title: Sweet-beverage consumption and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC).
abstract: BACKGROUND
  The consumption of sweet beverages has been associated with greater risk of type 2 diabetes and obesity, which may be involved in the development of pancreatic cancer. Therefore, it has been hypothesized that sweet beverages may increase pancreatic cancer risk as well.
  
  
  OBJECTIVE
  We examined the association between sweet-beverage consumption (including total, sugar-sweetened, and artificially sweetened soft drink and juice and nectar consumption) and pancreatic cancer risk.
  
  
  METHODS
  The study was conducted within the European Prospective Investigation into Cancer and Nutrition cohort. A total of 477,199 participants (70.2% women) with a mean age of 51 y at baseline were included, and 865 exocrine pancreatic cancers were diagnosed after a median follow-up of 11.60 y (IQR: 10.10-12.60 y). Sweet-beverage consumption was assessed with the use of validated dietary questionnaires at baseline. HRs and 95% CIs were obtained with the use of multivariable Cox regression models that were stratified by age, sex, and center and adjusted for educational level, physical activity, smoking status, and alcohol consumption. Associations with total soft-drink consumption were adjusted for juice and nectar consumption and vice versa.
  
  
  RESULTS
  Total soft-drink consumption (HR per 100 g/d: 1.03; 95% CI: 0.99, 1.07), sugar-sweetened soft-drink consumption (HR per 100 g/d: 1.02; 95% CI: 0.97, 1.08), and artificially sweetened soft-drink consumption (HR per 100 g/d: 1.04; 95% CI: 0.98, 1.10) were not associated with pancreatic cancer risk. Juice and nectar consumption was inversely associated with pancreatic cancer risk (HR per 100 g/d: 0.91; 95% CI: 0.84, 0.99); this association remained statistically significant after adjustment for body size, type 2 diabetes, and energy intake.
  
