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

## TL;DR

Drinking more sugar-sweetened beverages is linked to a higher long-term risk of developing irritable bowel syndrome, while artificial sweeteners and natural juice show no significant risk.

## Contribution

This study is the first large-scale prospective cohort to link sugar-sweetened beverage and added sugar intake with increased IBS risk.

## Key findings

- Higher sugar-sweetened beverage intake is associated with a 3% increased IBS risk per 100g/day.
- Added sugar consumption is linked to higher IBS risk compared to naturally occurring sugar.
- Artificially sweetened beverages and natural juice show no significant association with IBS.

## Abstract

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; p
trend = 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, p
trend = 0.062; Natural juice: HRQ4 VS no intake = 1.01, 0.87–1.18, p
trend = 0.363). Considering different sugar forms, increased IBS risk was detected in added sugar (HRQ4 VS Q1 = 1.20, 1.05–1.36, p
trend = 0.001), instead of naturally occurring sugar (HRQ4 VS Q1 = 0.99, 0.88–1.11, p
trend = 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.

In this large‐scale prospective cohort, higher intake of sugar‐sweetened beverages is associated with a higher risk of incident IBS, rather than the null association for artificially sweetened beverages or natural juice intake. Higher consumption of added sugar, instead of naturally occurring sugar, is associated with an increased risk of IBS development, suggesting the potential role of sugar forms rather than simply the amount.