Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review

The influence of gut microbiome on bone health and related dietary strategies against bone dysfunctions

The link between the gut microbiome and bone health has begun to attract widespread interest in recent years. The gut microbiome are vital in many diseases involving bone loss. Probiotics, prebiotics, and dietary supplements have been suggested to protect bone health by altering the composition of the gut microbiota. Notably, studying the relationship between the gut microbiome and bone health can provide a basis for the prevention and treatment of bone diseases. This review focuses on the link between the gut microbiome and bone diseases, exploring current knowledge of the mechanisms by which gut bacteria affect bone health. In addition, the influences of dietary supplements on the interactions between the gut microbiome and bone health are discussed. This knowledge will promote new ideas for gut microbiota-mediated dietary interventions in patients with bone diseases.

Long-Term Patterns of Bone Mineral Density in an Elite Soccer Player

Changes in bone mineral density (BMD) have been associated with association football (soccer) participation. Seasonal changes in BMD of soccer players have been proposed as well. However, previous investigations were based on short-term observations. Actually, longitudinal investigation of BMD in soccer players is lacking, possibly because of frequent inter-club transfer, changes in club policy or continued availability of the relevant facilities. Dual-energy X-ray Absorptiometry (DXA)-measured areal BMD (aBMD) was obtained during the competitive season in an elite soccer player along 10 consecutive years. Findings showed that (1) aBMD tends to increase with age, independently of body mass; (2) The right (preferred, kicking) leg has higher aBMD than the left (non-preferred, support) one; (3) Meaningful (i.e., >least significant change, LSC) changes in aBMD take place along the season; and (4) The off-season (transition) period has no effect on aBMD. Findings prompt for future research aimed at clarifying the long-term and seasonal patterns of bone characteristics in soccer in relation with age and type/dose of training. Season-around, long-term scrutiny of bone status in soccer players would help controlling for possible changes/asymmetries in bone mineralization/strength.

The relationship between healthy lifestyles and bone health: A narrative review

BACKGROUND

Bone health, especially osteoporosis among ageing populations, has become an important topic for both clinical and basic researchers. The relationship between bone health and healthy lifestyles has been frequently discussed. The present study focuses on the relationship between bone health and healthy lifestyles among older adults, based on a global comparison.

METHODS

This narrative review was performed by collecting clinical trials, basic research and reviews on lifestyle and bone health in PubMed database.

RESULTS

Positive effects of physical activity and negative effects of malnutrition, alcohol abuse, and cigarette smoking on bone health were revealed. The relationship between bone health and drinking coffee and tea is still inconclusive. Moreover, the diversity of each region should be aware when considering healthy lifestyles to improve bone health.

CONCLUSION

Healthy lifestyles are highly related to bone health, and different lifestyles may have different influences on regions with a high risk of bone diseases. It is practical to acknowledge the diversity of economic, religious, environmental and geological conditions in each region when providing suitable and effective recommendations for healthy lifestyles that can improve overall bone health.

A high-fat diet in the presence of vitamin D deficiency status is associated with a negative influence on calcaneal quantitative ultrasound parameters in young adults: a cross-sectional study

Vitamin D deficiency and a high-fat diet are considered health problems worldwide. The aims of this study were to examine the prevalence of vitamin D deficiency/insufficiency in young adults, factors related to the vitamin D status, and the influence of vitamin D deficiency and/or a high-fat diet on bone parameters. Here, we investigated the hypothesis that a high-fat diet in the presence of a vitamin D-deficient status would have a more negative influence on bone parameters than a normal-fat diet with such a status. In the present study, we targeted young Japanese adults aged 21-23 (n = 175). We conducted a diet survey based on 3-day food records, biochemical examination of serum, and quantitative ultrasound measurements at the calcaneus. As a result, the rates of vitamin D deficiency {serum 25-hydroxyvitamin D₃ [25(OH)D] concentration less than 20 ng/mL} and insufficiency [serum 25(OH)D concentration less than 30 ng/mL but not less than 20 ng/mL] were 60.6 and 30.9%, respectively. A positive correlation was observed between the serum 25(OH)D level and serum bone-specific alkaline phosphatase level, which is a serum marker of bone formation (r = 0.253, P< .01) or the speed of sound (SOS) as an index of bone density (r = 0.259, P< .01). A negative correlation was observed between the ratio of fat intake to total energy intake (%E) and serum 25(OH)D levels (r = -0.206, P< .01). Furthermore, we revealed that a high-fat diet in the presence of a vitamin D deficient status reduced the SOS parameter compared with a normal-fat diet with a vitamin D-deficient status (P< .05).

