Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance)

Brendan J. Guercio, Sui Zhang, Donna Niedzwiecki, Yanping Li, Ana Babic, Vicente Morales-Oyarvide, Leonard B. Saltz, Robert J. Mayer, Rex B. Mowat, Renaud Whittom, Alexander Hantel, Al Benson, Daniel Atienza, Michael Messino, Hedy Kindler, Alan Venook, Shuji Ogino, Emilie S. Zoltick, Meir Stampfer, Kimmie NgKana Wu, Walter C. Willett, Edward L. Giovannucci, Jeffrey A. Meyerhardt, Charles S. Fuchs*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose Observational studies have demonstrated increased colon cancer recurrence and mortality in states of excess energy balance, as denoted by factors including sedentary lifestyle, diabetes, increased dietary glycemic load, and increased intake of sugar-sweetened beverages. Nonetheless, the relation between artificially sweetened beverages, a popular alternative for sugar-sweetened beverages, and colon cancer recurrence and survival is unknown. Methods We analyzed data from 1,018 patients with stage III colon cancer who prospectively reported dietary intake during and after chemotherapy while enrolled in a National Cancer Institute-sponsored trial of adjuvant chemotherapy. Using Cox proportional hazards regressions, we assessed associations of artificially sweetened beverage intake with cancer recurrence and mortality. Results Patients consuming one or more 12-ounce servings of artificially sweetened beverages per day experienced an adjusted hazard ratio for cancer recurrence or mortality of 0.54 (95% confidence interval, 0.36 to 0.80) when compared to those who largely abstained (Ptrend = .004). Similarly, increasing artificially sweetened beverage intake was also associated with a significant improvement in both recurrence-free survival (Ptrend = .005) and overall survival (Ptrend = .02). Substitution models demonstrated that replacing a 12-ounce serving of a sugar-sweetened beverage with an isovolumetric serving of an artificially sweetened beverage per day was associated with a 23% lower risk of cancer recurrence and mortality (relative risk, 0.77; 95% confidence interval, 0.63 to 0.95; P = .02). Conclusion Higher artificially sweetened beverage consumption may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer. This association may be mediated by substitution for sugar-sweetened alternatives. Further studies are needed to confirm these findings.

Original languageEnglish (US)
Article numbere0199244
JournalPloS one
Volume13
Issue number7
DOIs
StatePublished - Jul 2018

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Guercio, B. J., Zhang, S., Niedzwiecki, D., Li, Y., Babic, A., Morales-Oyarvide, V., Saltz, L. B., Mayer, R. J., Mowat, R. B., Whittom, R., Hantel, A., Benson, A., Atienza, D., Messino, M., Kindler, H., Venook, A., Ogino, S., Zoltick, E. S., Stampfer, M., ... Fuchs, C. S. (2018). Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance). PloS one, 13(7), [e0199244]. https://doi.org/10.1371/journal.pone.0199244