Sugar-Sweetened Soft Drinks Consumption and Gastric Cancer: Results From the StoP Project

BACKGROUND Soft drinks, and specifically sugar-sweetened non-alcoholic beverages, have been associated with metabolic disease, all-cause and cancer mortality in selected studies. However, findings for gastric cancer are inconsistent. OBJECTIVES To evaluate the association between sugar sweetened soft drinks and the risk of gastric cancer using data from the StoP Project, a global consortium of gastric cancer including 34 case-control and nested cohort studies from the Americas, Asia and Europe. METHODS We conducted a pooled analysis within the StoP Project, using harmonized data from 17 case-control and nested cohort studies with available information on soft drinks. In the present work we did not consider low-calorie sweetened beverages. Overall, 5,929 gastric cancer cases and 16,092 controls were included. Soft drink intake was categorized according to frequency of consumption. Odds ratios (OR) for gastric cancer, and the corresponding 95% confidence intervals (CI), were computed using logistic regression models adjusted for relevant confounders, including total energy intake. Pooled ORs were computed using random-effects models. For dose-risk assessment, we fitted restricted cubic spline models in a two-stage dose-risk meta-analysis. RESULTS Compared with non-consumers, the pooled OR for gastric cancer was 1.18 (95% CI 0.98–1.42) for 2 servings/week to less than 1 serving/day, 1.42 (95% CI 1.06–1.91) for 1 serv- ing/day, and 1.64 (95% CI 1.17–2.30) for more than 1 serv- ing/day. Dose-risk analysis showed a progressive increase in gastric cancer risk with higher soft drink intake: OR 1.09 (95% CI 0.92–1.30) at 0.5, 1.25 (95% CI 0.99–1.59) at 1, 1.50 (95% CI 1.13–2.00) at 1.5, and 1.81 (95% CI 1.22–2.69) at 2.0 servings/day. No significant heterogeneity was found in stratified analyses by age, sex, alcohol consumption and total energy intake. CONCLUSIONS Sugar sweetened soft drink consumption was associated with an increased risk of gastric cancer, with a dose-risk relationship.