The Mediterranean Diet in Osteoporosis Prevention: An Insight in a Peri- and Post-Menopausal Population

Osteoporosis represent a widespread public health problem. The management and prevention of osteoporosis and related low energy fractures start with a correct lifestyle and proper nutrition. Several different nutrients are essential for bone and mineral metabolism, especially calcium. Nevertheless, a well-balanced nutrition, such as Mediterranean diet (MD), proved to be beneficial for several chronic diseases and also fragility fractures resulted lower in the Mediterranean area. A prospective observational study in a population of two hundred peri- and post-menopausal women (aged 30-80 years) was developed at Careggi hospital, Florence. Both MD adherence and dietary calcium intake were evaluated in occasion of a "first visit" and a "follow-up" visit, through validated questionnaires. From a descriptive point of view, although not statistically significant, in both visits a slight increase in calcium intake was observed for high adherence to MD diet. Moreover, a short nutritional interview (20 min) was applied in our population and demonstrated to be sufficient to significantly improve MD adherence level (mean score at T₀ = 6.98 ± 1.74 and T₁ = 7.53 ± 1.68), opening promising paths in osteoporosis prevention.

Risk Factors for Stress Fractures in Female Runners: Results of a Survey

BACKGROUND

Few studies compare women with and without stress fractures and most focus on younger, elite runners.

HYPOTHESIS/PURPOSE

Compare risk factors between female runners with and without a stress fracture history.

STUDY DESIGN

Case control.

METHODS

An online survey targeting women age ≥18 years was distributed primarily via social media. Questions included demographics, running details, cross training, nutrition, injury history, medical/menstrual history, and medications. Women with stress fracture histories answered questions about location, number, and changes made. Data were compared between groups using t-tests, chi-square tests, or Fisher's exact tests. Multivariable logistic regression models simultaneously investigated associations of multiple factors using backward variable selection.

RESULTS

Data from 1648 respondents were analyzed. Mean age was 40 years, and 25.4% reported stress fractures. Significant differences were found between groups for days/week running, mileage/week, running pace, years running, having a coach, cycling or swimming, calorie consumption for activity, other running injuries, medical history, medication/supplement intake, age at menarche, and going ≥6 months without a menstrual period. Odds of having a stress fracture were increased with osteopenia (OR 4.14), shin splints (OR 3.24), tendon injuries (OR 1.49), running >20 miles/week (OR 1.74-1.77) compared to 11-20 miles/week, having a coach (OR 1.86), and cycling (OR 1.15). Women running 11:00-11:59 minutes/mile or slower were less likely to have a stress fracture compared to those running 9:00-9:59 minutes/mile (OR 0.43-0.54). The odds of having a stress fracture were 1.43 times higher for going ≥ 6 months without a menstrual period. Use of calcium, probiotics, and vitamin D increased odds. Post fracture, common changes made were with cross training (49%), mileage (49%), and strength training (35%).

CONCLUSIONS

Multiple intrinsic and extrinsic factors were identified for female runners who sustained one or more stress fracture during running. Prospective studies are warranted to infer a cause and effect relationship amongst these variables and stress fracture risk.

LEVEL OF EVIDENCE

Level IV.

Plasma high-resolution metabolomics identifies linoleic acid and linked metabolic pathways associated with bone mineral density

BACKGROUND & AIMS

There is a considerable degree of variation in bone mineral density (BMD) within populations. Use of plasma metabolomics may provide insight into established and novel determinants of BMD variance, such as nutrition and gut microbiome composition, to inform future prevention and treatment strategies for loss of BMD. Using high-resolution metabolomics (HRM), we examined low-molecular weight plasma metabolites and nutrition-related metabolic pathways associated with BMD.

METHODS

This cross-sectional study included 179 adults (mean age 49.5 ± 10.3 yr, 64% female). Fasting plasma was analyzed using ultra-high-resolution mass spectrometry with liquid chromatography. Whole body and spine BMD were assessed by dual energy X-ray absorptiometry and expressed as BMD (g/cm2) or Z-scores. Multiple linear regression, pathway enrichment, and module analyses were used to determine key plasma metabolic features associated with bone density.

RESULTS

Of 10,210 total detected metabolic features, whole body BMD Z-score was associated with 710 metabolites, which were significantly enriched in seven metabolic pathways, including linoleic acid, fatty acid activation and biosynthesis, and glycerophospholipid metabolism. Spine BMD was associated with 970 metabolites, significantly enriched in pro-inflammatory pathways involved in prostaglandin formation and linoleic acid metabolism. In module analyses, tryptophan- and polyamine-derived metabolites formed a network that was significantly associated with spine BMD, supporting a link with the gut microbiome.

CONCLUSIONS

Plasma HRM provides comprehensive information relevant to nutrition and components of the microbiome that influence bone health. This data supports pro-inflammatory fatty acids and the gut microbiome as novel regulators of postnatal bone remodeling.

Evaluating and Strengthening the Evidence for Nutritional Bone Research: Ready to Break New Ground?

