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

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Auteur(s): Guercio BJ, Zhang S, Niedzwiecki D, Li Y, Babic A, Morales-Oyarvide V, et al
Nom de la publication : PLoS ONE 13(7): e0199244.
Année de publication : 2018


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 analysed 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 = 0.004). Similarly, increasing artificially sweetened beverage intake was also associated with a significant improvement in both recurrence-free survival (Ptrend = 0.005) and overall survival (Ptrend = 0.02). 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 = 0.02).
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.


This prospective study of 1,018 patients with stage III colon cancer, enrolled in a National Cancer Institute (NCI)-sponsored clinical trial, showed improved patient outcome in terms of cancer recurrence and survival with increased consumption of low calorie sweetened beverage, which may be mediated, completely or in part, by substitution for sugar-sweetened alternatives.

Specifically, the study found that the participants who drank one or more 12-ounce serving of low calorie sweetened beverages per day experienced a 46% improvement in risk of cancer recurrence or death, compared to those who didn’t drink these beverages. These associations were maintained after adjusting for potential confounders, including measures of energy balance, body mass index (BMI), physical activity, Western pattern diet and dietary glycemic load. Furthermore, replacing one can of sugar-sweetened beverage with a low calorie sweetened drink per day was associated with a significant improvement in patient outcomes: 23% for disease-free survival (DFS), 26% for recurrence-free survival (RFS), and 22% for overall survival (OS).

Although this study cannot provide evidence for causality given its observational design, however, its findings offer important insight into the role of low calorie sweetened drinks in colon cancer outcomes. As stated by the study’s senior author, Charles S. Fuchs, M.D., director of Yale Cancer Center, in a Press Release from Yale University: « Our study clearly shows they [low calorie sweetened beverages] help avoid cancer recurrence and death in patients who have been treated for advanced colon cancer, and that is an exciting finding. » Dr Fuchs also added that, « Factors such as obesity, sedentary lifestyle, a diet linked to diabetes — all of which lead to an excess energy balance — are known risk factors. We now find that, in terms of colon cancer recurrence and survival, use of artificially sweetened drinks is not a health risk, but is, in this study, a healthier choice. »

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