Nutrition's Double-Edged Sword: Understanding the Surprising Effects of Common Foods on Bones through a Cross-Sectional Study

Nutrition's Double-Edged Sword: Understanding the Surprising Effects of Common Foods on Bones through a Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nutrition's Double-Edged Sword: Understanding the Surprising Effects of Common Foods on Bones through a Cross-Sectional Study Ayesha Amin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4462519/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Osteoporosis, one of the most common bone diseases, affects 200 million people worldwide. Although medications are available to control the progression of this disease and to improve bone health, there are certain complications associated with almost all of them. This observational descriptive cross-sectional study examined the association between dietary habits and bone pain among 300 healthy individuals aged 19 to 35 years. Weekly dietary intake of milk, carbonated drinks, broiler chickens, fruits, and vegetables was assessed, and associations with bone pain were quantified using a bone pain score. Statistical analysis revealed a significant inverse relationship between milk consumption and bone pain (p < 0.001), whereas increased vegetable, carbonated drink, and broiler chicken intake were associated with higher bone pain scores (p < 0.001, p = 0.001, and p = 0.033, respectively). These findings suggest that certain dietary components significantly influence bone health and may guide nutritional recommendations for bone health preservation. Bone health Dietary factors Bone pain Broiler chicken Food Nutrition Figures Figure 1 1. Introduction Bone pain is characterized by sharp and dull pain that may be localized or travel through nerves. It is an indicator of declining bone health and can be caused by a variety of factors ranging from vitamin D deficiency to arthritis and bone cancer. Osteoporosis is one of the most common bone diseases worldwide and affects quality of life. Approximately 200 million women suffer from this disease globally, and the incidence of osteoporotic fractures worldwide is estimated to be 8.9 million. Statistically, 1 in 5 men and 1 in 3 women older than 50 years are expected to suffer from fragility fractures [ 1 ]. One of the crucial elements that determines bone health is dietary intake. A balanced diet rich in calcium, vitamin D, and minerals is essential for proper bone homeostasis. Some dietary components have a positive effect on bone homeostasis, while others have a negative effect. With the urbanization of the modern world, certain changes in our lifestyle, such as low exposure to sunlight, high consumption of carbonated drinks, and little to no walking or exercise practices, have started to negatively affect bone health. Vitamin D deficiency, menopause status, and glucocorticoid use are among the many internationally reported risk factors that affect bone health and ultimately contribute to osteoporosis. The incidence of bone diseases, such as osteoporosis, is rapidly increasing, and these diseases are becoming a major health concern worldwide. Although medications are available to control the progression of these diseases and to improve bone health, there are certain complications associated with almost all of them. This study was designed to revisit some of the most commonly reported dietary risk factors affecting bone health. While previous research has extensively examined the influence of dietary factors such as milk, carbonated drinks, and vegetables on bone health, the specific impact of broiler chicken consumption on skeletal integrity has largely been unexplored. This study represents the first investigation into the association between broiler chicken consumption and bone health outcomes in a young adult population. By addressing this gap in the literature, this research aims to provide novel insights into the potential role of broiler chickens in shaping skeletal health outcomes. This study aimed to report dietary risk factors that can be avoided to improve bone health so that prevention can be favored over treatment. 2. Materials and Methods 2.1. Ethical considerations This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of COMSATS University Islamabad. Informed consent was obtained from all participants prior to their involvement in the study. Participants were assured that their responses would remain confidential and that they could withdraw from the study at any time without any consequences. Data collected was anonymized to protect participants' identities and stored securely in compliance with data protection regulations. A total of 300 responses were obtained. 2.2. Data collection This observational descriptive cross-sectional study was conducted among residents of Islamabad, Pakistan. The data were collected by circulating surveys online, in person, and by interviewing illiterate respondents. Healthy individuals aged 19 to 35 years were included in the study. The exclusion criteria were the presence of any illness that may affect bone health, such as arthritis or cirrhosis, as well as the use of medications that affect bone health, such as glucocorticoids. Ethical approval was obtained from the institutional review board of COMSATS University Islamabad before this research was conducted. The purpose of the study was explained to all participants, and informed consent was obtained. A total of 300 responses were obtained. 