A healthy diet is essential to attain genetically determined peak bone mass and maintain optimal skeletal health across the adult lifespan. Despite the importance of nutrition for bone health, many of the nutritional requirements of the skeleton across the lifespan remain underexplored, poorly understood, or controversial. With increasingly aging populations, combined with rapidly changing diets and lifestyles globally, one anticipates large increases in the prevalence of osteoporosis and incidence of osteoporotic fractures. Robust, transparent, and reproducible nutrition research is a cornerstone for developing reliable public health recommendations to prevent osteoporosis and osteoporotic fractures. However, nutrition research is often criticized or ignored by healthcare professionals due to the overemphasis of weak science, conflicting, confusing or implausible findings, industry interests, common misconceptions, and strong opinions. Conversely, spurious research findings are often overemphasized or misconstrued by the media or prominent figures especially via social media, potentially leading to confusion and a lack of trust by the general public. Recently, reforms of the broader discipline of nutrition science have been suggested and promoted, leading to new tools and recommendations to attempt to address these issues. In this perspective, we provide a brief overview of what has been achieved in the field on nutrition and bone health, focusing on osteoporosis and osteoporotic fractures. We discuss what we view as some of the challenges, including inherent difficulties in assessing diet and its change, disentangling complex interactions between dietary components and between diet and other factors, selection of bone-related outcomes for nutrition studies, obtaining evidence with more unbiased designs, and perhaps most importantly, ensuring the trust of the public and healthcare professionals. This perspective also provides specific recommendations and highlights new developments and future opportunities for scientists studying nutrition and bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).

Dietary Patterns and Pediatric Bone

PURPOSE OF REVIEW

Much of what we know about dietary patterns (DPs) and bone is derived from cross-sectional studies in adults. Given, establishing healthy bones during childhood serves as a blueprint for adult bone, it is important to better understand the role of DPs on pediatric bone. The purpose of this review is to determine if DPs influence bone strength in children.

RECENT FINDINGS

The majority of studies investigating the role of DPs on pediatric bone are cross-sectional in design and examine data-derived "a posterori" DPs. Overall, the DPs characterized by high intakes of fruits and vegetables demonstrated positive effects on pediatric bone. Results from both "a posteriori" and "a priori" DPs approaches in children suggests that DPs dominated by the intake of fruits and vegetables might be beneficial for pediatric bone. Future studies may consider "a priori" DPs interventions to better understand relationship between DPs and pediatric bone.

The impact of a high fat diet on bones: potential mechanisms

High-fat diet led to bone loss via gut microbiota and fatty acid imbalances, immune disorder and adipose tissue accumulation inside and outside the bone marrow.

Are Brazilian adolescents eating enough fruits and vegetables? An assessment using data from the Study of Cardiovascular Risk in Adolescents

ABSTRACT Objective To estimate the usual consumption of fruits and vegetables by Brazilian adolescents. Methods We used 24-hour dietary recall data from the Study of Cardiovascular Risk in Adolescents conducted in 2013-2014 with 71,740 adolescents between 12 and 17 years old. The usual consumption of fruits and vegetables was estimated in the Statistical Analysis Software using the model of the United States National Cancer Institute, and evaluated according to sex, age, place of residence, economic class, and nutritional status of the participants. Results The mean of usual fruit and vegetable consumption was estimated at 171g/day, mostly fruits (128g/day), mainly in the form of fruit juice (64.8%). The minimum fruit and vegetable consumption of 400g/day recommended by the World Health Organization was reached only by 2% of the adolescents. The adolescents’ socioeconomic class or nutritional status had no impact on the usual fruit and vegetable consumption, but adolescents from northern Brazil had a significantly lower consumption than those from the midwestern region. Orange was both the most consumed fruit on a daily basis (mean of 42.6g/day, 90% as juice) and the most reported fruit (by 12.7% of the adolescents), followed by apples (10g/day; 5.6%) and bananas (8.4g/day; 8.3%). Tomato was the most consumed vegetable (9.2g/day), reported by 11.5% of the adolescents. Conclusion Public health policies are necessary to encourage fruit and vegetable consumption among Brazilian adolescents, including of pure juice, essential foods to prevent chronic diseases in adulthood.

Dietary protein intake from different animal and plant sources plays a minor role in the bone health of adults with or without intermittent fasting for decades

We examined whether bone health is related to protein intake from different sources by utilising a distinct, rare dietary pattern: avoidance of animal foods for approximately half of the year according to Christian Orthodox Church fasting. Four-hundred adults, of whom 200 had been following religious fasting for a median of 15 years and 200 were non-fasters, underwent anthropometry, measurements of bone mineral density (BMD) and bone mineral content (BMC), and completed a food frequency questionnaire. Groups did not differ significantly in anthropometric measures, BMD, or BMC. Fasters had higher consumption of seafood and lower consumption of red meat, poultry-eggs, dairy products, and grains-cereals than non-fasters. Protein intake from these food groups exhibited similar differences; overall, fasters had lower protein intake than non-fasters. BMD and BMC were positively, though weakly, correlated with red meat and poultry-egg consumption. Thus, protein intake seems to play a minor (if any) role in bone health.

