Sugar sweetened and artificially sweetened beverages, fruit and vegetable juices and cancer risk: a World Cancer Research Fund International Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

  1. Ahmad Jayedi
  2. Georgios Markozannes
  3. Sayada Zartasha Kazmi
  4. Margarita Cariolou
  5. Rita Vieira
  6. Sonia Kiss
  7. Katia Balducci
  8. Eirini Pagkalidou
  9. Sofia Cividini
  10. Dagfinn Aune
  11. Darren C Greenwood
  12. Laure Dossus
  13. Emma Fontvieille
  14. Nahid Ahmadi
  15. Yahya Mahamat-Saleh
  16. Amanda J. Cross
  17. Marc J. Gunter
  18. Shalini Jayasekar Zürn
  19. Christian C. Abnet
  20. Pietro Ferrari
  21. Vanessa L.Z. Gordon-Dseagu
  22. Kristy Maskell
  23. Christelle Clary
  24. Helen Croker
  25. Panagiota Mitrou
  26. Elio Riboli
  27. Monica Baskin
  28. Rajiv Chowdhury
  29. Mia Gaudet
  30. Edward Giovannucci
  31. Ellen Kampman
  32. Sarah J. Lewis
  33. Anne M. May
  34. Yikyung Park
  35. Tobias Pischon
  36. Gianluca Severi
  37. Lynette Hill
  38. Matty P. Weijenberg
  39. John Krebs
  40. Konstantinos K Tsilidis
  41. Doris S.M. Chan
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Abstract

Background

Sugar sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and fruit and vegetable juices are consumed worldwide, yet their associations with cancer remain unclear.

Methods

Within World Cancer Research Fund International’s Global Cancer Update Programme (CUP Global), we conducted a systematic review by searching PubMed and Embase until September 2024 for cohort studies of SSBs, ASBs, and juices and cancer risk. Meta-analyses were conducted to calculate the relative risks (RRs) and 95% CIs per 1 serving/day (355 mL for SSBs/ASBs; 177 mL for juices). Evidence was graded by the CUP Global Expert Panel. The CUP Global standard protocol was registered at: https://osf.io/7utbm/ .

Findings

We identified 158 publications from 51 cohorts. There was evidence of a probable causal positive association for SSBs, including carbonated SSBs, with pancreatic cancer incidence (RR 1.09 [95% CI 1.01–1.16]; I 2 =8%, n=18 studies), and for SSBs with colorectal cancer incidence (RR 1.07 [95% CI 1.00–1.14]; I 2 =41%, n=13). Limited suggestive evidence supported positive associations of SSBs with ovarian (RR 1.61 [95%CI 1.03–2.53]; I 2 =0%, n=2), endometrial (RR 1.21 [95%CI 1.03-1.42]; I 2 =0%, n=3), and postmenopausal breast cancer incidence (RR 1.05 [95%CI 1.00-1.10] ; I 2 =0%, n=6), and of carbonated ASBs with leukaemia incidence (RR 1.29 [95%CI 1.01-1.64]; I 2 =0%, n=2). There was evidence of a probable causal positive association for orange juice with different types of skin cancer including melanoma (RR 1.21 [95%CI 1.08-1.34]; I 2 =0%, n=4), and basal (RR 1.12 [95%CI 1.06-1.17]; I 2 =46%, n=2) and squamous cell carcinoma (RR 1.13 [95%CI 1.04-1.24]; I 2 =0%, n=2). An interactive evidence platform is available at: https://teacup.cc.ic.ac.uk/soft-drinks-cancer.html .

Interpretation

This review provides evidence supporting probable causal associations of SSBs with pancreatic and colorectal cancers, and of orange juice with skin cancers, with additional suggestive evidence for SSBs with other obesity-related cancers, extending concerns about sugary drink consumption beyond cardiometabolic health to cancer risk.

Funding

World Cancer Research Fund network of charities (American Institute for Cancer Research; World Cancer Research Fund; Wereld Kanker Onderzoek Fonds).

Article activity feed

  1. Version published to 10.64898/2026.06.22.26355879 on medRxiv