Cohort studyindependent cross-checkabstract checked I-SOD-109 standard review
Soft drinks slightly linked to reflux disease
Sweetened beverage intake and incident gastroesophageal reflux disease in a prospective cohort study.
Overview
Ma C et al.. Eur J Nutr 2025 · PMID 40498344 · DOI 10.1007/s00394-025-03707-9
Among 167,574 UK adults, drinking more than one sugary or diet soft drink a day was linked to a 7-12% higher risk of reflux disease.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Study sweetened drinks and reflux disease.
- How was the study done?
UK Biobank cohort followed about 13 years.
- How many people, animals or samples were studied?
167,574 adults; 10,454 GERD cases.
- What was actually found?
Sugary and diet drinks linked to slightly more reflux disease.
- How large was the observed effect?
HR 1.07 (SSB), 1.12 (ASB).
- What do the results mean in everyday life?
A small increase in risk; individual triggers vary.
- What are the study's limitations?
Observational; small effects.
- What does it say about Elawady's specific claim?
Supports a modest reflux link, not 'wrecking digestion'.
- Do the results apply to Germany and Europe?
UK data.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Ma C et al.
- Journal
- Eur J Nutr
- Year
- 2025
- Identifier
- PMID 40498344 DOI 10.1007/s00394-025-03707-9
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Shenzhen science foundation; authors declare no conflict (PubMed record)
2. Research question
Are SSB, ASB and natural juices associated with incident GERD?
3. Study design and population
- Study design
- Cohort study – Prospective cohort (UK Biobank) with repeated 24-h recalls and substitution analysis
- Population
UK Biobank participants free of GERD
- Country
United Kingdom
- Period
Diet 2009-2012; median follow-up 12.8 years
- Sample size
167,574; 10,454 incident GERD cases
- Inclusion and exclusion criteria
GERD-free at baseline; dietary recall available
4. Methods and endpoints
- Exposure / intervention
SSB, ASB, natural juice servings/day
- Comparator
Non-consumers
- Endpoints
Incident GERD (records)
- Statistical methods
Cox models; substitution analysis
5. Actual results
- Results
SSB >1 serving/day HR 1.07 (1.01-1.14); ASB >1/day HR 1.12 (1.05-1.21); natural juice >1/day HR 0.91 (0.85-0.97). Replacing 1 serving/day of SSB with juice HR 0.92 (0.88-0.95); ASB with juice 0.89 (0.86-0.93).
- Absolute risks
not reported; illustrative calculation in stats/C-SOD-12_reflux.py
- Authors' conclusion
Higher SSB and ASB intake was linked to increased GERD risk; moderate juice intake to lower risk.
6. Strengths
- Very large cohort
- Diagnosed GERD
- Repeated dietary recalls
7. Weaknesses
- Small effect sizes
- Residual confounding
- Juice finding may reflect healthier users
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational.
9. Assessment of the statistical interpretation
Relative increases of 7-12% with small absolute differences (approx. 0.4 percentage points over 12.8 years for HR 1.07).
10. Relevance to the specific claim
Supports a small association between soft drinks (sugary or diet) and GERD (C-SOD-12); both sweetener types show it, so sugar alone does not explain it.
11. Independent contrary findings
I-SOD-01 (no direct evidence of causation).
12. Transferability to Germany and Europe
European data.
13. Overall methodological judgement
Consistent with Mehta 2020; effect small.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Mechanism (carbonation, acidity, caffeine).