Dietary Diversity and the Risk of Fracture in Adults: A Prospective Study

Nutrition plays an important and modifiable role in bone health. This study aimed to investigate the effect of dietary diversity on the risk of any type of fracture in adults. Data from the China Health and Nutrition Survey collected between waves 1997 and 2015 were used. A total of 10,192 adults aged 40 years and older were included in the analysis. Both dietary diversity score (DDS) based on Chinese dietary guidelines (DDS-CDG) and minimum dietary diversity for women (DDS-MDD-W) were computed. Cox proportional hazards regression models were conducted to determine the association. Stratified analyses were conducted in women by the age of fracture using the case-control study approach. In men, higher scores in both the DDS-CDG (hazard ratio (HR) 0.70, 95% CI 0.56-0.88) and DDS-MDD-W (HR 0.67, 95% CI 0.54-0.82) were associated with decreased risk of fracture, however, the associations were not significant in women (DDS-CDG: HR 0.94, 95% CI 0.79-1.12; DDS-MDD-W: HR 0.93, 95% CI 0.79-1.09). In the stratified analyses, higher DDS-CDG (odds ratio (OR) 0.74, 95% CI 0.58-0.95) and higher DDS-MDD-W (OR 0.76, 95% CI 0.60-0.95) were associated with lower risks of fracture in women aged 40 to 60 years; in women aged over 60 years, no association was observed (DDS-CDG: OR 1.10, 95% CI 0.83-1.46; DDS-MDD-W: OR 1.00, 95% CI 0.79-1.27). In summary, higher dietary diversity was associated with decreased risk of fracture in men and middle-aged women, but not in women aged over 60 years.

Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and osteoporosis risk in postmenopausal Iranian women

This is the first study to examine the association of adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and osteoporosis risk in postmenopausal Iranian women. Findings suggest the inverse association of adherence to the DASH dietary pattern and osteoporosis risk in postmenopausal Iranian women.

INTRODUCTION

This study was aimed to examine the association of adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and osteoporosis risk in postmenopausal Iranian women, hypothesizing that higher adherence to this pattern is associated with lower risk of postmenopausal osteoporosis.

METHODS

One hundred fifty-one postmenopausal Iranian women aged 50-85 years participated in this cross-sectional study. Lumbar spine and femoral neck bone mineral densities (BMDs) were measured via dual-energy X-ray absorptiometry. Postmenopausal osteoporosis was then defined using the WHO criteria as a BMD T-score of ≤ - 2.5 standard deviations. The usual past-year dietary intakes were assessed by a valid and reliable 168-item food frequency questionnaire. The DASH score was then calculated based on energy-adjusted intakes of eight major dietary components usually emphasized (i.e., fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains) or minimized (i.e., sodium, sweets, and red or processed meats) in the DASH diet. The higher the DASH score of a participant, the higher the adherence to the DASH dietary pattern.

RESULTS

After adjusting for several potential covariates in the multivariable-adjusted binary logistic regression analysis, participants in the highest tertile of DASH score had lower risk of osteoporosis at lumbar spine than those in the lowest tertile (odds ratio = 0.28; 95% confidence interval, 0.09-0.88; p = 0.029). However, no significant association was observed between adherence to the DASH dietary pattern and risk of osteoporosis at femoral neck.

CONCLUSION

Findings suggest the inverse association of adherence to the DASH dietary pattern and osteoporosis risk in postmenopausal Iranian women.

Dietary Patterns, Body Composition, and Bone Health in New Zealand Postmenopausal Women

Nutrition affects bone health status. However, analysis of the dietary patterns gives insights into which particular combination of foods may influence nutritional status and bone health. The aim of this study was to explore the associations between dietary patterns, bone mineral density (BMD) and T-scores, and body composition in New Zealand postmenopausal women. This cross-sectional study examined 125 postmenopausal women aged between 54 and 81 years. Body composition, BMD and T-scores were determined using dual-energy X-ray a bsorptiometry (DXA). Diet composition was assessed using a validated food frequency questionnaire (FFQ) composed of 108 food items, from which 34 food groups were created. Dietary patterns were identified by principal component analysis. The bone and body composition data including skeletal sites T-scores, waist circumference, BMI and body fat percentage were regressed onto the dietary patterns. Four dietary patterns were identified; the milk and milk-rich beverages dietary pattern, the dessert, cheese and red meat dietary pattern, the fruit-rich, biscuit and crackers dietary pattern and the oily fish, sports drink and seafood-rich dietary pattern. The milk and milk-rich beverages dietary pattern was significantly positively associated with spine T-score (r = 0.247, P = 0.008), and not whole-body BMD (r = 0.182, P = 0.051). The oily fish, sports drink and seafood-rich dietary pattern was marginally negatively associated with waist circumference (r = −0.157, P = 0.094) and body mass index (r = −0.163, P = 0.081) and significantly associated with body fat percentage (r = −0.247, P = 0.008). Binary logistic regression indicated that intake of the milk and milk-rich beverages dietary pattern reduced the occurrence of osteoporosis [adjusted odds ratio OR (95% CI): 0.589 (0.353, 0.982)]. A dietary pattern characterized by a high factor loading of milk and milk-rich beverages was positively associated with whole-body BMD and spine T-score, while the oily fish, sports drink, seafood-rich dietary pattern was inversely associated with total body fat percentage. Consumption of milk, even with coffee showed a positive association with bone health among postmenopausal women. Further longitudinal intervention studies is warranted to confirm effects of dietary patterns on skeletal body sites such as hip and femoral neck T-scores.

