Meta-analysisindependent cross-checkabstract only checked I-SOD-07 standard review
Sugary drinks and bone density: meta-analysis
Sugar-sweetened beverage consumption and bone health: a systematic review and meta-analysis.
Overview
Ahn H, Park YK. Nutr J 2021 · PMID 33952276 · DOI 10.1186/s12937-021-00698-1
Higher sugary and fizzy drink intake was linked with lower bone density in adults.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Is SSB consumption associated with bone health?
- How was the study done?
Systematic review and meta-analysis (mainly observational).
- How many people, animals or samples were studied?
26 publications; 124,691 participants (meta-analysis n=4,312); Children and adults
- What was actually found?
Adults: ES -0.66 (-1.01 to -0.31); carbonated beverages ES -0.73 (-1.12 to -0.35); 18 of 20 qualitative studies supportive.
- How large was the observed effect?
ES -0.66
- What do the results mean in everyday life?
Association only.
- What are the study's limitations?
Observational; Small meta-analysed sample; Large SMDs suggest heterogeneity
- What does it say about Elawady's specific claim?
Supports direction of C-SOD-08 (not mechanism).
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
That phosphoric acid causes bone loss.
Scientific in-depth review
1. Full reference
- Authors
- Ahn H, Park YK
- Journal
- Nutr J
- Year
- 2021
- Identifier
- PMID 33952276 DOI 10.1186/s12937-021-00698-1
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Authors declared no competing interests
2. Research question
Is SSB consumption associated with bone health?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis (mainly observational).
- Population
Children and adults
- Country
Multinational
- Period
Literature to March 2021
- Sample size
26 publications; 124,691 participants (meta-analysis n=4,312)
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
SSB/carbonated beverages
- Comparator
Lower intake
- Endpoints
BMD
- Statistical methods
Random effects SMD
5. Actual results
- Results
Adults: ES -0.66 (-1.01 to -0.31); carbonated beverages ES -0.73 (-1.12 to -0.35); 18 of 20 qualitative studies supportive.
- Absolute risks
not applicable
- Authors' conclusion
SSB such as carbonated beverages inversely related to BMD in adults.
6. Strengths
- PROSPERO-registered
7. Weaknesses
- Observational
- Small meta-analysed sample
- Large SMDs suggest heterogeneity
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational base.
9. Assessment of the statistical interpretation
Large standardised effects need caution.
10. Relevance to the specific claim
Supports direction of C-SOD-08 (not mechanism).
11. Independent contrary findings
None.
12. Transferability to Germany and Europe
Moderate.
13. Overall methodological judgement
Supportive, low certainty.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Causality; fractures.
15. Linked fact checks
- Phosphoric acid in cola drains the bones; women who drink cola daily (sugary or diet) have 3.7% lower hip bone density. – Studies supporting the claim