2.3. Survey Section Demographic Information Demographic information was collected in the first section of the questionnaire. The factors included were age, sex, qualification, occupation, and family income. Dietary Information The second part of the questionnaire included information regarding dietary intake. The questions were related to the weekly intake frequency of milk, carbonated drinks, broiler chickens, fruits, and vegetables. The intake frequency was recorded as never, 1–2 times a week, 3–6 times a week, or daily. Bone Health Assessment In the last section of this study information about bone pain frequency was collected and then converted into a bone pain score (BPS) as depicted in Table 1 . Table 1 Scoring scheme for bone pain frequency Frequency Score Never 0 Sometimes 1 Often 2 All the time 3 2.4. Data analysis The responses collected online and through interviews were compiled in an Excel spreadsheet, and statistical analysis was performed using Jamovi version 1.6.23 [ 2 ]. 3. RESULTS A total of 300 responses were obtained for this study. The mean age of the participants was 28 ± 7 years. 67% of the participants were university graduates, 33% were employed full-time, and only 30% had a high income. Table 2 shows the detailed demographic information of the study participants. Table 2 Demographic information of the study participants. Variable Categories % of participants Age Mean 28 ± 7 Gender Female 73 Male 27 Qualification Illiterate 7 Secondary 24 Intermediate 5 Bachelors 47 Masters 17 Occupation Student 42 Housewife 25 Self-employed 11 Private employee 12 Government employee 10 Monthly Income 100,000 30 Among the dietary components, the highest daily consumption was of milk (42%), whereas the lowest consumption was of carbonated drinks, with 43% of respondents reporting no intake. Table 3 shows the detailed dietary consumption patterns of the study participants. Table 3 Dietary Consumption Patterns of Study Participants Dietary Components Consumption (%) (per week) Never 1–2 times 3–6 times Daily Carbonated Drinks 43 32 10 15 Milk 17 14 27 42 Vegetables 5 3 62 30 Fruits 0 5 56 39 Broiler Chicken 14 61 17 8 Upon converting the bone pain frequency into scores, milk and vegetable intake were found to be very highly significantly associated with bone pain. Bone pain increased with increasing vegetable intake (p < 0.001), whereas bone pain decreased with increasing milk intake (p < 0.001). The frequency of bone pain also increased with increasing broiler chicken consumption (p = 0.033) and carbonated drink intake (p = 0.001). However, no association was found between fruit intake and the incidence of bone pain (p = 0.645). Table 4 represents the mean BPS according to the frequency of dietary intake. Table 4 Differences in the mean bone pain score according to the frequency of dietary intake (ANOVA was used as the test of significance) Dietary Components Mean Bone Pain Score p value Never 1–2 times 3–6 times Daily Carbonated Drinks 0.448 0.558 1.00 1.00 0.001 Milk 0.650 0.727 0.226 0.206 < .001 Vegetables 0.385 1.50 0.820 1.23 < .001 Fruits 0.000 1.00 0.988 1.15 0.645 Broiler Chicken 0.590 0.477 0.792 0.957 0.033 4. Discussion The skeletal system is one of the most integral parts of an organism; it helps in movement, provides stability and support, and protects internal organs. Like in several age-related neurological diseases, such as dementia, osteoporosis is a very common age-related bone disease that is caused by a disturbance in bone homeostasis. Although medications are available to slow or mask the effects of this disease, there are certain complications associated with these medications, such as osteonecrosis in the case of bisphosphates and hypocalcemia in the case of Denosumab [ 3 ]. This study was conducted to determine the associations between certain dietary factors and bone pain, which is an indicator of declining bone health. Detailed surveys were circulated among participants of different ethnicities, social backgrounds, and educational levels. The survey collected information related to demographic information, dietary habits, and the frequency of bone pain. The risk factors chosen for this study were milk, carbonated drinks, fruits, vegetables, and broiler chickens. 4.1. Broiler chicken: a delicacy packed with health issues? This study reports an increase in the incidence of bone pain with increasing broiler chicken consumption. The production of broiler chickens is increasing worldwide to fulfill the nutritional requirements of the increasing population. To decrease their production time and cost and to increase their nutritional quality, multiple additives are used in chicken feed. These additives primarily consist of fats and proteins for rapid weight gain. Research has reported increased serum cholesterol levels and imbalanced serum steroidal hormone levels in female rats that were fed broiler chicken feed and meat [ 4 ]. An increase in cholesterol and hormonal imbalances are associated with fertility disorders such as polycystic ovarian syndrome (PCOS) [ 5 ], as well as multiple bone disorders, including osteoporosis and