Sugar-sweetened beverage consumption and bone health: a systematic review and meta-analysis

Detrimental effects of chronic sugar-sweetened carbonated soft drink consumption on inflammatory response and the size of apical periodontitis: An animal-based study

AIM

This study aimed to evaluate the effects of chronic consumption of two sugar-sweetened carbonated soft drinks - one containing caffeine (Coca-Cola®) and one without (Sprite®) - on the progression of periapical lesions and the levels of pro-inflammatory cytokines in rats.

METHODOLOGY

Twelve Wistar rats were divided into three groups (n = 4): Control group, Coca-Cola group and Sprite group. The rats in Coca-Cola and Sprite groups were given ad libitum access to their respective soft drinks for 3 months, while the Control group received filtered water. After 2 months of consumption, the pulps of the lower left first molars were exposed for 28 days to induce periapical lesions. Following euthanasia, the jaws were removed, and the periapical lesions were assessed using micro-computed tomography imaging. Blood samples were collected to analyse the pro-inflammatory cytokines IL-1β, IL-6, IL-2, IL-17 and TNF-α via Luminex assay. Non-parametric data were analysed using the Kruskal-Wallis test followed by Dunn's test, while parametric data were analysed using one-way ANOVA followed by Tukey's test (p < 0.05).

RESULTS

Both the Coca-Cola and Sprite groups exhibited periapical lesions with significantly greater volume and diameter compared to the Control group (p < 0.05). Additionally, both soft drink groups had significantly higher levels of IL-1β, IL-6 and IL-2 compared to the Control group (p < 0.05). The Sprite group displayed significantly higher levels of IL-1β than the Coca-Cola group (p < 0.05), while the Coca-Cola group showed significantly elevated TNF-α levels compared to both the Control and Sprite groups (p < 0.05). No significant differences in IL-17 levels were observed among the groups (p > 0.05).

CONCLUSIONS

The chronic consumption of sugar-sweetened carbonated soft drinks, regardless of caffeine content, has detrimental effects on the inflammatory response and progression of apical periodontitis in rats.

Associations between sugar-sweetened beverage consumption, weight-adjusted-waist index, with psychological symptoms: a cross-sectional survey of adolescents in mainland China

Background

The prevalence of psychological symptoms (emotional problems, behavioral problems, social adjustment difficulties) in adolescents continues to increase and has become a major concern in various countries. However, few studies have been conducted on the association between sugar-sweetened beverage (SSB) consumption, weight-adjusted waist index (WWI), and psychological symptoms in adolescents. The present study provides a reference for the prevention and intervention of psychological symptoms in Chinese adolescents.

Methods

A multistage stratified whole cluster random sampling method was used to assess psychological symptoms, SSB consumption, weight, waist circumference, and demographic information in 44,675 adolescents aged 12-17 years in mainland China in 2023. The associations between SSB consumption, WWI, and psychological symptoms among adolescents were analyzed using logistic regression model analysis and ordered logistic regression analysis with the generalized linear model.

Results

The prevalence of psychological symptoms among Chinese adolescents was 20.9%, with boys (21.4%) having a higher prevalence than girls (20.5%), and the difference was statistically significant (χ 2 value of 5.687, P < 0.05). The proportion of adolescents with SSB consumption >4 times/week was 14.5%, and the WWI value was 9.36 ± 1.13. Ordered logistic regression analysis showed that, using SSB consumption <1 times/week and WWI quartile of Q1 as the reference group, adolescents with SSB consumption >4 times/week and WWI quartile of Q4 had the highest risk of developing psychological symptoms (OR=2.01, 95% CI:1.76-2.30) (P <0.001). The same trend was observed in boys (OR=1.67, 95% CI: 1.39-2.00) and girls (OR=2.68, 95% CI: 2.17-3.31) (P <0.001).

Conclusions

The prevalence of adolescent psychological symptoms is high in mainland China and is associated with SSB consumption and WWI. Effectively reducing SSB consumption and WWI plays a positive role in the prevention and intervention of adolescent psychological symptoms.

Association between plain water intake and the risk of osteoporosis among middle-aged and elderly people in the United States: a cross-sectional study

Background

The connection between plain water intake (PWI) and osteoporosis risk is still unclear. The investigation aimed to identify the relationship between PWI and osteoporosis risk in middle-aged and elderly individuals in the United States (US).

Methods

This cross-sectional study was conducted among participants aged 50 years and older in the following waves of the National Health and Nutrition Examination Survey (NHANES): 2007-2008, 2009-2010, 2013-2014, and 2017-2018. The relationship between PWI and osteoporosis risk was examined by multivariable logistic regression models, accompanied by subgroup analyses and interaction tests. Smooth curve fitting and threshold effect analysis were utilized.

Results

The present investigation included 6,686 participants. In accordance with the fully adjusted model, individuals in the highest PWI tertile had a significantly reduced risk of osteoporosis in contrast to those in the lowest tertile [odds ratio (OR) = 0.62; 95% confidence interval (CI): 0.49-0.77; P for trend<0.001]. After adjusting for all covariates, a higher PWI was linked to a decreased risk of osteoporosis (OR = 0.92; 95% CI: 0.86-0.98; p = 0.008). No significant interactions were detected in the subgroup analyses for age, gender, race, body mass index, diabetic history, hypertension status, smoking history, consumption of prednisone or cortisone, or moderate or strenuous activity (all P for interaction>0.05). Smooth curve fitting and threshold effect analysis revealed that when PWI was less than 1,220 mL/day, there was a significant negative connection between PWI and osteoporosis risk (OR = 0.79; 95% CI: 0.70-0.89; p < 0.001); nevertheless that association was not significant when PWI was greater than 1,220 mL/day (OR = 1.06; 95% CI: 0.95-1.17; p = 0.288).

Conclusion

The outcomes of our investigation indicated that among middle-aged and older US adults, a higher PWI was connected with a moderately reduced osteoporosis risk. Managing PWI might reduce the osteoporosis risk.

