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Principal Investigator
Katherine McGlynn
National Cancer Institute
Position Title
Senior Investigator
About this CDAS Project
PLCO (Learn more about this study)
Project ID
Initial CDAS Request Approval
Sep 1, 2020
Consumption of sugar, sugar-sweetened beverages and liver cancer
Liver cancer incidence has been increasing in the U.S. for the past several decades. Although hepatitis B virus, hepatitis C virus, excessive alcohol consumption and smoking are well-established risk factors, the risk factor with the largest attributable risk in the U.S. is a constellation of hepato-metabolic conditions. These conditions, including metabolic syndrome, diabetes, obesity and non-alcoholic fatty liver disease (NAFLD), have all increased in prevalence in tandem with the increase in liver cancer. Also coincident with the rising incidence of liver cancer are the increased consumption of sugar-sweetened beverages (SSB) and added sugar. Evidence suggests that these dietary changes may be to related to the epidemics of obesity, diabetes, and NAFLD. SSB are the leading source of added sugars in the U.S. diet and their consumption may increase the risk of liver cancer by raising blood glucose levels, increasing insulin demand, and decreasing insulin sensitivity, as SSB result in a rapid increase in both blood glucose and insulin concentrations.

To date, few studies have examined the association between liver cancer and consumption of sugar or SSB. In 2000, a small Greek case-control study reported no overall association with sugar consumption, but did not examine SSB. In 2012, an NIH-AARP cohort study of 24 cancers reported no associations with liver cancer and total sugar, added sugar, total fructose or sucrose, but the analysis was limited to examining 222 cases among men and 66 cases among women. In contrast, a 2013 study in the EPIC cohort reported a significant association between total sugar consumption and liver cancer (HR=1.43, 95%CI=1.17-1.74). Given the inconsistency of the results, further examination of the sugar-liver cancer association, and in particular, the SSB-liver cancer association, is clearly warranted.

To examine the association of liver cancer with:
1) Consumption of sugar-sweetened beverages (regular soda, diet soda, juices);
2) Sugar (sugar, artificial sweeteners) added to coffee and tea.


Gieira Jones, DCEG-NCI
Barry Graubard, DCEG-NCI
Jessica Petrick, Boston University
Xuehong Zhang, Harvard University