osteopenia [ 6 ]. High cholesterol levels contribute to osteoporosis by inhibiting the differentiation and proliferation of osteoblasts. Research conducted on rats revealed low femur bone mass density (BMD) and increased CTx levels in rats that were fed cholesterol compared to those in the control group. One study reported the upregulation of genes responsible for bone resorption and the downregulation of those responsible for bone formation [ 7 ]. Roxarsone and several other arsenic additives and nitrogenous compounds are present in chicken feed to provide nitrogen, which is essential for an increase in muscle mass. These arsenic and nitrogenous compounds are associated with reduced BMD and osteoporosis. Arsenic exposure is associated with various diseases, including but not limited to cancer, diabetes, hypertension, and metabolic disorders. Research conducted on rats has also linked arsenic exposure to alterations in BMD due to the inhibition of osteoblast differentiation and increase in osteoclast proliferation, resulting in decreased bone formation and increased bone resorption. [ 8 ] [ 9 ]. 4.2. Carbonated Drinks: Sparkling Pain in Every Glass? Studies conducted on rat models have shown that carbonated drink consumption is associated with low bone mineral density and intertubular bleeding in kidneys [ 10 ]. Moreover, a survey-based study conducted in Pakistan reported a greater incidence of musculoskeletal bone pain in individuals with higher carbonated drink intake [ 11 ]. This study also reinforces the hypothesis that carbonated drink consumption negatively affects bone health since BPS increased with increasing consumption of carbonated drinks among the study participants. The negative effects could be due to multiple factors, such as kidney damage, high phosphoric acid content, and caffeine, which increase the production of parathyroid hormone, affect calcium homeostasis, and release calcium from bones, decreasing its strength and increasing the ease of breakage [ 12 ]. 4.3. Milk: A Bone's Best Friend or Foe? Milk and other dairy products are known to be rich sources of calcium and vitamin D, which are essential for bone health. However, some past studies have failed to determine the effect of milk on preventing bone fractures [ 13 ][ 14 ], whereas others have reported its positive influence [ 15 ]. This study suggests a positive influence of milk on bone health, i.e., higher milk intake, is associated with lower bone pain. 4.4. Vegetables: Essential Nutrients with Hidden Hazards? This study revealed a positive association between vegetable intake and BPS, i.e., pain frequency increased with increasing vegetable consumption. Vegetables have always been known to be essential for human health and are a great source of calcium. However, it is important to note that the calcium present in leafy green vegetables, such as kale, broccoli, and spinach, has lower bioavailability than the calcium present in dairy products. In addition, vegetables that contain phytic acid, tannic acid, and calcium oxalic acid combine with calcium in dietary components and form insoluble calcium salts that cannot be absorbed by the body [ 16 ]. Therefore, the variation in the mean BPS might be due to differences in the type of vegetables consumed by participants in each group. 5. Conclusion This study explored the relationship between specific dietary components and bone health. The findings indicate a complex interaction between diet and bone health, with milk consumption associated with reduced bone pain, while increased intake of vegetables, carbonated drinks, and broiler chickens correlated with higher bone pain scores. Notably, the adverse effects of broiler chicken on bone health, potentially linked to feed additives, represent a novel discovery that warrants further investigation. Declarations Conflict of Interest I declare that I have no financial or personal conflict of interest that could have influenced the research or interpretation of the results presented in this paper. Funding No funding was received to assist with the preparation of this manuscript. Author Contribution Ayesha Amin conceptualized, conducted, and wrote the manuscript. Data Availability The data that support the findings of this study are not openly available due to confidentiality and are available from the corresponding author upon reasonable request. References N. Lee, Y. J. Choi, and Y.-S. Chung, “The secular trends in the use of medications for osteoporosis in South Korea using Intercontinental Medical Statistics Health Sales Audit 2006–2018,” Osteoporos. Sarcopenia , vol. 6, no. 4, pp. 185–190, Dec. 2020, doi: 10.1016/j.afos.2020.11.007 . “jamovi - open statistical software for the desktop and cloud.” Accessed: May 01, 2024. [Online]. Available: https://www.jamovi.org/ K. N. Tu et al. , “Osteoporosis: A Review of Treatment Options,” P T Peer-Rev. J. Formul. Manag., vol. 43, no. 2, pp. 92–104, Feb. 2018. S. Ahmad, I. Ahmed, S. Haider, Z. Batool, and S. B. Ahmed, “Daily consumption of commercial chicken feed and meat lead to alterations in serum cholesterol and steroidal sex hormones in female rats,” Pak. J. Pharm. Sci. , vol. 30, no. 1 Suppl, pp. 257–261, Jan. 2017. S. Abraham Gnanadass, Y. Divakar Prabhu, and A. Valsala Gopalakrishnan, “Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update,” Arch. Gynecol. Obstet. , vol. 303, no. 3, pp. 631–643, Mar. 2021, doi: 10.1007/s00404-020-05951-2 . M. Almeida et al. , “Estrogens and Androgens in Skeletal Physiology and Pathophysiology,” Physiol. Rev., vol. 97, no. 1, pp. 135–187, Jan. 2017, doi: 10.1152/physrev.00033.2015 . L. You, Z. Sheng, C. Tang, L. Chen, L. Pan, and J. Chen, “High cholesterol diet increases osteoporosis risk via inhibiting bone formation in rats,” Acta Pharmacol. Sin. , vol. 32, no. 12, pp. 1498–1504, Dec. 2011, doi: 10.1038/aps.2011.135 . C.