The role of dairy products and non alcoholic beverages in bone fractures among schoolage children

Abstract

In order to assess consumption of the calcium rich dairy products, intake of non alcoholic beverages and physical activity as risk factors for bone fractures among schoolage children, a case control study was undertaken in Athens, Greece. During 1995 one hundred children 7 to 14 years old (74 boys and 26 girls) with single uncomplicated fractures of the upper and lower extremities and no evidence of coexisting metabolic condition affecting bone fragility were compared with 100 age-and gender-matched controls. The analysis was undertaken by modeling the data through conditional logistic regression. Several indicators point to an increased risk of fractures among physically active children, although none of the individual variables was statistically significant. Somatometrc factors were not related to fractures, although children with more advanced stage of development at Tanner's scale were apparently at increased risk. Intake of dairy products and of carbonated non cola beverages was not related to the occurrence of fractures. By contrast, intake of non carbonated beverages, mainly fruit juices, and of cola beverages were significantly associated with elevated risks of fractures [for an increase of one-half can per day, the odds ratios and associated 95% confidence intervals were 1.6 (1.2 to 2.3) and 1.7 (1.2 to 2.6) respectively]. In the absence of other common elements between cola and non carbonated beverages the positive associations of these beverages, with bone fractures probably reflect the increased rehydration needs of active children who are also at high risk for injuries.

Keywords

diet bone fractures children dehydration.

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References

Riggs BL , Melton LJ. Involutional osteoporosis . N Engl J Med 1986; 314: 1676–86.

Kanders B , Dempster DW , Lindsay R. Interaction of calcium nutrition and physical activity on bone mass in young women . J Bone Miner Res 1988; 2: 145–9.

Matkovic V. Calcium metabolism and calcium requirements during skeletal modeling and consolidation of bone mass . Am J Clin Nutr 1991; 54: 245S–260S.

Matkovic V , Fontana D , Tominac C , Goel P , Chesnut CH III. Factors that influence peak bone mass formation: A study of calcium balance and the inheritance of bone mass in adolescent females . Am J Clin Nutr 1990; 52: 878–88.

Kroger H , Kotaniemi A , Kroger L , Alhava E. Development of bone mass and bone density of the spine and femoral neck- a prospective study of 65 children and adolescents . Bone Miner 1993; 23: 171–82.

Margolis LH , Sparrow AW , Swanson GM. Growing into healthy adults: pediatric antecedents of adult disease. In: Halpern M , ed. Health Monograph Series No 3. Michigan Department of Public Health. Lansing, Michigan 1989.

Wyshak G , Frisch RE. Carbonated beverages, dietary calcium, the dietary calcium/phosphorus ratio, and bone fractures in girls and boys . J Adolesc Health 1994; 15: 210–15.

Petridou E , Malamou H , Doxiadis S , Pantelakis S , Kanellopoulou G , Toupadaki N et al. Blood lipids in Greek adolescents and their relation to diet, obesity and socioeconomic factors . Ann Epidemiol 1995; 5: 286–91.

Gnardellis C , Trichopoulou A , Katsouyanni K , Polychronopoulou E , Rimm EB , Trichopoulos D. Reproducibility and validity of an extensive semi-quantitive food frequency questionnaire among Greek school teachers . Epidemiology 1995; 6: 74–7.

10.

Willett W. Nutritional Epidemiology. New York: Oxford University Press, 1990: 245–71.

11.

Breslow NE , Day NE. Statistical methods in cancer research. Vol I. The analysis of case control studies. Lyon: IARC Scientific Publication 32, 1980.

12.

Petridou E , Kouri N , Trichopoulos D , Revinthi K , Skalkidis Y , Tong D. School injuries in Athens: socioeconomic and family risk factors . Epidemiol Commun Health 1994; 48: 490–1.

13.

Ainsworth BE , Haskell WL , Leon AS , Jacobs DR Jr , Montoye HJ , Sallis JF et al. Compendium of physical activities: Classification of energy costs of human physical activities . Med Sci Sports Exerc 1993; 25: 71–80.

14.

Greenland S. The effect of misclassification in the presence of covariates . Am J Epidemiol 1980; 112: 564–9.

15.

Anderson JJB. Calcium and phosphorus in health and disease. Anderson JJB , Garner SC eds. New York-London-Tokyo: Boca Raton, 1995, ISBNO-8493–7845–1.

16.

Nieves JW , Golden AL , Siris E , Kelsey JL , Lindsay R. Teenage and current calcium intake are related to bone mineral density of the hip and forearm in women aged 30–39 years . Am J Epidemiol 1995; 145: 342–51.

17.

Stracke H , Renner E , Knie G , Leidig G , Minne H , Federlin K. Osteoporosis and bone metabolic parameters in dependence upon calcium intake through milk and milk products . Eur J Clin Nutr 1993; 47: 617–22.

18.

Katzman DK , Bachrach LK , Carter DR , Marcus R. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls . J Clin Endocrinol Metab 1991; 73: 1332–9.

19.

Kroger H , Kotaniemi A , Vainio P , Alhava E. Bone densitometry of the spine and femur in children by dual-energy X-ray absorptiometry . Bone Miner 1992; 17: 75–85.

20.

Grimston SK , Morrison K , Harder JA , Hanley DA. Bone mineral density during puberty in Western Canadian children . Bone Miner 1992; 19: 85–96.

21.

Chan GM. Dietary calcium and bone mineral status of children and adolescents . Am J Dis Child 1991; 145: 631–4.

22.

Chinn S , Rona RJ , Gulliford MC. Weight-for- height in children aged 4–12 years. A new index compared to the normalized body mass index . Eur J Clin Nutr 1992; 46: 489–500.