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Comment & Response
February 2020

Hypertension and Unlikely Causality in the Association Between Soft Drink Consumption and Mortality—Reply

Author Affiliations
  • 1School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  • 2School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
  • 3Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
JAMA Intern Med. 2020;180(2):336-337. doi:10.1001/jamainternmed.2019.6127

In Reply We thank the authors of the letters addressing our study1 and welcome further discussion on the study design and its results.

Picon and Fuchs suggest that residual confounding by blood pressure may have contributed to the positive associations found between soft drink consumption and all-cause and circulatory disease deaths in our study.1 However, our results were similar when baseline systolic and diastolic blood pressure measurements were included in the multivariable models. For example, a hazard ratio (HR) of 1.26 (95% CI, 1.16-1.35) was found for the association between artificially sweetened soft drink consumption and all-cause mortality (≥2 glasses per day vs <1 glass per month), and this was practically unchanged when additionally adjusted for baseline blood pressure (HR, 1.25; 95% CI, 1.16-1.35). Likewise, for the association between artificially sweetened soft drink consumption and circulatory disease mortality, the association was near identical with (HR, 1.51; 95% CI, 1.29-1.77) and without (HR, 1.52; 95% CI, 1.30-1.78) adjustment for blood pressure. These analyses provide no evidence that confounding from blood pressure biased our results.

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