Bone Health for Gynaecologists

Osteoporosis, the most common bone disorder, profoundly impacts women's health, especially during postmenopausal phases. Characterised by diminished bone mineral density (BMD), it increases the risk of fractures, affecting mobility, quality of life, and potentially mortality. The present review analyses the intricate interactions among physiological alterations, diseases, and medications that lead to bone mineral density reduction in women. It underscores the importance of gynaecologists in the prevention, diagnosis, and management of osteoporosis via early risk assessment, suitable hormone treatment, and lifestyle modifications. Essential considerations encompass the categorisation of osteoporosis into primary (age-related) and secondary (attributable to diseases or pharmacological treatments) types, with particular emphasis on predisposing conditions such as premature menopause, hormone deficits, and cancer therapies. The significance of diagnostic instruments such as DXA and novel methodologies like trabecular bone score and quantitative ultrasonography is emphasised for precise evaluation and surveillance. The review also addresses nutritional methods, physical exercise, and pharmaceutical interventions, including hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMs), and other anti-resorptive drugs, to preserve bone health. This review highlights the important role of gynaecologists in maintaining women's bone health, promoting a proactive strategy to avert osteoporosis-related complications and enhance long-term results.

Characterisation of the influence of dietary fat and sugar on bone health utilising densitometry, micro-computed tomography and histomorphometry

Obesogenic feeding can affect systemic metabolism and impact bone health and microarchitecture, but the findings of published studies often appear contradictory. This study aimed to compare the effects of a medium-fat/high-sugar (MF/HS) and a high-fat/high-fructose (HF/Fr) diet on the femora of weanling male Wistar rats, examining bone mineral content and density (BMC, BMD), cortical and cancellous bone microarchitecture and the cell populations within bone. Furthermore, we explored the correlations between circulating bone-targeting factors (in particular leptin, adiponectin and insulin) and bone parameters. Rats were assigned to one of three dietary groups (control: CON; MF/HS: OB1; HF/Fr: OB2; n = 12 each) for 17 weeks. Right-hand side femora were subjected to densitometry to measure BMC and BMD, and micro-computed tomography (μCT) was utilised to assess cortical and cancellous bone. Osteoblast (N.Ob), osteoclast (N.Oc), adipocyte (N.Ad) and chondrocyte numbers (N.Ch) were quantified histomorphometrically. Diet OB1 was largely beneficial to bone, while diet OB2 exerted detrimental effects on BMC, BMD, bone microarchitecture and bone cell populations. In cortical bone, N.Ob was positively correlated with BMD, cortical area and serum leptin. In cancellous bone, N.Ob was positively correlated with serum leptin and BMD, while N.Oc was negatively correlated with serum leptin. Overall, these findings support a role for endogenous circulating leptin in promoting bone formation. We conclude that the impact of different obesogenic diets may be driven by individual dietary effects on circulating factors, which may partly explain the contradictory reports in existing literature on the impact of HF and HS diets on bone.

Adults with Phenylketonuria have suboptimal bone mineral density apart from vitamin D and calcium sufficiency

Introduction

Improvement of early diagnosis and treatment in patients with Phenylketonuria (PKU) allowed for healthy survival into adulthood of these patients, but non-neurological health impairments of unknown etiology emerged. One of these is impaired bone health that manifests in adolescence and adulthood, potentially depending not only on treatment adherence but also on additional lifestyle factors and nutrition.

Methods

Eighteen adults with PKU (18.3-51.6 years, ♀ n = 11) and 19 age- and gender-matched controls (18.3-54.9 years, ♀ n = 10) participated in the study. Bone metabolism-related parameters (BMRPs) in plasma, serum, and urine were analyzed. Dietary habits and lifestyle factors were obtained from questionnaires; a 6-min walk test and a dual X-ray absorptiometry measurement at two sites were performed. Phenylalanine (Phe) serum concentrations from the 5 years prior to study participation were collected from the patients' charts.

Results

Patients had reduced bone mineral density (BMD) T-score in hips (-0.67 ± 1.05) and lumbar spine (-0.71 ± 1.11, both p = 0.018). Most BMRPs in plasma, serum, and urine, as well as markers of oxidative stress did not differ from healthy controls. Whereas 89% of adults with PKU were vitamin D-sufficient, only 68% of controls reached vitamin D sufficiency. 25-Hydroxy vitamin D concentration was significantly higher in adults with PKU than that in controls [33.1 ng/mL (26.2-40.3) vs. 23.4 ng/mL (17.2-24.9); p < 0.001], whereas parathyroid hormone concentrations showed no difference [PKU: 27.6 pg/mL (19.6-42.8) vs. Co: 36.1 pg/mL (29.2-40.8); p = 0.089]. Neither Phe blood concentration nor dietary habits or lifestyle factors were associated with BMD in regression analysis.

Conclusion

Neither dietary habits nor lifestyle factors showed an association with BMD in this group of adults with PKU, whereas BMD was reduced.

Impact of Soft Drink Intake on Bone Development and Risk of Fractures in a Danish Cohort of Schoolchildren

BACKGROUND AND AIMS

Soft drink consumption is suspected to negatively impact bone health in children, but longitudinal evidence is limited. This study assessed the association between soft drink intake and bone health outcomes in Danish schoolchildren aged 7.7-12 years, within a physical activity intervention framework.

METHODS

This study was nested in the CHAMPS-DK trial, a quasi-experimental study. Participants (n = 529) were recruited from intervention schools offering 270 min of physical education (PE) per week (active arm) and control schools with 90 min of standard PE. Soft drink intake was assessed via a food-frequency questionnaire at baseline. Dual-energy X-ray absorptiometry (DXA) was used to measure Bone Mineral Content (BMC), Bone Area (BA), and Bone Mineral Density (BMD) at baseline and two-year follow-up (primary outcomes). Fracture incidence over a five-year period was recorded using the SMS-Track parental reporting system (secondary outcome). Multilevel mixed-effects linear regression and Weibull survival models were used to analyze associations.

