Abstract
BACKGROUND AND AIMS: Soft drink consumption is suspected to negatively impact bone health in children, but longitudinal evidence is limited. This study assessed the association between soft drink intake and bone health outcomes in Danish schoolchildren aged 7.7-12 years, within a physical activity intervention framework. METHODS: This study was nested in the CHAMPS-DK trial, a quasi-experimental study. Participants (n = 529) were recruited from intervention schools offering 270 min of physical education (PE) per week (active arm) and control schools with 90 min of standard PE. Soft drink intake was assessed via a food-frequency questionnaire at baseline. Dual-energy X-ray absorptiometry (DXA) was used to measure Bone Mineral Content (BMC), Bone Area (BA), and Bone Mineral Density (BMD) at baseline and two-year follow-up (primary outcomes). Fracture incidence over a five-year period was recorded using the SMS-Track parental reporting system (secondary outcome). Multilevel mixed-effects linear regression and Weibull survival models were used to analyze associations. RESULTS: Soft drink intake of more than twice per month did not significantly affect BMC, BA, or BMD over two years (Total body BMD: β = 0.004; 95% CI: (-0.007; 0.016). Adjustment for confounders such as age, sex, BMI, pubertal status, socioeconomic status, and physical activity did not change the results. Additionally, no significant difference in fracture risk was observed (HR = 0.86; 95% CI: [0.43; 1.71]). CONCLUSIONS: Soft drink intake had no measurable impact on bone health indices or fracture risk in children, irrespective of PE intervention. Future studies should investigate the effects of specific soft drink types (carbonated vs. non-carbonated) on bone development.