The Association Between Soft Drink Consumption and Bone Mineral Density Among Qatari Women: Analysis of Qatar Biobank Data

Abstract

With the rapid increase in longevity, osteoporosis is viewed as a global problem and recognized to be one of the most common diseases in both developed and developing world. It is common in older women, as the bone mineral density (BMD) tends to decrease with age, particularly after menopause. Decrease in BMD increases the risk of osteopenia and osteoporosis. Often the first clinical manifestation of osteoporosis might be a fracture, as the women do not recognize the decreases in BMD levels. Whilst age and hormonal changes are well established risk factors, there are other factors that have been investigated for possible links to increase the risk of osteoporosis. These factors include dietary patterns and lifestyle. Few studies have examined the soft drinks consumption as a potential riskfactor for lowering BMD levels. Reports from these studies presented conflicting findings. Some suggesting significant decreases in BMD levels due to soft drink consumption, while others find null associations. In the context of the unclear association, we made use of a relatively larger Qatar Bio-Bank (QBB) data to explore the cross-sectional association between soft drink consumption and BMD. The strength of the QBB data include objective and validated measurement of outcome and risk factors. This study included 1000 Qatari women age ≥ 40 years volunteered to take part in the QBB survey. BMD levels were measured using the Dual-Energy X-ray Absorptiometry (DXA) scan one of the most reliable and valid measures and the soft drink consumption was assessed using validated food frequency questionnaires. Data were checked for errors and explored using descriptive statistical methods. Multiple regression models were then used to assess the association between bone mineral density and soft drink consumption. The use of multiple regression was essential to adjust for a number of person-centered confounders. Given those with lower BMD levels were considered to have high risk of osteoporosis, quantile regression models were used. This is one of the most sophisticated models that is meant to identify the risk factors associated with high risk population while adjusting for potential confounders. Nutritional epidemiology studies have shown use of quantile regressions can pick up the risk factors much more efficiently. Our findings suggest that there was a clinically and statistically significant association between BMD and soft drink consumption after adjusting for age, BMI, menopausal status, smoking status, physical activities, milk intake, and fruit and vegetable consumption. Further high-quality studies with long term follow up with specific purpose of testing the hypothesis are warranted before we can comment on potential causal association. If future cohort studies were to confirm such association, it is possible to develop appropriate public health intervention to improve bone health via reduced soft drink consumption.