Association between the 10-year predicted risk of atherosclerotic cardiovascular disease and dietary patterns among Canadian adults 40-79 years

BACKGROUND/OBJECTIVES

Identifying groups at risk for atherosclerotic cardiovascular disease (ASCVD) and improving prevention strategies are important due to the high rates of these diseases in the world. We aimed to determine the 10-year ASCVD risk and cardiovascular age gap (CAG) of Canadians 40-79 and the association between prevalent dietary patterns and ASCVD risk, and CAG.

SUBJECTS/METHODS

Health measures and dietary intake information were obtained from 2088 respondents representative of 13,655,671 Canadians 40-79 years in the cross-sectional Canadian Health Measures Survey Cycles 1 and 2 (2007-11). The estimated 10-year ASCVD risk and CAG were determined for 40-79 years adults across different levels of sociodemographic/lifestyle factors. Dietary patterns emerged using the principal component analysis from 32 food groups collected using food frequency questionnaire. The association between 10-year ASCVD risk, and CAG, with dietary patterns was investigated controlling for potential covariates. Survey data were weighted and bootstrapped to be nationally representative.

RESULTS

The mean 10-year ASCVD risk of 40-79 years was 6.9%. The mean CAG for men was -4.1 years (older) and for females was +0.4 years (younger). Four dietary patterns emerged. Of note, the "High carbohydrate and protein" dietary pattern, which included potatoes, red meat, sausage, egg and ice-cream/frozen yoghurt was positively associated with 10-year ASCVD (P_trend = 0.013). The "Healthy like" and "Fast food" dietary patterns had an inverse (p < 0.0001) and positive (p = 0.005) association, respectively, with CAG.

CONCLUSIONS

Dietary patterns prevalent among this population were associated with CAG and ASCVD risk. Interventions for promoting healthy dietary patterns may be beneficial to reduce ASCVD in Canada.

Healthy eating index-2015 and bone mineral density among adult Iranian women

This is the first study to examine the potential association of adherence to the healthy eating index-2015 (HEI-2015) and bone health. Findings suggest that better diet quality (i.e., a higher HEI-2015 score) is significantly associated with a small but clinically important increase in bone mineral density among adult Iranian women.

PURPOSE

The HEI-2015 is a multidimensional measure of diet quality used to assess how well people's dietary behaviors align with key recommendations of the 2015-2020 Dietary Guidelines for Americans for achieving a healthy dietary pattern. We examined the potential association of the HEI-2015 and bone mineral density (BMD) among adult Iranian women, hypothesizing that a higher HEI-2015 score is associated with greater BMD.

METHODS

Four-hundred sixteen participants (mean age 48.0 years; 64.7% premenopausal) participated in this cross-sectional study. Lumbar spine and femoral neck BMDs were measured via dual-energy X-ray absorptiometry. Dietary intakes were assessed using a valid and reliable food frequency questionnaire. The HEI-2015 score was calculated based on dietary intakes of 13 components emphasized or minimized in the HEI-2015. The higher the HEI-2015 score, the better the diet quality.

RESULTS

After adjusting for potential covariates in the multiple linear regression analysis, higher HEI-2015 scores were associated with greater lumbar spine and femoral neck BMDs (lumbar spine: standardized beta-coefficient [β] = 0.292; femoral neck: β = 0.192; both P < 0.001). Similar significant associations were found among premenopausal (lumbar spine: β = 0.337; femoral neck: β = 0.262; both P < 0.001) and postmenopausal women (lumbar spine: β = 0.198; femoral neck: β = 0.287; both P < 0.050). Overall, every 10-unit increase in the HEI-2015 score was associated with a 0.03 g/cm² higher multivariable-adjusted BMD at both lumbar spine and femoral neck (both P < 0.001).

CONCLUSION

Findings suggest that better diet quality, as indicated by a higher HEI-2015 score, is significantly associated with a small but clinically important increase in BMD among adult Iranian women.

Effects of Potassium or Sodium Supplementation on Mineral Homeostasis: A Controlled Dietary Intervention Study

CONTEXT

Although dietary potassium and sodium intake may influence calcium-phosphate metabolism and bone health, the effects on bone mineral parameters, including fibroblast growth factor 23 (FGF23), are unclear.

OBJECTIVE

Here, we investigated the effects of potassium or sodium supplementation on bone mineral parameters.

