Home Journal Excerpts Carbonated Beverages and Bone Health Carbonated Beverages, Dietary Calcium, the Dietary Calcium/Phosphorus Ratio, and Bone Fractures in Girls and Boys
Carbonated Beverages, Dietary Calcium, the Dietary Calcium/Phosphorus Ratio, and Bone Fractures in Girls and Boys PDF Print E-mail
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Saturday, 01 January 1994 00:00
“Purpose: The aim of this study was to explore the association between carbonated beverage consumption, as well as other nutritional intake, and the occurrence of bone fractures in girls (mean +/- SD) 14.3 yr +/- 1.8 and boys 14.6 yr +/- 1.6. Methods: Food-frequency questionnaires and medical histories were obtained from 76 girls and 51 boys. Subjects were recruited from a swimming club and physicians' offices; their physical characteristics are representative of the normal adolescent population. Results: The data show a strong association between cola beverage consumption and bone fractures in girls [the adjusted odds ratio (OR) = 3.59; 95% confidence interval (CI) 1.21, 10.75; p = 0.022]. High intake of dietary calcium was protective (adjusted OR = 0.284; 95% CI 0.087, 0.920; p = 0.036). No association between the non-cola drinks and bone fractures was found. In boys, only total caloric intake was associated with the risk of bone fractures; the association was inverse. Conclusion: The high consumption of carbonated beverages and the declining consumption of milk are of great public health significance for girls and women because of their proneness to osteoporosis in later life.”

“Calcium intake and the calcium/phosphorus ratio in relation to bone fractures and osteoporosis are of great current interest. In earlier work, we reported a statistically significant association between the consumption of non-alcoholic carbonated beverages and bone fractures, which occurred among women form college athletes, 21-80 years of age. If was hypothesized that the association was attributable to cola drinks that contain phosphoric acid.”

“A higher activity level was inversely associated with risk of fractures (OR is 0.216; 95% CI 0.081, 0.573; p = 0.002). (Using a three-point scale of physical activity, a dose-response inverse relationship between activity and fractures was observed.”

“The consumption of cola beverages is associated with bone fractures (unadjusted OR is 3.19; 95% CI 1.21, 8.42; p = 0.019). The consumption of all carbonated beverages is marginally associated with bone fractures (OR is 2.29; 95% CI 0.89, 5.95; p = 0.090)); the association is statistically significant when activity level and caloric intake are controlled for.”

“The result from this study of adolescent girls confirm our earlier findings of an association between bone fractures and carbonated beverage consumption in older women and former college athletes (whose ages ranged from 21 to 80 years). They also support our hypothesis that the association is due to the cola drinks, which contain phosphoric acid. High calcium intake from all sources is protective, but the association of milk consumption alone and bone fractures is not significant. Cola drinks, all carbonated beverages combined, and dietary calcium intake are significant risk factors for bone fractures after adjusting for age, weight, height, activity level and total caloric intake. A lower calcium/phosphorus ratio is marginally significant. The non-cola drinks, caffeine-free drinks, and low-calorie drinks showed no significant association with bone fractures. We also considered the relation between total caffeine intake and the risk of fractures. The results showed no significant association. Heaney et al. have reported that among normal middle-aged women caffeine intake appears to contribute to a worsening of calcium balance. The levels of caffeine intake in our adolescents averaged about 65 mg / day, and are considerably less than the 0.35 gm / day for Heaney's subjects.”

“The odds ratio for the cola drinks, adjusted for activity level and caloric intake, is 3.6, although the sample in this study is relatively small. In addition, the association between cola beverages and bone fractures was significant, controlling for whether subjects were orthopedists' patients or not. The protective effect of calcium is consistent and biologically plausible.”

“Peak bone mass is now recognized as a key determinant of osteoporosis in later life. It has been suggested that osteoporotic fractures may be delayed by modifications of diet and activity among young women; and that adolescence could be a critical period for bone mass formation. Matkovic et al. report that by age 16 yr, daughters had accumulated 90%-97% of the bone mass of their pre-menopausal mothers. The adverse effects of carbonated beverage consumption (especially colas) on the risk of bone fractures and the protective effect of calcium has been shown in active girls under 17 years. These findings are of considerable public health significance, particularly because of (a) the high consumption of carbonated beverages (estimated as more than 40 gallons per person per year), and declining consumption of milk; and (b) the proneness of women to osteoporosis in the peri- and post-menopausal years.”


Wyshak, Grace PhD and Frisch, Rose E., PhD, "Carbonated Beverages, Dietary Calcium, the Dietary Calcium/Phosphorus Ratio, and Bone Fractures in Girls and Boys", Journal of Adolescent Health, January 1, 1994, Vol. 15, Num. 0, pp. 210-215

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