Association between total sugar intake and all-cause mortality according to bone health status: A retrospective...

The relationship between total sugar intake and all-cause mortality remains insufficiently understood. This study aimed to evaluate the association between total sugar intake and all-cause mortality among individuals with varying bone health status. This retrospective cohort study was based on data from the National Health and Nutrition Examination Survey. A total of 15,886 participants were included, comprising 9783 individuals with normal bone density and 6103 with osteopenia or osteoporosis. Cox proportional hazards regression models and Kaplan-Meier curves were used to assess the association between total sugar intake and all-cause mortality across different bone health statuses. Restricted cubic splines were applied to explore potential nonlinear relationships. Subgroup analyses were performed based on age, sex, body mass index, diabetes, and hypertension. Significant differences in demographics, lifestyle habits, medical history, and mortality were observed between individuals with normal bone density and those with osteopenia or osteoporosis. After adjusting for potential confounders, the hazard ratios for all-cause mortality across tertiles of total sugar intake were 1.000, 1.067 (95% confidence interval: 0.890-1.279), and 1.279 (95% confidence interval: 1.076-1.522), respectively (P for trend = .013). Additionally, each 10-unit increase in total sugar intake was associated with a 2.9% increase in all-cause mortality risk (P < .001). Notably, this association was significant only among participants with osteopenia or osteoporosis, but not among those with normal bone density. The results were consistent across most subgroups. Higher total sugar intake was associated with increased all-cause mortality among individuals with compromised bone health (osteopenia or osteoporosis), but not among those with normal bone density.