Sugar-Sweetened Beverages, Artificially Sweetened Beverages and Sugar Forms With Long-Term Risk of Irritable Bowel Syndrome: A Large-Scale Prospective Cohort Study

We aimed to examine the prospective association of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), natural juice, and sugar forms with irritable bowel syndrome (IBS). Participants free of IBS, celiac disease, inflammatory bowel disease, and any cancer at recruitment were included (N = 178,711, 53.1% female). SSB, ASB, natural juice, and different sugar forms' consumption were measured via a 24-h dietary recall questionnaire. The primary outcome was incident IBS. A Cox proportional hazard model adjusting for age, sex, BMI, Townsend deprivation index, education, ethnicity, smoking, alcohol drinking, physical activity, total energy intake, type 2 diabetes, depression, and anxiety was conducted to assess the relationship. Mean consumption of SSB, ASB, and natural juice was 90.0, 72.4, and 105.7 g/day, respectively. During a median of 11.3-year follow-up, 2690 participants developed IBS. Every 100 g/day SSB increment was associated with a 3% higher IBS risk (HR = 1.03, 95% CI: 1.01-1.05). Compared with no SSB intake, the highest quartile was associated with an increased risk of IBS (HR = 1.19, 1.03-1.37; ptrend = 0.017). Regarding ASB and natural juice, no significant association was detected in those who consumed the highest quartile versus no intake (ASB: HRQ4 VS no intake = 1.12, 0.95-1.31, ptrend = 0.062; Natural juice: HRQ4 VS no intake = 1.01, 0.87-1.18, ptrend = 0.363). Considering different sugar forms, increased IBS risk was detected in added sugar (HRQ4 VS Q1 = 1.20, 1.05-1.36, ptrend = 0.001), instead of naturally occurring sugar (HRQ4 VS Q1 = 0.99, 0.88-1.11, ptrend = 0.869). Higher intake of SSB, rather than ASB and natural juice, is associated with increased IBS risk. Higher consumption of added sugar, instead of naturally occurring sugar, is associated with higher IBS risk. These findings highlight the importance of limiting SSB consumption in diets to reduce the modifiable burden of IBS.