RESULTS

Soft drink intake of more than twice per month did not significantly affect BMC, BA, or BMD over two years (Total body BMD: β = 0.004; 95% CI: (-0.007; 0.016). Adjustment for confounders such as age, sex, BMI, pubertal status, socioeconomic status, and physical activity did not change the results. Additionally, no significant difference in fracture risk was observed (HR = 0.86; 95% CI: [0.43; 1.71]).

CONCLUSIONS

Soft drink intake had no measurable impact on bone health indices or fracture risk in children, irrespective of PE intervention. Future studies should investigate the effects of specific soft drink types (carbonated vs. non-carbonated) on bone development.

Nutrition and Osteoporosis Prevention

PURPOSE OF REVIEW

Osteoporosis affects 50% of women and 20% of men after the age of 50. Fractures are associated with significant morbidity, increased mortality and altered quality of life. Lifestyle measures for fragility fracture prevention include good nutrition including adequate protein and calcium intakes, vitamin D sufficiency, and regular weight bearing physical exercise.

RECENT FINDINGS

Dietary protein is one of the most important nutritional considerations as it affects bone mineral density, trabecular and cortical microstructure, and bone strength. When calcium intake is sufficient, higher dietary protein intake is associated with lower risk of fracture. Dairy products are a valuable source of calcium and high quality protein. Dairy product consumption, particularly fermented dairy products, are associated with a lower risk of hip fracture and vegan diets are associated with increased fracture risk. Other dietary factors associated with reduced fracture risk include at least 5 servings per day of fruits and vegetables, regular tea drinking, adherence to a Mediterranean diet and other dietary patterns which provide fibers, polyphenols and fermented dairy products. Such dietary patterns may confer health benefits through their effect on gut microbiota composition and/or function. A balanced diet including minerals, protein, fruits and vegetables is an important element in the prevention of osteoporosis and of fragility fracture.

Dietary recommendations of the Moroccan Society of Rheumatology (SMR) for patients with ostéosarcopenia

OBJECTIVE

The objective of this study was to develop the first Moroccan recommendations concerning nutrition in patients with osteosarcopenia.

MATERIAL AND METHODS

A steering committee consisting of rheumatologists and nutritionists drafted the initial version of the recommendations in light of the literature review and the recommendations of international societies. The draft was reviewed by a reading committee of 13 experts to approve the final version.

RESULTS

Four overarching principles and ten recommendations were established. The overarching principles emphasize that nutritional advice is not a substitute for the pharmacological treatment of osteosarcopenia. Instead, it should be based on scientific evidence and take into account the specific characteristics of Moroccan society. The recommendations emphasize the significance of adequate calcium and vitamin D intake while evaluating the benefit-risk ratio in instances where calcium supplementation is indicated. A balanced intake of trace elements, vitamins, proteins, and dairy products should be maintained. The Mediterranean diet is recommended, while vegetarian diets and restrictive diets in individuals who are not overweight are not advised. It is recommended that individuals who fast during Ramadan consume a varied and balanced diet. It is recommended that the consumption of soft drinks and alcohol be limited. The consumption of phytoestrogens from food in moderation is considered beneficial as part of a balanced diet. Nevertheless, the use of supplements is not advised.

CONCLUSION

The purpose of this work is to provide Moroccan rheumatologists with a practical tool to improve the nutritional aspect in patients with osteosarcopenia.

Unraveling the role of BMI and blood markers in the relationship between plant-based diets and osteoporosis: A prospective cohort study

BACKGROUND

The potential adverse effects of plant-based diets on bone health have raised significant concern, while the prospective evidence is limited. This study aimed to evaluate the association between plant-based diet indexes and incident osteoporosis while exploring the underlying mechanisms involved in this relationship.

METHODS

The analysis included 202,063 UK Biobank participants conducted between 2006 and 2022. Plant-based diet indexes (hPDI and uPDI) were calculated using the 24-h dietary questionnaire. Cox proportional risk regression and mediation analysis were used to explore the associations of plant-based diet indexes with osteoporosis, estimating the contribution of BMI and blood markers.

RESULTS

We found the highest quintile for hPDI (HR = 1.16; 95% CI: 1.05 to 1.28) and uPDI (HR = 1.15; 95% CI: 1.05 to 1.26) were associated with an increased risk of osteoporosis. BMI was identified as an important mediator in the association between hPDI and osteoporosis, with mediation proportions of 46.17%. For blood markers, the mediating (suppressing) effects of C-reactive protein, alkaline phosphatase, and insulin-like growth factor-1 on the association between uPDI (hPDI) and osteoporosis were significant, ranging from 5.63%-16.87% (4.57%-6.22%).

CONCLUSION

Adherence to a plant-based diet is associated with a higher risk of osteoporosis, with BMI and blood markers potentially contributing to this relationship. Notably, even a healthy plant-based diet necessitates attention to weight management to mitigate its impact on bone loss. These findings emphasize the importance of personalized dietary recommendations and lifestyle interventions to decrease the risk of osteoporosis.

Sugar-Sweetened Beverages and Adverse Human Health Outcomes: An Umbrella Review of Meta-Analyses of Observational Studies

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health.