DESIGN, SETTING, PARTICIPANTS

We performed a post hoc analysis of a dietary controlled randomized, blinded, placebo-controlled crossover trial. Prehypertensive individuals not using antihypertensive medication (n = 36) received capsules containing potassium chloride (3 g/d), sodium chloride (3 g/d), or placebo. Linear mixed-effect models were used to estimate treatment effects.

RESULTS

Potassium supplementation increased plasma phosphate (from 1.10 ± 0.19 to 1.15 ± 0.19 mmol/L, P = 0.004), in line with an increase in tubular maximum of phosphate reabsorption (from 0.93 ± 0.21 to 1.01 ± 0.20 mmol/L, P < 0.001). FGF23 decreased (114.3 [96.8-135.0] to 108.5 [93.5-125.9] RU/mL, P = 0.01), without change in parathyroid hormone and 25-hydroxy vitamin D3. Fractional calcium excretion decreased (from 1.25 ± 0.50 to 1.11 ± 0.46 %, P = 0.03) without change in plasma calcium. Sodium supplementation decreased both plasma phosphate (from 1.10 ± 0.19 to 1.06 ± 0.21 mmol/L, P = 0.03) and FGF23 (from 114.3 [96.8-135.0] to 108.7 [92.3-128.1] RU/mL, P = 0.02). Urinary and fractional calcium excretion increased (from 4.28 ± 1.91 to 5.45 ± 2.51 mmol/24 hours, P < 0.001, and from 1.25 ± 0.50 to 1.44 ± 0.54 %, P = 0.004, respectively).

CONCLUSIONS

Potassium supplementation led to a decrease in FGF23, which was accompanied by increase in plasma phosphate and decreased calcium excretion. Sodium supplementation reduced FGF23, but this was accompanied by decrease in phosphate and increase in fractional calcium excretion. Our results indicate distinct effects of potassium and sodium intake on bone mineral parameters, including FGF23.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01575041.

Is a Healthy Diet Also Suitable for the Prevention of Fragility Fractures?

Osteoporosis and sarcopenia contribute to the risk of fracture in the population. These conditions share common features, and it is known that a healthy diet may have beneficial effects on both, theoretically resulting in fewer fractures. The present narrative review gives an overview of recent epidemiological research related to the association between healthy diets/dietary patterns, bone health and fragility fractures. The review also gives a brief overview on general dietary recommendations and advice as the cornerstone of public health nutrition. Although muscle health and sarcopenia contribute to the risk of fractures, these endpoints were not the focus of this review. Healthy diets are nutrient dense and contain bioactive components that are needed for the constant remodeling of the skeleton and to slow the rate of bone loss and muscle wasting, thus contributing to the prevention of fragility fractures. Compliance with healthy dietary patterns were predominantly found to be inversely associated with bone outcomes, although this was not entirely consistent across all studies. Different a priori diet scores, such as the Mediterranean diet score and the Dietary Inflammatory Index, as well as a posteriori data driven dietary patterns, such as the prudent or healthy dietary pattern, were inversely associated with fragility fractures in different populations. In conclusion, different healthy dietary patterns may contribute to bone health and less fractures. Following current dietary guidelines is thus advisable for the prevention of fragility fractures.

Influence of General Mineral Condition on Collagen-Guided Alveolar Crest Augmentation

The local regeneration of bone defects is regulated by general hormone, enzyme, ion, and vitamin levels. General diseases and dysregulation of the human mineral system can impact this process, even in alveolar crest. The aim of this study is to investigate a relation between bone density, measured in two-dimensional X-rays, and general mineral condition of patients. The study included 42 patients on whom tooth extractions were performed. Data were divided into two groups: the region where collagen scaffold (BRM) was used and the reference region of intact normal bone (REF). Two-dimensional intraoral radiographs were taken in all cases just after the surgery (00 M) and 12 months later (12 M). Thyrotropin (TSH), parathormone (PTH), Ca²⁺ in serum, HbA1c, vitamin 25(OH)D₃, and spine densitometry were checked. Digital texture analysis in MaZda 4.6 software was done. Texture Index (TI: BRM 1.66 ± 0.34 in 00 M, 1.51 ± 0.41 in 12 M, and REF 1.72 ± 0.28) and Bone Index (BI: BRM 0.73 ± 0.17 in 00 M, 0.65 ± 0.22 41 in 12 M, and REF 0.80 ± 0.14) were calculated to evaluate bone regeneration process after 12 months of healing (TI (p < 0.05) and BI (p < 0.01) are lower in BRM 12 M than in REF). This showed a relation between BI and TSH (R² = 26%, p < 0.05), as well as a between BI and patient age (R² = 65%, p < 0.001), and a weak relation between TI and TSH level (R² = 10%, p < 0.05). This study proved that a collagen scaffold can be successfully used in alveolar crest regeneration, especially in patients with a high normal level of TSH in the middle-aged population.

