94–1.04) | 1.03 (0.95–1.12) | 0.72 | 1.02 (0.99–1.06) | |
| Artificially sweetened beverage category | |||||||
| NHS | Number of cases, n | 2242 | 1123 | 2870 | 1260 | — | |
| Person years | 758,074 | 353,549 | 866,359 | 418,616 | — | ||
| Age-adjusted model | 1.00 | 1.02 (0.95–1.10) | 1.02 (0.96–1.08) | 1.01 (0.94–1.09) | 0.88 | 1.00 (0.97–1.04) | |
| Multivariable model 13 | 1.00 | 1.02 (0.95–1.10) | 1.01 (0.95–1.07) | 1.05 (0.98–1.13) | 0.22 | 1.02 (0.99–1.06) | |
| Multivariable model 24 | 1.00 | 1.00 (0.93–1.08) | 0.97 (0.92,1.03) | 0.99 (0.92–1.07) | 0.87 | 1.00 (0.97–1.04) | |
| NHS II | Number of cases, n | 935 | 408 | 1327 | 1214 | — | |
| Person years | 548,370 | 225,896 | 703,317 | 780,973 | — | ||
| Age-adjusted model | 1.00 | 1.02 (0.90–1.14) | 1.00 (0.92–1.09) | 0.88 (0.81–0.97) | <0.01 | 0.96 (0.93–0.98) | |
| Multivariable model 13 | 1.00 | 1.03 (0.91–1.16) | 0.99 (0.91–1.08) | 0.93 (0.84–1.01) | 0.04 | 0.98 (0.95–1.01) | |
| Multivariable model 24 | 1.00 | 1.02 (0.91–1.15) | 0.98 (0.89–1.07) | 0.91 (0.83–1.00) | 0.02 | 0.98 (0.95–1.00) | |
| Pooled5 | Number of cases, n | 3177 | 1531 | 4197 | 2474 | — | |
| Person Years | 1,306,444 | 579,445 | 1,569,676 | 1,199,588 | — | ||
| Age-adjusted model | 1.00 | 1.02 (0.96–1.09) | 1.01 (0.97–1.06) | 0.96 (0.91–1.01) | 0.01 | 0.98 (0.96–1.00) | |
| Multivariable model 13 | 1.00 | 1.02 (0.96–1.09) | 1.01 (0.96–1.06) | 1.00 (0.95–1.06) | 0.61 | 1.00 (0.98–1.02) | |
| Multivariable model 24 | 1.00 | 1.01 (0.95–1.07) | 0.98 (0.94–1.03) | 0.96 (0.91–1.02) | 0.08 | 0.99 (0.97–1.01) | |
Values are HRs with 95% CIs in parentheses. ASB, artificially sweetened beverage; MET, metabolic equivalent; NHS, Nurses’ Health Study; NHSII, Nurses’ Health Study II; SSB, sugar-sweetened beverage.
P value for trend was calculated by assigning the median values to each quartile and modeling the median values as a continuous variable.
Multivariable model 1: stratified by age in months and calendar year, adjusted for SSB or ASB intake, race (non-Hispanic Caucasian, African, Asian, Hispanic Caucasian), age at menarche (<12, 12, 13, 14, >14 years), age at menopause (premenopausal, <45, 45–49, 50–52, ≥53 years), postmenopausal hormone use (never user; past user; current user: estrogen only for <5 years; current user: estrogen only for ≥5 years; current estrogen + progestin user for <5 years; current estrogen + progestin user for ≥5 years; current user of other types), oral contraceptive use history (never, ever), parity and age at first birth (nulliparous, 1 child before age 25, 1 child at ≥25 years of age, ≥2 children before age 25, ≥2 children ≥25 years of age), breastfeeding history (never, breastfed for ≤6 months, breastfed for >6 months), family history of breast cancer (yes or no), history of benign breast disease (yes or no), height (<1.60, 1.60–1.64, 1.65–1.69, 1.70–1.74, ≥1.75 meters), cumulatively updated alcohol intake (0, <5, 5–9, 10–14, ≥15 g/d), cumulatively updated total caloric intake (kcal/day, quintiles), physical activity (linear MET-h/week), BMI at age 18 years (<20.0, 20.0–21.9, 22.0–23.9, 24.0–26.9, ≥27.0 kg/m2), a modified Alternate Healthy Eating Index score (with SSBs and alcohol removed), and socioeconomic status.
Multivariable model 2 includes the variables from multivariable model 1 plus the change in weight since age 18 (lost ≥2 kg, lost 0–1 kg, gained 0–2 kg, gained 3–5 kg, gained 6–10 kg, gained 11–20 kg, gained 21–25 kg, gained >25 kg).
The pooled model was also stratified by cohort.