Genome-wide association study of osteoporosis identifies genetic risk and interactions with Dietary Approaches to Stop Hypertension diet and sugar-sweetened beverages in a Hispanic cohort of older adults

Osteoporosis (OP) and low bone mass can be debilitating and costly conditions if not acted on quickly. This disease is also difficult to diagnose as the symptoms develop unnoticed until fracture occurs. Therefore, gaining understanding of the genetic risk associated with these conditions could be beneficial for health-care professionals in early detection and prevention. The Boston Puerto Rican Osteoporosis (BPROS) study, an ancillary study to the Boston Puerto Rican Health Study (BPRHS), collected information regarding bone and bone health. All bone measurements were taken during regular BPROS visits using dual-energy X-ray absorptiometry. The OP was defined as T-score ≤ -2.5 (≥2.5 SDs below peak bone mass). Dietary variables were collected at the second wave of the BPRHS via a food frequency questionnaire. We conducted genome-wide associations with bone outcomes, including BMD and OP for 978 participants. We also examined the interactions with dietary quality on the relationships between genotype and bone outcomes. We further tested if candidate genetic variants described in previous GWAS on OP and BMD contribute to OP risk in this population. Four variants were associated with OP: rs114829316 (IQ motif containing J gene), rs76603051, rs12214684 (melanin-concentrating hormone receptor 2 gene), and rs77303493 (Ras and Rab interactor 2 gene), and 2 variants were associated with BMD of lumbar spine (rs11855618, cingulin-like 1 gene) and hip (rs73480593, NTRK2), reaching the genome-wide significance threshold of P ≤ 5E-08. In a gene-diet interaction analysis, we found that 1 SNP showed a significant interaction with the overall Dietary Approaches to Stop Hypertension (DASH) score, and 7 SNPs with sugar-sweetened beverages (SSBs), a major contributor to the DASH score. This study identifies new genetic markers related to OP and BMD in older Hispanic adults. Additionally, we uncovered unique genetic markers that interact with dietary quality, specifically SSBs, in relation to bone health. These findings may be useful to guide early detection and preventative care.

The Effects of Different Dietary Patterns on Bone Health

Bone metabolism is a process in which osteoclasts continuously clear old bone and osteoblasts form osteoid and mineralization within basic multicellular units, which are in a dynamic balance. The process of bone metabolism is affected by many factors, including diet. Reasonable dietary patterns play a vital role in the prevention and treatment of bone-related diseases. In recent years, dietary patterns have changed dramatically. With the continuous improvement in the quality of life, high amounts of sugar, fat and protein have become a part of people's daily diets. However, people have gradually realized the importance of a healthy diet, intermittent fasting, calorie restriction, a vegetarian diet, and moderate exercise. Although these dietary patterns have traditionally been considered healthy, their true impact on bone health are still unclear. Studies have found that caloric restriction and a vegetarian diet can reduce bone mass, the negative impact of a high-sugar and high-fat dietary (HSFD) pattern on bone health is far greater than the positive impact of the mechanical load, and the relationship between a high-protein diet (HPD) and bone health remains controversial. Calcium, vitamin D, and dairy products play an important role in preventing bone loss. In this article, we further explore the relationship between different dietary patterns and bone health, and provide a reference for how to choose the appropriate dietary pattern in the future and for how to prevent bone loss caused by long-term poor dietary patterns in children, adolescents, and the elderly. In addition, this review provides dietary references for the clinical treatment of bone-related diseases and suggests that health policy makers should consider dietary measures to prevent and treat bone loss.

Sugar-Sweetened Beverage Consumption and Height Loss in Adults: A Longitudinal Analysis in the EPIC-Norfolk Study

BACKGROUND

Height loss in aging has been recognized to reflect a decline in musculoskeletal health but not investigated in relation to dietary factors, such as sugar-sweetened beverages (SSBs), the consumption of which may deteriorate musculoskeletal health.

OBJECTIVES

This study aimed to evaluate the longitudinal association of habitual consumption of total SSBs and its subtypes with height loss and examine effect-modification by age, sex, and anthropometry.

METHODS

We evaluated 16,230 adults aged 40-79 y in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort. At baseline (1993-1997), SSB consumption (soft drinks, squashes, sweetened milk beverages, sweetened coffee/tea, and sweetened alcoholic beverages) was assessed using 7-d food diaries. Height was objectively measured at the baseline, second (1997-2000), and third (2004-2011) health checks. Multivariable linear regression was used to examine baseline SSB consumption and the rate of height change over the follow-up.

RESULTS

The median (IQR) height change was -1.07 (-2.09 to -0.28) cm/10 y. Adjusted for potential confounders including behavioral factors, medications, and baseline body mass index (BMI), total SSB consumption was associated with height loss (β: -0.024; 95% CI: -0.046, -0.001 cm/10 y per 250 g/d of SSB), and similar results were seen for the individual beverages, except for sweetened milk beverages (β: +0.07; 95% CI: -0.16, 0.30), with wide CIs. No effect-modification by prespecified factors was evident, except for baseline BMI (P-interaction = 0.037). Total SSB consumption was associated with height loss (-0.038; 95% CI: -0.073, -0.004) in participants with BMI ≤ 25 kg/m2 but not apparently in those with BMI > 25 kg/m2.

CONCLUSIONS

SSB consumption was modestly associated with height loss, particularly in adults with normal weight status.

Impact of carbonated beverages on early onset of osteoporosis: A narrative review

Background: Processed and semi-processed foods are getting popular in the diets of the Western population. The Western diet is almost coupled with consuming carbonated beverages, either alcoholic or nonalcoholic. The presence of sugar, caffeine, and alcohol in different carbonated beverages and detrimental dietary patterns are leading causes of obesity, diabetes, and periodontal diseases in the young population. Aims: This article aims to review the impact of carbonated beverages on early onset of osteoporosis. Methods: A nonsystematic literature review searches in PubMed and Google Scholar electronic databases with predefined terms relating to carbonated beverages, caffeine intake, childhood obesity, osteoporosis, and bone softness. Results: Bone diseases significantly increase due to early exposure to caffeine and phosphoric acid in the pubertal period. Musculoskeletal growth is a dynamic and complex process, and bone mass achievement is of great importance in this process. According to the global burden of diseases, bone disorders consist of "6.8% of total disability-adjusted life-years." The consumption of soft drinks and their impact on bone accretion and bone mineral density in the young population is under research in the current literature on osteoporotic disorders. Since bone is a metabolically active tissue, it's in constant reconstruction mode. This process is regulated by genetic, hormonal, nutritional, and physical factors. Any imbalance in one of these processes might lead to mineral deposition and osteoporosis. Conclusion: Habitual intake of carbonated drinks with added sugars and caffeine is associated with increased body weight and bone fragility; stringent regulations are needed for proper education.

