Soda has never been part of a healthy diet. In addition to promoting weight gain and concurrent health issues, it can be particularly tough on teeth thanks to its sugar and acidic content. And now it appears that we have more evidence that picking up a soda bottle may have even more dire consequences. According to a new study published in the Journal of the American Medical Association, drinking two soft drinks daily is associated with a higher risk of death from a variety of ailments.

The study looked at 451,743 healthy subjects from 10 European countries that had been recruited for the long-running European Prospective Investigation into Cancer and Nutrition, or EPIC. The participants provided information between 1992 and 2000.

The researchers examined the subjects' reported consumption of soft drinks and their overall mortality rate during a follow-up period of between 11 and 19 years later, which saw 41,693 deaths in that time. Mortality among those who consumed more than two sugary drinks a day was higher than those reporting consumption of less than one drink a month. This was in spite of the fact high-volume consumers were an average of roughly two years younger than their low-volume counterparts.

Notably, the study found that the cause of death differed among subjects who reported drinking artificially sweetened beverages and sugar-sweetened options. Drinks with artificial sweeteners were associated with circulatory diseases like coronary artery disease. Sugar-laden drinks were linked to digestive diseases, which can include ailments involving the liver and intestines.

The study’s authors drew two possible conclusions. One, fructose in sugary drinks leads to liver lipogenesis, a precursor to liver disease in non-alcoholics. Artificially flavored drinks might introduce glucose intolerance. Deaths among those consuming the artificially flavored beverages were consistent even among those with a healthy body weight. The authors were careful to note that long-term effects of sweeteners are still poorly understood.

[h/t MarketWatch]