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Sweetened vs. Unsweetened Coffee Consumption and Mortality
Quick Takes
- Moderate consumption of unsweetened coffee was associated with a lower risk for all-cause mortality and cardiovascular mortality.
- Moderate consumption of sugar-sweetened coffee was also associated with a lower risk for death, while artificially sweetened coffee was not significantly associated with mortality.
Study Questions:
Does the addition of sweeteners (sugar or artificial sweeteners) to coffee increase the risk of all-cause and cause-specific mortality?
Methods:
Data from the UK Biobank were used in this prospective cohort study of participants residing in England, Wales, or Scotland between 2006–2010, and who were free of cardiovascular disease (CVD) or cancer at baseline. Follow-up began in 2009 and ended in 2018. Participants who did not complete at least one online 24-hour dietary recall questionnaire were excluded. Dietary consumption of coffee was divided into four groups (nonconsumers, unsweetened coffee consumers, sugar-sweetened coffee consumers, and artificially sweetened coffee consumers). Mortality data were obtained from death certificates according to the National Health Service Information Centre (England and Wales) and the National Health Service Central Register Scotland (Scotland). Mortality data were available through February 25, 2018 for England and Wales and through February 28, 2017 for Scotland.
Results:
A total of 171,616 adults (mean age 55.6 years [SD 7.9]) were included in the present study. During a median follow-up of 7.0 years, 3,177 deaths were recorded (including 1,725 cancer deaths and 628 CVD deaths). A total of 130,132 of the participants were coffee drinkers, with the majority (55.4%) reporting consumption of unsweetened coffee. Consumers of sugar-sweetened and artificially sweetened coffee added an average of 1.1 teaspoons (SD, 0.6) and 1.4 teaspoons (SD, 0.6) of sugar and sweetener, respectively. Nonconsumers of coffee were more likely to drink tea. Sugar-sweetened coffee consumers were more likely to be male, from a lower social class, and current smokers and generally had less healthy diets. Artificially sweetened coffee consumers were more likely to be older, former heavy smokers, and obese and to report hypertension, diabetes, depression, and a family history of CVD. Unsweetened coffee consumers were of a higher social class and generally had healthier diets. U-shaped associations were observed with unsweetened coffee, sugar-sweetened coffee, and artificially sweetened coffee with mortality.
Compared with nonconsumers, consumers of various amounts of unsweetened coffee (>0 to 1.5, >1.5 to 2.5, >2.5 to 3.5, >3.5 to 4.5, and >4.5 drinks/day) had lower risks for all-cause mortality after adjustment for lifestyle, sociodemographic, and clinical factors, with respective hazard ratios of 0.79 (95% confidence interval [CI], 0.70-0.90), 0.84 (CI, 0.74-0.95), 0.71 (CI, 0.62-0.82), 0.71 (CI, 0.60-0.84), and 0.77 (CI, 0.65-0.91). For consumption of sugar-sweetened coffee, the hazard ratios were 0.91 (CI, 0.78-1.07), 0.69 (CI, 0.57-0.84), 0.72 (CI, 0.57-0.91), 0.79 (CI, 0.60-1.06), and 1.05 (CI, 0.82-1.36) for consumption intakes of coffee (>0 to 1.5, >1.5 to 2.5, >2.5 to 3.5, >3.5 to 4.5, and >4.5 drinks/day, respectively). The association between artificially sweetened coffee and mortality was less consistent. The association of coffee drinking with mortality from cancer and CVD was largely consistent with that with all-cause mortality. U-shaped associations were also observed for instant, ground, and decaffeinated coffee.
Conclusions:
The investigators concluded that moderate consumption of unsweetened and sugar-sweetened coffee was associated with lower risk for death.
Perspective:
These data are, in general, consistent with prior studies of coffee intake, while adding additional information on sweeteners often added to coffee. Regarding cardiovascular mortality, moderate consumption of unsweetened coffee (i.e., 2.5 to 3.5 drinks/day) was associated with a lower risk for CVD compared to no coffee intake; however, sweetened coffee was attenuated when adjusted for possible confounders. Use of artificial sweeteners in coffee did not appear to be significantly associated with mortality outcomes. Limitations of these data include self-reported data on coffee consumption and the inclusion of tea drinkers in the noncoffee consumers.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Diet, Hypertension
Keywords: Cardiovascular Diseases, Coffee, Depression, Diabetes Mellitus, Diet, Healthy, Hypertension, Neoplasms, Obesity, Primary Prevention, Smokers, Social Class, Sweetening Agents, Tea
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