Dietary patterns - A scoping review for Nordic Nutrition Recommendations 2023

Background

A dietary pattern can be defined as the quantities, proportions, variety, or combination of foods and drinks typically consumed. The dietary pattern approach aims to place emphasis on the total diet as a long-term health determinant, instead of focussing on separate foods and nutrients, which may interact or confound each other.

Aim

This scoping review describes the totality of evidence for the role of dietary patterns for health-related outcomes as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023 (NNR2023).

Methods

We used evidence from 10 qualified systematic reviews identified by the NNR2023 project. No additional literature search was conducted.

Results

Strong or moderate evidence linked dietary patterns high in vegetables, fruits, whole grains, fish, low-fat dairy and legumes, and low in red and processed meats, sugar-sweetened beverages, sugary foods- and refined grains with beneficial health outcomes, such as reduced risk of cardiovascular disease (CVD), type 2 diabetes, obesity, cancer, bone health, and premature death. We also found limited evidence suggesting a relationship with the described dietary patterns in childhood and decreased risk of obesity and hypertension later in life. Most studies have been conducted among adult populations, and thus, there is a need for studies in certain subgroups, such as children and adolescents as well as the elderly.

Coffee Drinking and the Odds of Osteopenia and Osteoporosis in Middle-Aged and Older Americans: A Cross-Sectional Study in NHANES 2005-2014

The study investigates the association of coffee consumption and odds of osteoporosis/osteopenia among individuals older than 50 years in the United States. In NHANES 2005-2014, drinking ≤ 2 cups(16 oz) of coffee per day can reduce the risk of osteoporosis/osteopenia at the femoral neck and lumbar spine in US adults. Previous epidemiological studies revealed that daily coffee intake reduced the incidence of a cluster of metabolic diseases, however, the link between coffee consumption and prevalence of osteoporosis/osteopenia still remain inconclusive and awaits further confirmation. Based on data collection from 2005 to 2014 survey cycles, National Health and Nutrition Examination Survey (NHANES), a sample size of 8789 participants aged 50 and above completing two nonconsecutive 24-h dietary recalls were eventually enrolled for analysis. Associations between coffee intake and BMD were assessed. A lower odds of having femoral neck osteopenia/osteoporosis (FOO) was observed in participants with moderate intake of coffee (≤ 2 cups per day), rather than other beverages (OR 0.83; 95% CI, 0.72-0.95; p = 0.01). Moreover, significant associations existed between daily caffeine intake and both FOO and lumbar-spine osteopenia/osteoporosis (LOO). Even after adjusting for decaffeinated coffee, tea, sugar-sweetened beverages (SSBs), and coffee consumption, osteopenia and osteoporosis the odds remained lower at both femoral and neck levels. Our data suggest moderate habitual coffee intake (≤ 2 cups coffee/day) would have protective effects against osteoporosis/osteopenia of femoral neck and spine, among US adults over the age of 50.

Bone health: biology and nutrition

PURPOSE OF REVIEW

Recent findings in the influence of dietary patterns, dairy products, beverages and microbiota composition and function on bone health are reviewed and discussed.

RECENT FINDINGS

Evidence is accumulating on the increased risk of fracture in individuals following a vegan diet. Meta-analysis of randomized controlled trials indicates a favourable, though of low amplitude, effect of dairy products on bone mass accrual during childhood and adolescence. Though mostly based on results from observational studies, it seems that dairy product consumption, particularly fermented dairy products, is associated with a lower risk of hip fracture. Regular green tea drinkers may have a lower fracture risk than tea abstainers. Magnesium intake is beneficial for bone health. Prune supplements prevents bone loss in untreated postmenopausal women. This seems to be associated with modification of gut microbiota.

SUMMARY

This information should help the medical practitioners facing questions from their patients on how to protect bone health through nutrition.

Magnitude of sugar-sweetened beverage consumption and associated factors among women aged 15-49 years old in two Sub-Saharan African countries

BACKGROUND

The consumption of Sugar-Sweetened Beverages (SSBs) has been linked to the global epidemic of obesity and chronic disease. Following the economic growth, urbanization, and attractive market for beverage companies, the consumption of SSBs is a rising public health challenge in low and middle-income countries. Hence, this study aimed to assess the magnitude of SSBs consumption and associated factors among women of reproductive age group in two SSA countries.

METHODS

This cross-sectional study used data from Integrated Public Use Micro Data Series-Performance Monitoring for Action (IPUMS-PMA) with a total sample of 3759 women aged 15-49 years old in Burkina Faso and Kenya. The data was collected on June - August 2018 in Burkina Faso, and May -August 2018 in Kenya. SSBs consumption was measured by asking a woman if she drank SSBs yesterday during the day or night, whether at home or anywhere else. A mixed-effect logistic regression model was employed to identify associated factors.

RESULT

Half (50.38%) [95%CI; 46.04, 54.71] of women consumed SSBs. Sociodemographic characteristics like primary education (AOR = 1.35; 95%CI: 1.05-1.74), secondary education (AOR = 1.46; 95%CI: 1.13-1.90), being employed (AOR = 1.28; 95%CI: 1.05-1.56),and dietary characteristics like consumption of savory and fried snack (AOR = 1.61; 95%CI = 1.24-2.09), achieved minimum dietary diversity (AOR = 1.67; 95%CI: 1.38-2.01), moderate household food insecurity (AOR = 0.74, 95% CI: 0.58, 0.95), and sever household food insecurity (AOR = 0.71, 95% CI: 0.56, 0.89) had significant statistical association with SSBs consumption.

CONCLUSION

Consumption of SSBs among women in two Sub-Saharan African countries (Burkina Faso and Kenya) is high. Having higher educational status, being employed, achieved minimum dietary diversity, and having low/no household food in-security were found to be significantly associated with SSBs compared with their counterparts. We recommend for further study in other African countries using objective measurements of SSBs consumption.

