Vitamin D2026-07

Milk Intake, Sun Exposure, and Caffeinated Energy Drink Consumption in Children and Adolescents: Evidence, Uncertainty, and Implications for Peak Bone Mass Accrual.

Sakkas Giorgos K, Ntoumas Ilias, Tsagkalis Antonis, Karatzaferi Christina — Nutrients

Summary

This review examines how lifestyle factors like milk intake, sun exposure, and caffeinated energy drinks affect bone development in children and teenagers. It highlights that adequate calcium, calcium-rich foods, and physical activity are crucial for strong bones. While vitamin D is essential for mineral balance, its supplementation mainly benefits those with deficiencies, and sun exposure is a key way to get it. The study also notes that direct links between energy drinks and bone health are limited.

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Key points

Adequate calcium intake, calcium-rich foods, and weight-bearing physical activity are most important for strong bones in youth.
Vitamin D is crucial for mineral balance, and preventing its deficiency is key for bone health.
Sun exposure is a primary natural source of vitamin D, though its effectiveness varies by factors like season and skin type.
Direct evidence linking caffeinated energy drinks to poor bone development in children is currently very limited.

What the study looked at

What question did this study ask? This review aimed to understand how lifestyle factors like drinking milk, getting sun exposure, and consuming caffeinated energy drinks influence the development of strong bones in children and teenagers. It specifically looked at how these factors contribute to achieving peak bone mass, which is crucial for long-term skeletal health. How was it studied? Researchers conducted a comprehensive narrative review, systematically searching multiple scientific databases for studies related to bone health in young people. They gathered information on various exposures, including milk and dairy products, calcium, vitamin D, sun exposure, physical activity, sleep, caffeine, and energy drinks, to evaluate the existing evidence. What did it find? The review found that the strongest evidence supports adequate calcium intake, calcium-rich foods, and weight-bearing physical activity as key contributors to bone strength. Vitamin D is essential for maintaining mineral balance, and preventing its deficiency is vital for bone health, with sun exposure being a significant natural source. The study also noted that while milk is a good source of calcium, it's just one part of a calcium-rich diet. Direct evidence linking caffeinated energy drinks to impaired bone development in children was found to be very limited, suggesting their impact might be more indirect, perhaps by displacing healthier drink choices.

Dietary takeaway

To support strong bones in children and adolescents, focus on a diet rich in calcium, such as dairy products, fortified plant-based milks, and leafy greens. Ensuring adequate vitamin D intake, often through safe sun exposure and some fortified foods like milk and cereals, is also crucial for mineral absorption and bone health. Remember that this is one review, and while its findings are valuable, individual dietary needs and health conditions can vary, so always consult with a healthcare professional for personalized advice.

Abstract

BACKGROUND/OBJECTIVES: Childhood and adolescence are critical periods for bone mineral accrual and future skeletal reserve. Milk intake, sun exposure and caffeinated energy drink consumption are familiar lifestyle concepts, but they differ substantially in biological proximity and evidential strength. This structured narrative review critically evaluates these exposures in relation to peak bone mass accrual in youth. METHODS: PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library and Google Scholar were searched from database inception to 23 June 2026. Search terms combined pediatric population terms with bone outcomes and exposure terms related to milk/dairy, calcium, vitamin D, sun exposure, physical activity, sleep, caffeine and energy drinks. A literature collection flowchart and a GRADE-informed evidence appraisal table are provided to improve transparency and clinical interpretability. RESULTS: Evidence is strongest for adequate calcium intake, calcium-rich foods and weight-bearing physical activity as modifiable contributors to skeletal accrual. Vitamin D is essential for mineral homeostasis, but supplementation effects on bone density in otherwise healthy children are context-dependent and appear most relevant for deficiency prevention or treatment. Milk intake is best interpreted as a practical marker of calcium-rich dietary patterns rather than as the only route to calcium adequacy. Sun exposure is an indirect determinant of vitamin D status and is modified by season, latitude, skin pigmentation, clothing, sunscreen, adiposity and outdoor behavior. Direct evidence linking caffeinated energy drinks to impaired pediatric bone accrual is very limited. The relevance of caffeinated energy drink intake is better framed as indirect and hypothesis-generating, through possible displacement of calcium-rich beverages, sleep disruption and clustering with poorer lifestyle patterns. CONCLUSIONS: A prevention framework for pediatric bone health should emphasize calcium adequacy, avoidance of vitamin D deficiency, mechanical loading and correct pediatric DXA interpretation using Z-scores. Energy drinks can be included as a lifestyle concern, but conclusions should remain cautious because direct skeletal evidence is limited.

View on PubMed →DOI: 10.3390/nu18132156