Higher healthy lifestyle scores are associated with greater bone mineral density in middle-aged and elderly Chinese adults

This study examined the association between healthy lifestyle score (HLS), which contained 7 items (smoking, BMI, physical activity, diet, alcohol, sleep and anxiety) and BMD. Results showed HLS was positively associated with BMD at all studied sites, suggesting that healthier lifestyle patterns might be beneficial to bone health.

PURPOSE

Previous studies have reported favourable associations of individual healthy lifestyle factors with bone mineral density (BMD), but limited evidence showed the relationship of a combined healthy lifestyle score (HLS) with BMD. This study examined the association between the HLS and BMD.

METHODS

This community-based cross-sectional study included 3051 participants aged 40-75 years. The HLS contained 7 items (smoking, BMI, physical activity, diet quality, alcohol intake, sleep and anxiety). BMD values of whole body (WB), lumbar spine 1-4 (L_1-4), total hip (TH) and femur neck (FN) were measured using dual-energy X-ray absorptiometry.

RESULTS

After adjusting for potential covariates, HLS was positively associated with BMD at all studied sites (P-trend < 0.01). The mean BMDs were 2.69% (WB), 5.62% (L_1-4), 6.13% (TH) and 5.71% (FN) higher in participants with HLS of 6-7 points than in those with HLS of 0-2 points. The per 1 of 7 unit increase in the HLS was associated with increases of 7.63 (WB)-13.4 (TH) mg/cm² BMD levels at all sites. These favourable associations tended to be more pronounced in men than in women. Among the 7 items, physical activity contributed most to the favourable associations, followed by BMI, non-smoking and diet; the other three items played little roles. Sensitivity analyses showed that the significant associations remained after excluding any one of the 7 components or excluding fracture subjects at all sites.

CONCLUSION

Higher HLS was associated with greater BMD in middle-aged and elderly Chinese, suggesting that healthier lifestyle patterns might be beneficial to bone health.

Nutrients and Dietary Patterns Related to Osteoporosis

Osteoporosis is a common chronic disease characterized by a decrease in bone mineral density, impaired bone strength, and an increased risk of fragility fractures. Fragility fractures are associated with significant morbidity, mortality and disability and are a major public health problem worldwide. The influence of nutritional factors on the development and progression of this disease can be significant and is not yet well established. Calcium intake and vitamin D status are considered to be essential for bone metabolism homeostasis. However, some recent studies have questioned the usefulness of calcium and vitamin D supplements in decreasing the risk of fractures. The adequate intake of protein, vegetables and other nutrients is also of interest, and recommendations have been established by expert consensus and clinical practice guidelines. It is important to understand the influence of nutrients not only in isolation but also in the context of a dietary pattern, which is a complex mixture of nutrients. In this review, we evaluate the available scientific evidence for the effects of the main dietary patterns on bone health. Although some dietary patterns seem to have beneficial effects, more studies are needed to fully elucidate the true influence of diet on bone fragility.

Dietary Intake, D3Cr Muscle Mass, and Appendicular Lean Mass in a Cohort of Older Men

BACKGROUND

We examined cross-sectional associations between dietary patterns, macronutrient intake, and measures of muscle mass and lean mass in older men.

METHODS

Participants in the Osteoporotic Fractures in Men (MrOS) cohort (n = 903; mean ± SD age 84.2 ± 4 years) completed brief Block food frequency questionnaires (May 2014-May 2016); factor analysis was used to derive dietary patterns. The D3-creatine (D3Cr) dilution method was used to measure muscle mass; dual-energy x-ray absorptiometry (DXA) was used to measure appendicular lean mass (ALM). Generalized linear models were used to report adjusted means of outcomes by dietary pattern. Multiple linear regression models were used to determine associations between macronutrients and D3Cr muscle mass and DXA ALM. Multivariable models were adjusted for age, race, clinic site, education, depression, total energy intake, height, and percent body fat.

RESULTS

Greater adherence to a Western dietary pattern (high factor loadings for red meat, fried foods, and high-fat dairy) was associated with higher D3Cr muscle mass (p-trend = .026). Adherence to the Healthy dietary pattern (high factor loadings for fruit, vegetables, whole grains, and lean meats) was not associated with D3Cr muscle mass or DXA ALM. Total protein (β = 0.09, 95% CI = 0.03, 0.14) and nondairy animal protein (β = 0.16, 95% CI = 0.10, 0.21) were positively associated with D3Cr muscle mass. Nondairy animal protein (β = 0.06, 95% CI = 0.002, 0.11) was positively associated with DXA ALM. Associations with other macronutrients were inconsistent.

CONCLUSIONS

Nondairy animal protein intake (within a Western dietary pattern and alone) was positively associated with D3Cr muscle mass in older men.