High-Sucrose Diet Accelerates Arthritis Progression in a Collagen-Induced Rheumatoid Arthritis Model

SCOPE

High dietary sugar and sweeteners are suspected to cause the development of rheumatoid arthritis (RA) symptoms through the induction of proinflammatory cytokine release. However, the mechanisms by which increased dietary sugar affects RA etiology are not yet fully understood. The study uses a mouse model of collagen-induced RA (CIA) to investigate the relationship between excessive sugar consumption and RA risk.

METHODS AND RESULTS

RA-associated pathological features are assessed in the nonimmunized (NI) control group, the CIA-positive control group, and the CIA + high-sucrose diet (CIA+HS, 63% calories from sucrose) group. Compared with the CIA group, the CIA+HS group shows a greater increase in paw thickness and clinical scores, as well as, a higher degree of pannus formation and inflammation in the knee, ankle, and sole tissues. Moreover, the infiltration of immune cells is increased in the CIA+HS group. Although the expression of hepatic lipogenic genes, is not altered, that of toll-like receptor (TLR4) and IL-1β is considerably elevated in the CIA+HS group.

CONCLUSIONS

These findings suggest that excessive sucrose consumption causes hepatic fibrosis and inflammation, contributing to the pathophysiology of RA.

Soft drinks, tea and coffee consumption in relation to risk of fracture: evidence from china health and nutrition survey

INTRODUCTION

To investigate the association between soft drinks, tea and coffee consumption, and risk of fracture in the China Health and Nutrition Survey.

MATERIALS AND METHODS

A cross-sectional study with multi-stage random cluster sampling was conducted in nine Chinese provinces in 2004, 2006, 2009 and 2011. A total of 36,740 participants were included the data analyses. Self-administered questionnaires and physical examinations provided data on beverages consumption, fracture history, and other potential risk factors. Binary logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potentially confounding variables.

RESULTS

The prevalence of fracture increased over the 7-year period of the surveys, with 1833 (5.3%) participants reporting a fracture history. Soft drink consumption increased over this time period, and tea consumption was relatively stable, whereas coffee consumption tended to increase sharply. Consumers of soft drinks ≥ 3 times/week (versus never) had a higher risk of fracture (OR = 1.86, 95% CI = 1.43-2.32, p < 0.001, p for trend = 0.039). Consumers of tea ≥ 5 cups/day (versus never) also had a higher risk of fracture (OR = 1.21, 95% CI = 1.09-1.45, p = 0.028, p for trend < 0.001). Similarly, consumers of coffee ≥ 2 cups/day (versus never) had a higher risk of fracture (OR = 1.84, 95% CI = 1.01-3.34, p = 0.045, p for trend = 0.002). Subgroup analyses by gender suggested that coffee consumption increased risk of fracture in females (OR = 1.84, 95% CI = 1.32-2.63, p = 0.001).

CONCLUSION

Our findings suggest that high consumption of soft drinks, tea and coffee is associated with an increased risk of fracture in the Chinese population. Which has important public health implications given the widespread consumption of these beverages.

Dietary sugar consumption and health: umbrella review

OBJECTIVE

To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary sugar consumption and health outcomes.

DESIGN

Umbrella review of existing meta-analyses.

DATA SOURCES

PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and hand searching of reference lists.

INCLUSION CRITERIA

Systematic reviews and meta-analyses of randomised controlled trials, cohort studies, case-control studies, or cross sectional studies that evaluated the effect of dietary sugar consumption on any health outcomes in humans free from acute or chronic diseases.

RESULTS

The search identified 73 meta-analyses and 83 health outcomes from 8601 unique articles, including 74 unique outcomes in meta-analyses of observational studies and nine unique outcomes in meta-analyses of randomised controlled trials. Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected. Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence) and ectopic fatty accumulation (added sugars) (class IV evidence). Low quality evidence indicated that each serving/week increment of sugar sweetened beverage consumption was associated with a 4% higher risk of gout (class III evidence) and each 250 mL/day increment of sugar sweetened beverage consumption was associated with a 17% and 4% higher risk of coronary heart disease (class II evidence) and all cause mortality (class III evidence), respectively. In addition, low quality evidence suggested that every 25 g/day increment of fructose consumption was associated with a 22% higher risk of pancreatic cancer (class III evidence).

CONCLUSIONS

High dietary sugar consumption is generally more harmful than beneficial for health, especially in cardiometabolic disease. Reducing the consumption of free sugars or added sugars to below 25 g/day (approximately 6 teaspoons/day) and limiting the consumption of sugar sweetened beverages to less than one serving/week (approximately 200-355 mL/week) are recommended to reduce the adverse effect of sugars on health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022300982.

Bone fragility during the COVID-19 pandemic: the role of macro- and micronutrients

Bone fragility is the susceptibility to fracture due to poor bone strength. This condition is usually associated with aging, comorbidities, disability, poor quality of life, and increased mortality. International guidelines for the management of patients with bone fragility include a nutritional approach, mainly aiming at optimal protein, calcium, and vitamin D intakes. Several biomechanical features of the skeleton, such as bone mineral density (BMD), trabecular and cortical microarchitecture, seem to be positively influenced by micro- and macronutrient intake. Patients with major fragility fractures are usually poor consumers of dairy products, fruit, and vegetables as well as of nutrients modulating gut microbiota. The COVID-19 pandemic has further aggravated the health status of patients with skeletal fragility, also in terms of unhealthy dietary patterns that might adversely affect bone health. In this narrative review, we discuss the role of macro- and micronutrients in patients with bone fragility during the COVID-19 pandemic.