-T. Wu, T.-Y. Lu, D.-C. Chan, K.-S. Tsai, R.-S. Yang, and S.-H. Liu, “Effects of Arsenic on Osteoblast Differentiation in Vitro and on Bone Mineral Density and Microstructure in Rats,” Environ. Health Perspect. , vol. 122, no. 6, pp. 559–565, Jun. 2014, doi: 10.1289/ehp.1307832 . Z. Liu et al. , “ Nrf2 deficiency aggravates the increase in osteoclastogenesis and bone loss induced by inorganic arsenic,” Toxicol. Appl. Pharmacol., vol. 367, pp. 62–70, Mar. 2019, doi: 10.1016/j.taap.2019.02.003 . R. Ogur et al. , “Evaluation of the effect of cola drinks on bone mineral density and associated factors,” Basic Clin. Pharmacol. Toxicol., vol. 100, no. 5, pp. 334–338, May 2007, doi: 10.1111/j.1742-7843.2007.00053.x . A. Mehmood, T. F. Zeb, R. Amin, H. F. Waseem, F. Anjum, and A. Shaikh, “Effects of Carbonated Drinks on Bone Health of Young Adults: a study conducted amongst students of Health University”. L. Chen, R. Liu, Y. Zhao, and Z. Shi, “High Consumption of Soft Drinks Is Associated with an Increased Risk of Fracture: A 7-Year Follow-Up Study,” Nutrients, vol. 12, no. 2, p. 530, Feb. 2020, doi: 10.3390/nu12020530 . K. Holvik, H. E. Meyer, I. Laake, D. Feskanich, T. K. Omsland, and A.-J. Søgaard, “Milk drinking and risk of hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS),” Br. J. Nutr. , vol. 121, no. 6, pp. 709–718, Mar. 2019, doi: 10.1017/S0007114518003823 . P. Fardellone, “The effect of milk consumption on bone and fracture incidence, an update,” Aging Clin. Exp. Res. , vol. 31, no. 6, pp. 759–764, Jun. 2019, doi: 10.1007/s40520-019-01192-9 . P. Matía-Martín, M. Torrego-Ellacuría, A. Larrad-Sainz, C. Fernández-Pérez, F. Cuesta-Triana, and M. Á. Rubio-Herrera, “Effects of Milk and Dairy Products on the Prevention of Osteoporosis and Osteoporotic Fractures in Europeans and Non-Hispanic Whites from North America: A Systematic Review and Updated Meta-Analysis,” Adv. Nutr. Bethesda Md, vol. 10, no. suppl_2, pp. S120–S143, May 2019, doi: 10.1093/advances/nmy097 . N. Liu, F. Zeng, K. Zhang, and Z. Tang, “A community-based cross-sectional study for relationship of frequency of vegetables intake and osteoporosis in a Chinese postmenopausal women sample,” BMC Womens Health, vol. 16, p. 28, Jun. 2016, doi: 10.1186/s12905-016-0307-5 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Introduction","content":"\u003cp\u003eBone pain is characterized by sharp and dull pain that may be localized or travel through nerves. It is an indicator of declining bone health and can be caused by a variety of factors ranging from vitamin D deficiency to arthritis and bone cancer. Osteoporosis is one of the most common bone diseases worldwide and affects quality of life. Approximately 200\u0026nbsp;million women suffer from this disease globally, and the incidence of osteoporotic fractures worldwide is estimated to be 8.9\u0026nbsp;million. Statistically, 1 in 5 men and 1 in 3 women older than 50 years are expected to suffer from fragility fractures [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the crucial elements that determines bone health is dietary intake. A balanced diet rich in calcium, vitamin D, and minerals is essential for proper bone homeostasis. Some dietary components have a positive effect on bone homeostasis, while others have a negative effect.\u003c/p\u003e \u003cp\u003eWith the urbanization of the modern world, certain changes in our lifestyle, such as low exposure to sunlight, high consumption of carbonated drinks, and little to no walking or exercise practices, have started to negatively affect bone health. Vitamin D deficiency, menopause status, and glucocorticoid use are among the many internationally reported risk factors that affect bone health and ultimately contribute to osteoporosis.\u003c/p\u003e \u003cp\u003eThe incidence of bone diseases, such as osteoporosis, is rapidly increasing, and these diseases are becoming a major health concern worldwide. Although medications are available to control the progression of these diseases and to improve bone health, there are certain complications associated with almost all of them. This study was designed to revisit some of the most commonly reported dietary risk factors affecting bone health. While previous research has extensively examined the influence of dietary factors such as milk, carbonated drinks, and vegetables on bone health, the specific impact of broiler chicken consumption on skeletal integrity has largely been unexplored. This study represents the first investigation into the association between broiler chicken consumption and bone health outcomes in a young adult population. By addressing this gap in the literature, this research aims to provide novel insights into the potential role of broiler chickens in shaping skeletal health outcomes. This study aimed to report dietary risk factors that can be avoided to improve bone health so that prevention can be favored over treatment.