| Aus den Original-Papers |  |
Limitations
To our knowledge, this study is the largest to date to investi-
gate the association between soft drink consumption and mor-
tality. However, it has several limitations. Given the observa-
tional design of the study, it is not possible to establish causality
between soft drink consumption and mortality, and we rec-
ognize that the observed associations may be biased because
of residual confounding. However, the large number of par-
ticipants and recorded deaths (approximately 42 000) al-
lowed us to conduct analyses by subgroups of other mortal-
ity risk factors, and we generally observed similar associations
across subgroups of considered risk factors. Furthermore, the
negative control analysis found no association between con-
sumption of soft drinks and deaths from external causes. This
study was also limited by a single assessment of soft drink con-
sumption at baseline.
Conclusions
In this study, the high level of consumption of total, sugar-
sweetened, and artificially sweetened soft drinks was associ-
ated with elevated risks of death from all causes. Positive
associations were observed between sugar-sweetened soft
drinks and digestive disease deaths as well as between artifi-
cially sweetened soft drinks and circulatory disease deaths.
Further studies are needed to investigate the possible ad-
verse health effects of artificial sweeteners. The results of this
study are supportive of ongoing public health campaigns aimed
at reducing the consumption of soft drinks
[https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-1241.2009.02051.x]
Conclusions
Several lines of evidence suggest that the chronic consumption of large amounts of cola soft drinks may adversely affect potassium homeostasis and result in potentially severe conditions such as hypokalaemic myopathy. In an era where the food industry presses towards an increase in portion sizes of these preparations, the aforementioned observations may have important public health implications. Although cola discontinuation and potassium supplementation usually lead to an uneventful recovery in the most of the cases, the cola-induced chronic hypokalaemia clearly predisposes to the development of potentially fatal complications such as cardiac arrhythmias (21,22). In addition, chronic hypokalaemia may be a cause of increased morbidity because of fatigue, loss of productivity and muscular symptoms that vary from mild weakness to profound paralysis. Further studies are needed to justify the use of limitations in the maximum recommended daily dose of these soft drinks.
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