The primary objective of this study is to evaluate the associations of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and natural fruit juices (NJs) consumption with incident osteoarthritis (OA). We further aim to explore whether different types of beverages have distinct effects on OA risk, considering potential metabolic and inflammatory pathways that may link beverage intake to joint health.

A total of 198,927 UK Biobank participants  who were free of osteoarthritis (OA) at baseline and had completed at least one 24-hour dietary recall were included in the analysis. Cox proportional hazards models were applied to investigate the associations between the consumption of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and natural fruit juices (NJs) (categorized as 0, <1, and ≥1 cup, can, carton, or a 250-mL serving per day) and the risk of incident knee, hip, and hand OA. In addition, substitution analyses were conducted to estimate the potential impact of replacing one type of beverage with another on OA risk, providing insights into dietary modification strategies for OA prevention.

During a median follow-up of 13.65 years, 18470 (49.73%)  knee, 12064 (32.83%) hip, and 6605 (17.78%) hand OA cases were documented. Compared with non-consumers, those consuming ≥1 serving/day of either SSBs or ASBs exhibited a significantly higher risk of knee (hazard ratio [HR] (95% confidence interval [CI]), SSBs: 1.10 (1.04-1.17), P=0.002; ASBs: 1.07 (1.01-1.14), P=0.047) and hand OA (HR (95%CI), SSBs: 1.13 (1.02-1.25), P=0.014, ASBs: 1.21 (1.10-1.34), P<0.001), whereas consuming ≥1 serving/day of NJs was associated with a lower risk (HR (95%CI), knee OA: 0.93 (0.88-0.98), P=0.007; hand OA: 0.92 (0.84-1.01), P=0.060). Substitution analysis indicated that replacing one serving per day of SSBs or ASBs with NJs was associated with a lower risk of knee (HRs=0.91-0.95) and hand OA (HRs=0.81-0.97).

Higher consumption of SSBs and ASBs was associated with increased risks of incident knee and hand OA, whereas substituting these beverages with NJs may mitigate the risk.