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Ethical considerations\u003c/h2\u003e \u003cp\u003e This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of COMSATS University Islamabad. Informed consent was obtained from all participants prior to their involvement in the study. Participants were assured that their responses would remain confidential and that they could withdraw from the study at any time without any consequences. Data collected was anonymized to protect participants' identities and stored securely in compliance with data protection regulations. A total of 300 responses were obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Data collection\u003c/h2\u003e \u003cp\u003eThis observational descriptive cross-sectional study was conducted among residents of Islamabad, Pakistan. The data were collected by circulating surveys online, in person, and by interviewing illiterate respondents.\u003c/p\u003e \u003cp\u003eHealthy individuals aged 19 to 35 years were included in the study. The exclusion criteria were the presence of any illness that may affect bone health, such as arthritis or cirrhosis, as well as the use of medications that affect bone health, such as glucocorticoids.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the institutional review board of COMSATS University Islamabad before this research was conducted. The purpose of the study was explained to all participants, and informed consent was obtained. A total of 300 responses were obtained.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Survey Section\u003c/h2\u003e \u003cp\u003e \u003cb\u003eDemographic Information\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDemographic information was collected in the first section of the questionnaire. The factors included were age, sex, qualification, occupation, and family income.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDietary Information\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe second part of the questionnaire included information regarding dietary intake. The questions were related to the weekly intake frequency of milk, carbonated drinks, broiler chickens, fruits, and vegetables. The intake frequency was recorded as never, 1\u0026ndash;2 times a week, 3\u0026ndash;6 times a week, or daily.\u003c/p\u003e \u003cp\u003e \u003cb\u003eBone Health Assessment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn the last section of this study information about bone pain frequency was collected and then converted into a bone pain score (BPS) as depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScoring scheme for bone pain frequency\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll the time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data analysis\u003c/h2\u003e \u003cp\u003eThe responses collected online and through interviews were compiled in an Excel spreadsheet, and statistical analysis was performed using Jamovi version 1.6.23 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eA total of 300 responses were obtained for this study. The mean age of the participants was 28\u0026thinsp;\u0026plusmn;\u0026thinsp;7 years. 67% of the participants were university graduates, 33% were employed full-time, and only 30% had a high income. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the detailed demographic information of the study participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of the study participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% of participants\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20,000\u0026ndash;50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51,000\u0026ndash;80,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81,000\u0026ndash;100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the dietary components, the highest daily consumption was of milk (42%), whereas the lowest consumption was of carbonated drinks, with 43% of respondents reporting no intake. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the detailed dietary consumption patterns of the study participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDietary Consumption Patterns of Study Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDietary Components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eConsumption (%) (per week)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;2 times\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;6 times\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbonated Drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFruits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroiler Chicken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUpon converting the bone pain frequency into scores, milk and vegetable intake were found to be very highly significantly associated with bone pain. Bone pain increased with increasing vegetable intake (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas bone pain decreased with increasing milk intake (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The frequency of bone pain also increased with increasing broiler chicken consumption (p\u0026thinsp;=\u0026thinsp;0.033) and carbonated drink intake (p\u0026thinsp;=\u0026thinsp;0.001). However, no association was found between fruit intake and the incidence of bone pain (p\u0026thinsp;=\u0026thinsp;0.645). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e represents the mean BPS according to the frequency of dietary intake.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferences in the mean bone pain score according to the frequency of dietary intake (ANOVA was used as the test of significance)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietary Components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMean Bone Pain Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;2 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;6 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbonated Drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFruits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroiler Chicken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe skeletal system is one of the most integral parts of an organism; it helps in movement, provides stability and support, and protects internal organs. Like in several age-related neurological diseases, such as dementia, osteoporosis is a very common age-related bone disease that is caused by a disturbance in bone homeostasis. Although medications are available to slow or mask the effects of this disease, there are certain complications associated with these medications, such as osteonecrosis in the case of bisphosphates and hypocalcemia in the case of Denosumab [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study was conducted to determine the associations between certain dietary factors and bone pain, which is an indicator of declining bone health. Detailed surveys were circulated among participants of different ethnicities, social backgrounds, and educational levels. The survey collected information related to demographic information, dietary habits, and the frequency of bone pain. The risk factors chosen for this study were milk, carbonated drinks, fruits, vegetables, and broiler chickens.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Broiler chicken: a delicacy packed with health issues?\u003c/h2\u003e \u003cp\u003eThis study reports an increase in the incidence of bone pain with increasing broiler chicken consumption. The production of broiler chickens is increasing worldwide to fulfill the nutritional requirements of the increasing population. To decrease their production time and cost and to increase their nutritional quality, multiple additives are used in chicken feed. These additives primarily consist of fats and proteins for rapid weight gain.\u003c/p\u003e \u003cp\u003eResearch has reported increased serum cholesterol levels and imbalanced serum steroidal hormone levels in female rats that were fed broiler chicken feed and meat [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. An increase in cholesterol and hormonal imbalances are associated with fertility disorders such as polycystic ovarian syndrome (PCOS) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], as well as multiple bone disorders, including osteoporosis and osteopenia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHigh cholesterol levels contribute to osteoporosis by inhibiting the differentiation and proliferation of osteoblasts. Research conducted on rats revealed low femur bone mass density (BMD) and increased CTx levels in rats that were fed cholesterol compared to those in the control group. One study reported the upregulation of genes responsible for bone resorption and the downregulation of those responsible for bone formation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRoxarsone and several other arsenic additives and nitrogenous compounds are present in chicken feed to provide nitrogen, which is essential for an increase in muscle mass. These arsenic and nitrogenous compounds are associated with reduced BMD and osteoporosis. Arsenic exposure is associated with various diseases, including but not limited to cancer, diabetes, hypertension, and metabolic disorders. Research conducted on rats has also linked arsenic exposure to alterations in BMD due to the inhibition of osteoblast differentiation and increase in osteoclast proliferation, resulting in decreased bone formation and increased bone resorption. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Carbonated Drinks: Sparkling Pain in Every Glass?\u003c/h2\u003e \u003cp\u003eStudies conducted on rat models have shown that carbonated drink consumption is associated with low bone mineral density and intertubular bleeding in kidneys [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, a survey-based study conducted in Pakistan reported a greater incidence of musculoskeletal bone pain in individuals with higher carbonated drink intake [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This study also reinforces the hypothesis that carbonated drink consumption negatively affects bone health since BPS increased with increasing consumption of carbonated drinks among the study participants. The negative effects could be due to multiple factors, such as kidney damage, high phosphoric acid content, and caffeine, which increase the production of parathyroid hormone, affect calcium homeostasis, and release calcium from bones, decreasing its strength and increasing the ease of breakage [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Milk: A Bone's Best Friend or Foe?