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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Mullee A, Gunter MJ, Murphy N. Hypertension and Unlikely Causality in the Association Between Soft Drink Consumption and Mortality—Reply. JAMA Intern Med. 2020;180(2):336–337. doi:10.1001/jamainternmed.2019.6127
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