sugar-sweetened and artificially sweetened beverage intake and gastric cancer incidence

Prospective cohort study evaluating the association between sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption and the risk of developing gastric cancer (1):

• analysed multi-decade data from 112,284 participants across two large prospective US cohorts (Nurses' Health Study and Health Professionals Follow-Up Study) with over 3.2 million person-years of follow-up
• frequent consumption of sugar-sweetened beverages was associated with a statistically significant, markedly elevated risk of incident gastric cancer, whereas artificially sweetened beverages showed no such association

Main Clinical Findings

• sugar-sweetened beverages (SSBs): consuming 1 or more servings per day of SSBs was associated with a more than two-to-three-fold increase in gastric cancer risk compared with rare consumption (<1 serving per month) (HR 3.04; statistically significant)
• artificially sweetened beverages (ASBs): no significant association was observed between ASB consumption (including diet sodas containing aspartame or other artificial sweeteners) and gastric cancer incidence
• total fructose intake: higher dietary intake of fructose (the primary sweetener used in SSBs) tracked positively with increased gastric cancer incidence across the total cohort and in women
• Helicobacter pylori status: sub-analysis of participants with serologic testing revealed no association between SSB intake and H. pylori infection status, indicating that the elevated cancer risk is independent of H. pylori exposure

Proposed Biological Mechanisms

• hyperinsulinaemia and insulin resistance: high sugar/fructose intake promotes rapid spikes in blood glucose and serum insulin, upregulating insulin-like growth factor-1 (IGF-1) signaling pathways implicated in gastrointestinal carcinogenesis
• metabolic dysfunction and adiposity: chronic SSB consumption drives weight gain, visceral adiposity, systemic low-grade inflammation, and hormonal alterations
• gut dysbiosis: excessive dietary fructose and simple sugars alter the gastric and intestinal microbiome, potentially promoting a pro-inflammatory microenvironment

Clinical Implications

• lifestyle modification and public health: provides epidemiological evidence supporting dietary recommendations to limit intake of sugar-sweetened beverages as a modifiable risk factor for gastrointestinal malignancies
• early-onset gastric cancer trends: aligns with rising rates of metabolic dysfunction and obesity, which may contribute to the increasing incidence of gastric cancer in younger demographics

Reference

1. Gweon TG, Ha J, Kim H, Du M, Song M, Chan AT. Association between sugar-sweetened and artificially sweetened beverage intake and gastric cancer incidence. Gastro Hep Advances. 2026;5(11):101097.