  
  CONCLUSIONS
  Soft-drink consumption does not seem to be associated with pancreatic cancer risk. Juice and nectar consumption might be associated with a modest decreased pancreatic cancer risk. Additional studies with specific information on juice and nectar subtypes are warranted to clarify these results.
authors: Department of Public Health, Faculty of Medicine, Miguel Hernández University, Alicante, Spain; The Spanish Biomedical Research Centre in Epidemology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain;
authors: Eva M
authors: EM
authors: Navarrete-Muñoz
authors: Global eHealth Unit, Department of Primary Care and Public Health.
authors: Petra A
authors: PA
authors: Wark
authors: Department of Epidemiology and Biostatistics, and The Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBEROBN), Health Institute Carlos III, Madrid, Spain; Medical Research Institute of Palma, University Hospital Son Espases, Palma de Mallorca, Spain; mariaadoracion.romaguera@ssib.es.
authors: Dora
authors: D
authors: Romaguera
authors: Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
authors: Nirmala
authors: N
authors: Bhoo-Pathy
authors: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA;
authors: Dominique
authors: D
authors: Michaud
authors: The Spanish Biomedical Research Centre in Epidemology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain; Andalusian School of Public Health. Biomedical Research Institute of Granada; University Hospital of Granada/Granada University, Granada, Spain;
authors: Esther
authors: E
authors: Molina-Montes
authors: Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark;
authors: Anne
authors: A
authors: Tjønneland
authors: Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark;
authors: Anja
authors: A
authors: Olsen
authors: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus C, Denmark;
authors: Kim
authors: K
authors: Overvad
authors: Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health team, National Institute for Health and Medical Research, Villejuif, France; UMRS 1018, Université Paris Sud, Villejuif, France; Institut Gustave Roussy, Villejuif, France;
authors: Marie-Christine
authors: MC
authors: Boutron-Ruault
authors: Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health team, National Institute for Health and Medical Research, Villejuif, France; UMRS 1018, Université Paris Sud, Villejuif, France; Institut Gustave Roussy, Villejuif, France;
authors: Françoise
authors: F
authors: Clavel-Chapelon
authors: Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health team, National Institute for Health and Medical Research, Villejuif, France; UMRS 1018, Université Paris Sud, Villejuif, France; Institut Gustave Roussy, Villejuif, France;
authors: Guy
authors: G
authors: Fagherazzi
authors: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;
authors: Verena A
authors: VA
authors: Katzke
authors: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;
authors: Tilman
authors: T
authors: Kühn
authors: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany;
authors: Annika
authors: A
authors: Steffen
authors: Hellenic Health Foundation, Athens, Greece; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece;
authors: Antonia
authors: A
authors: Trichopoulou
authors: Hellenic Health Foundation, Athens, Greece;
authors: Eleni
authors: E
authors: Klinaki
authors: Hellenic Health Foundation, Athens, Greece;
authors: Eleni-Maria
authors: EM
authors: Papatesta
authors: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy;
authors: Giovanna
authors: G
authors: Masala
authors: Epidemiology and Prevention Unit. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;
authors: Vittorio
authors: V
authors: Krogh
authors: Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, ASP Ragusa, Italy;
authors: Rosario
authors: R
authors: Tumino
authors: Human Genetics Foundation,Torino, Molecular and Genetic Epidemiology Unit, Torino, Italy;
authors: Alessio
authors: A
authors: Naccarati
authors: Dipartamento di Medicina Clinica e Chirurgia, Federico II University of Naples, Naples, Italy;
authors: Amalia
authors: A
authors: Mattiello
authors: MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands;
authors: Petra H
authors: PH
authors: Peeters
authors: Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway;
authors: Charlotta
authors: C
authors: Rylander
authors: Department of Chronic Diseases, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway;
authors: Christine L
authors: CL
authors: Parr
authors: Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway;
authors: Guri
authors: G
authors: Skeie
authors: Department of Community Medicine, University of Tromsø-the Arctic University of Norway, Tromsø, Norway; Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Samfundet Folkhälsan, Helsinki, Finland;
authors: Elisabete
authors: E
authors: Weiderpass
authors: Public Health Directorate, Asturias, Spain;
authors: J Ramón
authors: JR
authors: Quirós
authors: Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute, Catalan Institute of Oncology, Barcelona, Spain;
authors: Eric J
authors: EJ
authors: Duell
authors: The Spanish Biomedical Research Centre in Epidemology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain; Public Health Direction Biodonostia Basque Regional Health Department, San Sebastian, Spain;
authors: Miren
authors: M
authors: Dorronsoro
authors: The Spanish Biomedical Research Centre in Epidemology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain;
authors: José María
authors: JM
authors: Huerta
authors: The Spanish Biomedical Research Centre in Epidemology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain; Navarre Public Health Institute, Pamplona, Spain;
authors: Eva
authors: E
authors: Ardanaz
authors: Medical Research Council Epidemiology Unit.
authors: Nick
authors: N
authors: Wareham
authors: Department of Public Health and Primary Care, and Clinical Gerontology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom;
authors: Kay-Tee
authors: KT
authors: Khaw
authors: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;
authors: Ruth C
authors: RC
authors: Travis
authors: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;
authors: Tim
authors: T
authors: Key
authors: Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France;
authors: Magdalena
authors: M
authors: Stepien
authors: Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, Netherlands; and.
authors: Heinz
authors: H
authors: Freisling
authors: Department of Epidemiology and Biostatistics, and.
authors: Elio
authors: E
authors: Riboli
authors: Department of Epidemiology and Biostatistics, and Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, Netherlands; and Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Netherlands.
authors: H Bas
authors: HB
authors: Bueno-de-Mesquita
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D001628:Beverages / Q000009:adverse effects / Q000032:analysis; D002253:Carbonated Beverages / Q000009:adverse effects* / Q000032:analysis; D015331:Cohort Studies; D004040:Dietary Carbohydrates / Q000009:adverse effects* / Q000032:analysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D000067030:Fruit and Vegetable Juices / Q000009:adverse effects / Q000032:analysis; D055951:Functional Food / Q000009:adverse effects / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D057566:Self Report; D013549:Sweetening Agents / Q000009:adverse effects* / Q000032:analysis
chemical_list: D004040:Dietary Carbohydrates; D013549:Sweetening Agents
keywords: epidemiology; juice and nectar; pancreatic cancer; prevention; risk factors; soft drinks; sugary drinks; sweet beverages