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

Nutr J. 2021 May 5;20(1):41. doi: 10.1186/s12937-021-00698-1.


Background: Current evidence demonstrate that sugar-sweetened beverages (SSBs) and bone health are related; however, there has been only a few reviews on the link between SSBs and bone health. A systematic review and meta-analysis was performed to investigate the association between SSBs consumption and bone health in chidren and adults.

Methods: Relevant studies of SSBs and bone health published up to 15 March 2021 were searched using PubMed, the Web of Science, Cochrane Library, and a reference search. A random-effects meta-analysis was conducted to estimate the standardized mean difference (SMD). Subgroup analyses were performed to identify whether effects were modified by age, sex, measured skeletal sites, type of SSBs, and SSBs intake questionnaire.

Results: Twenty-six publications including 124,691 participants were selected on the review. The results from this meta-analysis showed a significant inverse association between SSBs intake and bone mineral density (BMD) in adults (ES: -0.66, 95% CI: - 1.01, - 0.31, n = 4312). Eighteen of the 20 studies included in the qualitative-only review in children and adults supported the findings from the meta-analysis. When subgroup analysis was performed according to skeletal site, a large effect was found on whole body BMD (ES: -0.97, 95% CI: - 1.54, - 0.40). There was a moderate effect on BMD in females (ES: -0.50, 95% CI: - 0.87, - 0.13). There was a moderate or large effect on BMD in individuals aged under 50 years (under 30 years: ES: -0.57, 95% CI: - 0.97, - 0.17; 30 to 50 years: ES: -1.33, 95% CI: - 1.72, - 0.93). High consumption of carbonated beverages had a moderate effect on BMD (ES: -0.73, 95% CI: - 1.12, - 0.35).

Conclusion: The meta-analysis showed that SSBs consumption such as carbonated beverages were inversely related to BMD in adults. Qualitative review supported the results of meta-analysis.

Trial registration: This review was registered in the PROSPERO database under identifier CRD42020164428 .

Keywords: Bone fractures; Bone health; Bone mineral density; Carbonated beverages; Meta-analysis; Sugar-sweetened beverages; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Beverages
  • Bone Density
  • Bone and Bones
  • Carbonated Beverages
  • Child
  • Female
  • Humans
  • Sugar-Sweetened Beverages*