\u003c/h2\u003e \u003cp\u003eMilk and other dairy products are known to be rich sources of calcium and vitamin D, which are essential for bone health. However, some past studies have failed to determine the effect of milk on preventing bone fractures [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], whereas others have reported its positive influence [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study suggests a positive influence of milk on bone health, i.e., higher milk intake, is associated with lower bone pain.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Vegetables: Essential Nutrients with Hidden Hazards?\u003c/h2\u003e \u003cp\u003eThis study revealed a positive association between vegetable intake and BPS, i.e., pain frequency increased with increasing vegetable consumption. Vegetables have always been known to be essential for human health and are a great source of calcium. However, it is important to note that the calcium present in leafy green vegetables, such as kale, broccoli, and spinach, has lower bioavailability than the calcium present in dairy products. In addition, vegetables that contain phytic acid, tannic acid, and calcium oxalic acid combine with calcium in dietary components and form insoluble calcium salts that cannot be absorbed by the body [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, the variation in the mean BPS might be due to differences in the type of vegetables consumed by participants in each group.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study explored the relationship between specific dietary components and bone health. The findings indicate a complex interaction between diet and bone health, with milk consumption associated with reduced bone pain, while increased intake of vegetables, carbonated drinks, and broiler chickens correlated with higher bone pain scores. Notably, the adverse effects of broiler chicken on bone health, potentially linked to feed additives, represent a novel discovery that warrants further investigation.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eConflict of Interest\u003c/strong\u003e \u003cp\u003eI declare that I have no financial or personal conflict of interest that could have influenced the research or interpretation of the results presented in this paper.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAyesha Amin conceptualized, conducted, and wrote the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are not openly available due to confidentiality and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eN. 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Tang, \u0026ldquo;A community-based cross-sectional study for relationship of frequency of vegetables intake and osteoporosis in a Chinese postmenopausal women sample,\u0026rdquo; BMC Womens Health, vol. 16, p. 28, Jun. 2016, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12905-016-0307-5\u003c/span\u003e\u003cspan address=\"10.1186/s12905-016-0307-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bone health, Dietary factors, Bone pain, Broiler chicken, Food, Nutrition","lastPublishedDoi":"10.21203/rs.3.rs-4462519/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4462519/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOsteoporosis, one of the most common bone diseases, affects 200\u0026nbsp;million people worldwide. Although medications are available to control the progression of this disease and to improve bone health, there are certain complications associated with almost all of them. This observational descriptive cross-sectional study examined the association between dietary habits and bone pain among 300 healthy individuals aged 19 to 35 years. Weekly dietary intake of milk, carbonated drinks, broiler chickens, fruits, and vegetables was assessed, and associations with bone pain were quantified using a bone pain score. Statistical analysis revealed a significant inverse relationship between milk consumption and bone pain (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas increased vegetable, carbonated drink, and broiler chicken intake were associated with higher bone pain scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.001, and p\u0026thinsp;=\u0026thinsp;0.033, respectively). These findings suggest that certain dietary components significantly influence bone health and may guide nutritional recommendations for bone health preservation.\u003c/p\u003e","manuscriptTitle":"Nutrition's Double-Edged Sword: Understanding the Surprising Effects of Common Foods on Bones through a Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-08 17:13:47","doi":"10.21203/rs.3.rs-4462519/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2d72266-1e93-46ad-8cd5-efab2fc7d99a","owner":[],"postedDate":"July 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-24T08:08:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-08 17:13:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4462519","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4462519","identity":"rs-4462519","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}