Cohort studyindependent cross-checkabstract checked★ key study I-SOD-125 in-depth review

Soft drinks linked to slightly more kidney disease

Sweetened Beverage Intake and Incident Chronic Kidney Disease in the UK Biobank Study.

Overview

Heo GY et al.. JAMA Netw Open 2024 · PMID 38416492 · DOI 10.1001/jamanetworkopen.2023.56885

Among 127,830 UK adults, drinking more than one sugary or diet soft drink a day was linked to 19-26% higher risk of chronic kidney disease.

Does the study support the specific claim? Partly · Methodological quality: high

Study explained simply

What did the researchers want to find out?: Examine sweetened drinks and kidney disease.
How was the study done?: UK Biobank cohort over about 10 years.
How many people, animals or samples were studied?: 127,830 adults; 4459 CKD cases.
What was actually found?: Sugary and diet drinks linked to more CKD; juice not.
How large was the observed effect?: HR 1.19 (SSB), 1.26 (ASB).
What do the results mean in everyday life?: Replacing soft drinks with water may be good for kidneys.
What are the study's limitations?: Observational; not cola-specific.
What does it say about Elawady's specific claim?: Supports a modest link; does not prove damage.
Do the results apply to Germany and Europe?: UK data.
What can explicitly not be concluded from this study?: Cannot prove causation.

Are SSB, ASB and natural juice associated with incident CKD?

Study design: Cohort study – Prospective population-based cohort with substitution analysis
Population: UK Biobank participants without CKD
Country: United Kingdom
Period: Median follow-up 10.5 years
Sample size: 127,830; 4459 incident CKD (3.5%)
Inclusion and exclusion criteria: No CKD history; at least one dietary questionnaire

Results: SSB >1 serving/day AHR 1.19 (1.05-1.34). ASB >0-1/day AHR 1.10 (1.01-1.20); >1/day 1.26 (1.12-1.43). Natural juice not associated (>1/day HR 0.99, 0.87-1.11). Replacing SSB with ASB: HR 1.03 (0.96-1.10); replacing 1 serving/day SSB with juice 0.93 (0.87-0.97) or water 0.93 (0.88-0.99).
Absolute risks: Overall cumulative incidence 3.5%; illustrative excess ~0.7 percentage points over 10.5 years at HR 1.19 (approximation, stats/C-SOD-09_ckd.py)
Authors' conclusion: Lower consumption of SSB or ASB may reduce the risk of developing CKD.

Modest relative associations; the similar ASB association argues against sugar alone and suggests confounding or other components.

Supports a modest association between soft drinks and CKD (C-SOD-09), replacing the single 1980s case-control study as the main evidence.

Lo 2021 meta-analysis (I-SOD-126): pooled RR not significant.

UK data.

Best prospective evidence; association modest; causation not established.

Multidimensional assessment
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	mixed
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Cola-specific and phosphoric-acid-specific effects.