Long-Term Cola Intake Does Not Cause Evident Pathological Alterations in the Femoral Bone Microstructure: An Animal Study in Adult Mice

Short-term animal experiments and association studies in humans have shown that cola intake may have a detrimental impact on bone mineral density (BMD); however, other bone parameters have not been investigated. This study examined the effects of long-term cola consumption on the femoral bone microstructure using adult mice (n = 32) as an animal model, which were divided into water and cola groups depending on whether they received water or cola along with a standard rodent diet for 6 months. Micro-computed tomography revealed that cola intake did not significantly affect all measured parameters characterizing trabecular bone mass and microarchitecture, as well as cortical microarchitecture and geometry in both sexes, although a slight deterioration of these parameters was noted. Cola consumption also resulted in a slightly, statistically insignificant worsening of bone mechanical properties. In contrast to female mice, males receiving cola had a lower area of primary osteons' vascular canals. Nevertheless, long-term cola intake did not cause evident pathological alterations in the femur of adult mice, possibly due to a balanced diet and no restriction of physical activity. Therefore, the adverse effects of cola consumption on BMD, the only bone parameter studied so far, may be caused by other risk and lifestyle factors.

Dietary recommendations in the prevention and treatment of osteoporosis

INTRODUCTION

This article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie - SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d'Informations sur les Ostéoporoses - GRIO) on the role of diet in the prevention and treatment of osteoporosis.

METHODS

The recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to "daily practices" were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies.

RESULTS

A Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and "high quality" protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics.

CONCLUSIONS

These are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines.

Psychometric properties of the Chinese version of the sugar-sweetened beverages media literacy scale for undergraduates

Specific domains of the Sugar-Sweetened Media Literacy Scale (SSM-ML) have been shown to significantly assess sugar-sweetened beverage (SSB) calorie intake in the US population. This study aimed to describe the psychometric properties of the revised Chinese version of the SSB-ML (C-SSB-ML) and evaluate its validity and reliability. Results from 975 undergraduates at two of the largest universities in a province in southwest China showed that Cronbach's alphas for the overall scale, the three dimensions, and two-halves analysis were satisfactory (0.71-0.92). The criterion-related validity of the C-SSB-ML was positively associated with the e Health literacy scale (eHEALS). Confirmatory factor analysis showed that the three-factor model of the C-SSB-ML had adequate fit indices χ² (153) = 4349.93, p < 0.001; Comparative fit index (CFI), Tucker-Lewis index (TLI), Incremental fit index (IFI) >0.90; Standardized Root Mean Square Residual (SRMR) <0.07; and Root Mean Square Error of Approximation (RMSEA) <0.08. Our findings provide evidence for a valid and reliable tool that can be used to assess sugar-sweetened media literacy in Chinese undergraduates and will help organizations leverage media literacy in strategy formulation to ensure SSB intake is controlled as much as possible through effective efforts on all fronts.

Serum PFAS and Urinary Phthalate Biomarker Concentrations and Bone Mineral Density in 12-19 Year Olds: 2011-2016 NHANES

CONTEXT

Per- and polyfluoroalkyl substances (PFAS) and phthalates are 2 families of environmental endocrine disruptors that may be associated with areal lower bone mineral density (aBMD).

OBJECTIVE

To examine associations between serum PFAS and urinary phthalate biomarker concentrations and their mixtures with aBMD Z-scores in adolescents.

DESIGN, PATIENTS, AND MEASURES

We examined serial cross-sectional data from male (n = 453) and female (n = 395) 12- to 19-year-old participants in the 2011 through 2016 National Health and Nutrition Examination Survey with measures of serum PFAS, urinary phthalate metabolites, and dual-energy X-ray absorptiometry aBMD Z-scores (total body less head). In sex-specific models, we used linear regression to examine associations of individual PFAS and phthalate biomarkers with aBMD Z-scores, and Bayesian kernel machine regression to examine the association of the overall PFAS/phthalate biomarker mixture with aBMD Z-scores. We replicated the analysis, stratifying by race/ethnicity.

RESULTS

Participants were (mean ± SD) 15 ± 2.1 years of age. In males, each doubling of serum perfluorooctanoate (PFOA), perfluorooctane sulfonate, urinary mono-isobutyl phthalate (MiBP), mono-n-butyl phthalate, and the overall PFAS/phthalate mixture was associated with a lower aBMD Z-score (eg, for PFOA: -0.24; 95% CI, -0.41 to -0.06). Serum PFOA and urinary MiBP were associated with higher aBMD Z-scores in females (eg, for PFOA: 0.09; 95% CI, -0.07 to 0.25). Findings did not differ by race/ethnicity.

CONCLUSIONS

Certain PFAS and phthalates may be associated with reduced bone mineral density in adolescent males. Bone mineral density tracks across the life course, so if replicated in longitudinal cohorts, this finding may have implications for lifelong skeletal health.

Associations between bone mineral density and chronic obstructive pulmonary disease

Objective

To assess the relationship between chronic obstructive pulmonary disease (COPD) severity and bone mineral density (BMD) in the whole body and different body areas.

Methods

This retrospective, cross-sectional study included patients with COPD. Demographic and lung function data, COPD severity scales, BMD, and T scores were collected. Patients were grouped by high (≥–1) and low (<–1) T scores, and stratified by body mass index, airway obstruction, dyspnoea, and exercise capacity (BODE) index. The relationship between whole-body BMD and BODE was evaluated by Kendall’s tau-b correlation coefficient. Risk factors associated with COPD severity were identified by univariate analyses. BMD as an independent predictor of severe COPD (BODE ≥5) was verified by multivariate logistic regression. BMD values in different body areas for predicting severe COPD were assessed by receiver operating characteristic curves.

Results

Of 88 patients with COPD, lung-function indicators and COPD severity were significantly different between those with high and low T scores. Whole-body BMD was inversely related to COPD severity scales, including BODE. Multivariate logistic regression revealed that BMD was independently associated with COPD severity. The area under the curve for pelvic BMD in predicting severe COPD was 0.728.

Conclusion

BMD may be a novel marker in predicting COPD severity, and pelvic BMD may have the strongest relative predictive power.

