An American study which found teenagers who consume large amounts of carbonated soft drinks are more likely to commit acts of violence has puzzled health experts.
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A survey of Boston public high school students found teenagers who drank more than five cans of non-diet soft drink per week were significantly more likely to have carried a weapon and to have been violent with peers, family members and romantic partners.
But researchers were unsure if the caffeine and sugar in fizzy drinks increased aggression levels in the teens or if other factors were responsible for the aggression.
''Frequent soft drink consumption was associated with a 9 to 15 percentage point increase in the probability of engaging in aggressive actions, even after controlling for gender, age, race, body mass index, typical sleeping patterns, tobacco use and having family dinners,'' the study's authors wrote in the British Medical Association journal Injury Prevention. ''There may be a direct cause-and-effect relationship, perhaps due to the sugar and caffeine content of soft drinks, or there may be other factors, unaccounted for in our analyses, that cause both high soft drink consumption and aggression.''
The authors said their findings dealt with the largely black and Hispanic high school students from Boston public schools and might not be generalisable to other populations.
Leading Australian public health advocate Professor Mike Daube said the findings needed to be interpreted extremely carefully, but there were other reasons why young people should avoid soft drinks.
''I'm not sure what it tells us beyond that in the US there is quite a lot of violence and a lot of young people are drinking soft drinks,'' Professor Daube said.
The Boston study was undertaken by Sarah Solnick, of the University of Vermont, and David Hemenway, of the Harvard School of Public Health.