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 B Benson III, Daniel Atienza, Michael Messino, Hedy Kindler, Alan Venook, Shuji Ogino, Emilie S. Zoltick, Meir Stampfer, Kimmie Ng & 5 others Kana Wu, Walter C. Willett, Edward L. Giovannucci, Jeffrey A. Meyerhardt, Charles S. Fuchs

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 1 2018

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Beverages
relapse
colorectal neoplasms
Colonic Neoplasms
beverages
Recurrence
Mortality
Sugars
neoplasms
sugars
Chemotherapy
drug therapy
Survival
confidence interval
Neoplasms
Hazards
Substitution reactions
Confidence Intervals
Sedentary Lifestyle
National Cancer Institute (U.S.)

ASJC Scopus subject areas

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

Cite this

Guercio, Brendan J. ; Zhang, Sui ; Niedzwiecki, Donna ; Li, Yanping ; Babic, Ana ; Morales-Oyarvide, Vicente ; Saltz, Leonard B. ; Mayer, Robert J. ; Mowat, Rex B. ; Whittom, Renaud ; Hantel, Alexander ; Benson III, Al B ; Atienza, Daniel ; Messino, Michael ; Kindler, Hedy ; Venook, Alan ; Ogino, Shuji ; Zoltick, Emilie S. ; Stampfer, Meir ; Ng, Kimmie ; Wu, Kana ; Willett, Walter C. ; Giovannucci, Edward L. ; Meyerhardt, Jeffrey A. ; Fuchs, Charles S. / Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer : Results from CALGB 89803 (Alliance). In: PloS one. 2018 ; Vol. 13, No. 7.
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title = "Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance)",
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.",
author = "Guercio, {Brendan J.} and Sui Zhang and Donna Niedzwiecki and Yanping Li and Ana Babic and Vicente Morales-Oyarvide and Saltz, {Leonard B.} and Mayer, {Robert J.} and Mowat, {Rex B.} and Renaud Whittom and Alexander Hantel and {Benson III}, {Al B} and Daniel Atienza and Michael Messino and Hedy Kindler and Alan Venook and Shuji Ogino and Zoltick, {Emilie S.} and Meir Stampfer and Kimmie Ng and Kana Wu and Willett, {Walter C.} and Giovannucci, {Edward L.} and Meyerhardt, {Jeffrey A.} and Fuchs, {Charles S.}",
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Guercio, BJ, Zhang, S, Niedzwiecki, D, Li, Y, Babic, A, Morales-Oyarvide, V, Saltz, LB, Mayer, RJ, Mowat, RB, Whittom, R, Hantel, A, Benson III, AB, Atienza, D, Messino, M, Kindler, H, Venook, A, Ogino, S, Zoltick, ES, Stampfer, M, Ng, K, Wu, K, Willett, WC, Giovannucci, EL, Meyerhardt, JA & Fuchs, CS 2018, 'Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance)', PloS one, vol. 13, no. 7, e0199244. https://doi.org/10.1371/journal.pone.0199244

Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer : Results from CALGB 89803 (Alliance). / Guercio, Brendan J.; Zhang, Sui; Niedzwiecki, Donna; Li, Yanping; Babic, Ana; Morales-Oyarvide, Vicente; Saltz, Leonard B.; Mayer, Robert J.; Mowat, Rex B.; Whittom, Renaud; Hantel, Alexander; Benson III, Al B; Atienza, Daniel; Messino, Michael; Kindler, Hedy; Venook, Alan; Ogino, Shuji; Zoltick, Emilie S.; Stampfer, Meir; Ng, Kimmie; Wu, Kana; Willett, Walter C.; Giovannucci, Edward L.; Meyerhardt, Jeffrey A.; Fuchs, Charles S.

In: PloS one, Vol. 13, No. 7, e0199244, 01.07.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer

T2 - Results from CALGB 89803 (Alliance)

AU - Guercio, Brendan J.

AU - Zhang, Sui

AU - Niedzwiecki, Donna

AU - Li, Yanping

AU - Babic, Ana

AU - Morales-Oyarvide, Vicente

AU - Saltz, Leonard B.

AU - Mayer, Robert J.

AU - Mowat, Rex B.

AU - Whittom, Renaud

AU - Hantel, Alexander

AU - Benson III, Al B

AU - Atienza, Daniel

AU - Messino, Michael

AU - Kindler, Hedy

AU - Venook, Alan

AU - Ogino, Shuji

AU - Zoltick, Emilie S.

AU - Stampfer, Meir

AU - Ng, Kimmie

AU - Wu, Kana

AU - Willett, Walter C.

AU - Giovannucci, Edward L.

AU - Meyerhardt, Jeffrey A.

AU - Fuchs, Charles S.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

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DO - 10.1371/journal.pone.0199244

M3 - Article

VL - 13

JO - PLoS One

JF - PLoS One

SN - 1932-6203

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