Bone Health in School Age Children: Effects of Nutritional Intake on Outcomes

The maximum rate of bone mass accumulation is during early adolescence. As such, a focus on optimizing mineral nutrition in school age children, defined here as approximately 5 to 15 years of age, is crucial to minimize the risk of bone loss that occurs later in life leading to osteoporosis and fractures. Optimizing bone mass in this age group requires attention to an overall healthy diet including adequate calcium, phosphorus, magnesium, and vitamin D. Special concerns may exist related to children who follow a restricted diet such as a vegan diet, those with intolerance or allergies to dairy, and those with chronic health conditions including young adolescents with eating disorders. Public policy messages should focus on positive aspects of bone health nutrition in this age group and avoid overly specific statements about the exact amounts of foods needed for healthy bones. In this regard, dietary recommendations for minerals vary between North America and Europe and these are higher than the values that may be necessary in other parts of the world. The management of many children with chronic illnesses includes the use of medications that may affect their bone mineral metabolism. Routine lab testing for bone mineral metabolism including the serum 25-hydroxyvitamin D level is not indicated, but is valuable for at-risk children, especially those with chronic illnesses.

The impact of lifestyle on forearm fractures in children: A retrospective cohort analysis

BACKGROUND AND OBJECTIVES

Forearm fractures are frequent in children. It is important to identify predisposing factors for increased fracture risk. This retrospective analysis aimed to investigate the correlation between forearm fractures in children and co-factors such as age, TV consumption, consumption of soft drinks, the kind of soft drinks consumed as well as physical activity in daily life and BMI.

METHODS

This retrospective cohort analysis compared 355 participants at the age of 4 to 12 between 2017 and 2018 with and without forearm fractures in children. It was based on a questionnaire to assess the above-mentioned cofactors regarding behavior and lifestyles choices and aimed to identify whether or not these lead to an increased risk of forearm fractures. For statistical analysis logistic regression was used.

RESULTS

Logistic regression showed a significant effect on forearm fractures in children for the variables age (Odds ratio 3.3 [95% confidence interval 1.5-7.3], P = .003), TV consumption (Odds ratio 5.4 [95% confidence interval 2.5-22.6], P < .001), consumption of soft drinks (Odds ratio 2.6 [95% confidence interval 1.2-5.6], P = .013), and the kind of soft drinks consumed (Odds ratio 3.1 [95% confidence interval 1.5-6.3], P = .003), [Nagelkerkes-R² = 0.458; Chi² = 85.037; df = 6]) with a strong effect according to Cohen (f² = 0.84).

CONCLUSION

The study showed a significant correlation between TV and soft drink consumption and increased risk for forearm fractures in children. TV consumption and consumption of soft drinks should be reduced in children to prevent forearm fractures.

Prospective Associations of Sugar-Sweetened Beverage Consumption During Adolescence with Body Composition and Bone Mass at Early Adulthood

BACKGROUND

Adolescents have a higher consumption of sugar-sweetened beverages (SSBs) than other age groups, but little is known of the impact of SSB intake during adolescence on body composition and bone mass in early adulthood.

OBJECTIVES

Associations of SSB intake from 14 to 20 y with fat, lean, and bone mass at 20 y of age were evaluated.

METHODS

Study participants were 1137 offspring (562 females) from the Raine Study. Food intake, including SSB consumption in servings/d (1 serving = 250 mL), was estimated using FFQs at 14, 17, and 20 y of age. DXA scanning at 20 y measured whole body fat mass, lean mass, and bone mineral content (BMC). Using latent class growth analysis, 4 SSB intake trajectory classes were identified: consistently low (n = 540, intakes mostly <0.5 serving/d), increasing (n = 65), decreasing (n = 258), and consistently high (n = 274, intakes mostly >1.3 servings/d).

RESULTS

Median total SSB intake was 0.8, 0.7, and 0.5 serving/d, and median carbonated SSB intake was 0.3, 0.3, and 0.4 serving/d at 14, 17, and 20 y, respectively. Mean ± SD BMI (in kg/m2) was 23.9 ± 4.2 at 20 y. After adjustment for covariates including sex, demographic, energy intake, and maternal factors, individuals with "consistently high" SSB consumption had significantly higher total body fat mass at 20 y than those with "consistently low" consumption (23.3 ± 0.6 compared with 21.2 ± 0.4 kg, P = 0.004), which remained significant after further adjustment for "Healthy" and "Western" dietary patterns (23.2 ± 0.6 compared with 21.2 ± 0.4 kg, P = 0.011). No significant associations were observed between SSB intake trajectory classes and lean body mass or BMC at 20 y.

CONCLUSIONS

In this cohort, consistently higher consumption of SSBs in adolescence and early adulthood are associated with increased fat mass but not with bone mass at 20 y of age.

Substitution of Sugar-Sweetened Beverages for Other Beverages: Can It Be the Next Step Towards Healthy Aging?

PURPOSE OF REVIEW

With the prolongation of life expectancy, the gap between lifespan and "health span," the disease-free lifespan, has been widening due to the massive burden of age-related chronic diseases and research on healthy aging has been gaining momentum. A growing body of evidence suggests that diet is a strong determinant of healthy aging and consumption of sugar-sweetened beverages (SSB), a major source of added sugars, predicts poor health outcomes in the aging population, including cardiovascular disease, diabetes, and cancer. Evidence further supports a link between sugar-sweetened beverages-triggered pathological processes and biologic factors of aging, including inflammaging, oxidative stress, and alterations in intestinal microbiota. At present, substitution of sugar-sweetened beverages with healthier alternative beverage remains the most robust strategy to limit the deleterious effects of sugar-sweetened beverages on health worldwide and may help achieve healthy longevity. The purpose of this review is to provide an overview of mechanisms by which sugar-sweetened beverages consumption may impact the physiological aging process and how a simple intervention of beverage replacement may promote healthy aging.

RECENT FINDINGS

Recent findings indicate that SSB are associated with accelerated aging phenotype and activate various adverse biological processes such as chronic inflammation, oxidative stress, insulin resistance, and gut dysbiosis. Replacing SSB with healthier beverages may be a reasonable option to reduce the burden of chronic disease in the aging population and even prolong life and healthspan.