Premature aging was assessed using the Deficit Accumulation Index (DAI), which is the ratio of the number of age-related chronic health conditions each survivor had out of 44 conditions total.

Previous studies have shown that lifestyle factors such as diet and physical activity influence healthy aging in individuals without a history of cancer. High consumption of sugar and sugar-sweetened beverages is associated with a wide range of health conditions associated with aging, such as diabetes, metabolic syndrome, cardiovascular disease, cognitive impairment, and all-cause mortality.

The authors assessed the consumption of sugar and sugar-sweetened beverages in the study population using a food frequency questionnaire (FFQ). The FFQ included 110 foods, from which sugar intake was calculated using nutrient databases.

Nutrient intake was calculated using the United States Department of Agriculture Food and Nutrient Databases, which contains information on the sugar content of various foods.

The Deficit Accumulation Index (DAI) is based on 44 health conditions associated with aging. Each item was scored from 0 (absent) to 1 (present and/or most severe), summed, and divided by the total number of items examined. Thus, the DAI (range 0–1) is the proportion of deficits out of up to 44 items. The DAI is positively associated with mortality in the SJLIFE cohort. The DAI was categorized into low (<0.2), medium (0.2–<0.35), and high (≥0.35) groups.

To estimate the associations between DAI categories and sugar and sugar-sweetened beverages intake, the authors performed multinomial logistic regression, where the low DAI group (DAI < 0.2) was the reference.

72%, 20%, and 8% of survivors belonged to the low, medium, and high deficit accumulation groups, respectively. Almost half of them (46%) consumed sugar and sugar-sweetened drinks more than once a day.

Each 25 g/1000 kcal increase in total sugar intake was associated with a 23–27% greater chance of being in the medium or high DAI group. In analyses using sugar intake and DAI as continuous variables, total and added sugar intake were also positively associated with DAI category.

Frequent consumption of sugar-sweetened beverages was associated with greater deficit accumulation. An increase in sugar-sweetened beverages consumption of three times per week was associated with an 8% and 20% greater odds of being in the medium and high DAI groups, respectively. Compared with individuals who consumed sugar-sweetened beverages less than once per week, those who consumed sugar-sweetened beverages more than twice per day were 1.5 times more likely to be in the medium group and more than 5 times more likely to be in the high DAI group. An increase in sugar-sweetened beverages consumption of 355 g/day (about 1 can) was associated with an 8-18% greater odds of being in the medium or high DAI group.

In summary, high sugar intake, particularly added sugars during food preparation or processing, and regular consumption of sugar-sweetened beverages were associated with an increased risk of premature aging.

The prevalence of excessive intake of added sugars among the study subjects was consistently higher than in the NHANES adult population, across sociodemographic subgroups. In addition, one in two subjects consumed at least one sugar-sweetened beverage per day, the largest source of added sugar in the US diet.

The findings, although limited, are consistent with previous studies and plausible biological mechanisms, and support the notion that sugar has detrimental effects on aging in cancer survivors, similar to those described in the general population.