Individuals who consumed a lot of sugar-sweetened beverages (SSB) also tend to have overall poor dietary habits, which makes it difficult to tease out the adverse effects of soda alone, researchers said here.

They analyzed the dietary habits of more than 25,000 Swedes without diabetes, cardiovascular disease, or cancer, and found that the group that consumed the most SSB’s — at about a 12 oz can of soda per day — also consumed fewer healthy foods (P<0.002).

The researchers broke up foods into 24 categories; fatty foods like sausages and french fries were put in unhealthier categories, while healthier foods, which consisted of fruits, vegetables, yogurt, fiber-rich bread, and fish were categorized as healthier.

Those who consumed healthier drinks, like tea or juice, also consumed healthier foods, found the authors. High consumption of coffee was associated with higher intakes of meat and high-fat margarine and a lower intake of breakfast cereals (all P<0.002).

The cohort was 60% women, and all were 45-74 years old, and the mean body mass index was 25.6. Data were taken from the Swedish Malmö Diet and Cancer Cohort. Diet history was assessed by a 7-day food record and a 168-item questionnaire. The linear regression was adjusted for age, sex, season, method, body mass index, leisure time physical activity, total energy intake, smoking, education, and alcohol intake.

“Other studies have seen similar things,” said Brunkwall. “But it’s been lacking, this kind of study, in a more systematic way and with a bigger cohort.”

Brunkwall said that doing diet studies, and looking at all of the factors that can affect health, can be extremely complex.

“The message of this study is that if you only look at sugar-sweetened beverages you sort of miss a whole lot of other things,” she said. “You don’t eat a single product or a single food — you eat in combinations and in patterns.”

She added that researchers should be aware of the flaws of single-food or single-nutrient studies when they’re reading or interpreting other research.

The research was cross-sectional, so the researchers were not able to draw conclusions about causation.