Prudent and traditional dietary patterns are positively and negatively associated with bone mineral density in Iranian adults, respectively

To assess the association of dietary patterns and bone mineral density (BMD), 340 healthy Iranian adults (mean age 41.5 ± 7.7 y; 79.1% female) participated in this cross-sectional study. Lumbar spine and femoral neck BMDs were measured using dual-energy X-ray absorptiometry. Dietary intakes were evaluated by a valid and reliable 168-item food frequency questionnaire, and three major dietary patterns were identified using principal component factor analysis. Mean values for lumbar spine and femoral neck BMDs in participants were 0.96 ± 0.13 and 0.92 ± 0.12 g/cm², respectively. After controlling for age, body mass index, physical activity, energy intake, sunlight exposure, gender, education, employment status, supplement intake, and smoking in the analysis of covariance models, multivariable adjusted means of femoral neck BMD of participants in the highest tertile of the prudent pattern score (rich in green leafy vegetables, other vegetables, tomatoes, yellow vegetables, fruits and fruit juices, olives, nuts, fish, low-fat dairy products, and Doogh) were significantly higher than those in the lowest tertile (mean difference and 95% CI: 0.043 [0.003; 0.083] g/cm², P = 0.032). In contrast, multivariable adjusted means of lumbar spine BMD of participants in the highest tertile of the traditional pattern score (high in Abgoosht, vegetable oils, salt, legumes, pickles, cruciferous vegetables, refined grains, potatoes, and organ meats) were significantly lower than those in the lowest tertile (mean difference and 95% CI: -0.057 [-0.098; -0.015] g/cm², P = 0.003). The Western pattern was not associated with BMD. In conclusion, the prudent and traditional dietary patterns are positively and negatively associated with BMD in Iranian adults, respectively.

Dietary Patterns of Greek Adults and Their Associations with Serum Vitamin D Levels and Heel Quantitative Ultrasound Parameters for Bone Health

The aim of this study is to investigate the dietary patterns which indicate the nutritional habits of Greek adults and their effects on serum 25(OH)D levels and quantitative ultrasound (QUS) parameters for bone health. This study is part of OSTEOS, an observational cross-sectional study. In total, 741 adults from rural and urban areas throughout Greece were recruited. A validated food frequency questionnaire (FFQ) was used for assessment of the population’s dietary habits. Serum 25(OH)D was measured by enzyme immunoassay; QUS parameters were assessed with an Achilles device. Principal component analysis (PCA) was carried out for dietary pattern determination, and univariate analysis of variance was used for the assessment of 25(OH)D, broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) determinants. Six dietary patterns explain 52.2% of the variability of Greek adults’ nutritional habits. The ‘vegetables–fruit’ dietary pattern explains the biggest rate of variability. Determinants of serum 25(OH)D are body mass index (BMI), elderly status, summer sun exposure, organized physical activity, a ‘healthy’ pattern in winter months, and adherence to a ‘sweet’ pattern. Determinants of QUS parameters are age, BMI, sedentary time, organized physical activity participation, and adherence to a ‘healthy’ pattern.

Effect of Dietary Insulinemia on All-Cause and Cause-Specific Mortality: Results From a Cohort Study

Background: Insulin response to diet might predict the risk of mortality; however, the evidence is limited. We prospectively evaluated the link between the dietary hyperinsulinemia index (DHI) and dietary insulin resistance index (DIRI) with all-cause and cause-specific (cardiovascular disease [CVD] and cancer) mortality.Methods: The National Health and Nutrition Examination Survey (1999-2010) database was used. Vital status through December 31, 2011, was ascertained. Stepwise linear regression models consisted of 39 macro/micronutrients applied, and fasting plasma C-peptide for the DHI and triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C) for the DIRI were used. Adjusted Cox regression (followed by propensity score matching) was performed to determine the hazard ratios (HRs) and 95% confidence interval (95% CIs).Results: Overall, 22,246 participants were included (mean age = 47.8 years; 48.9% men). There was a significant increasing risk of mortality across the quartiles of DHI, i.e., participants with a highest score of DHI (Q4) had a greater risk of all-cause (HR: 1.21, 95% CI: 1.17-1.26), CVD (HR: 1.17, 95% CI: 1.07-1.29), and cancer (HR: 1.15, 95% CI: 1.08-1.23) mortality compared with the first quartile (Q1; p < 0.001 for all comparisons). Similarly, participants in the highest DIRI quartile (Q4) had 23% and 31% higher risk of all-cause and CVD mortality, respectively, compared with Q1, while the association between cancer mortality and DIRI was non-significant (HR: 0.88, 95% CI: 0.35-2.61).Conclusions: These findings highlight, for the first time, the detrimental role (association) of insulinemia and insulin resistance potential of diet on all-cause and cause-specific mortality. Our findings support the role of C-peptide and TG/HDL-C ratio as cost-effective and practical biomarkers in clinical settings. These results need to be confirmed to establish their implications.

Association of Empirical Dietary Atherogenic Indices with All-Cause and Cause-Specific Mortality in a Multi-Ethnic Adult Population of the United States

Serum uric acid (SUA) and apolipoprotein B (apoB) are markers of the risk of morbidity and mortality. However, no study has investigated their role, simultaneously with nutritional factors, on the risk of mortality. We calculated the dietary uricaemia score (DUS) and the dietary atherogenic score (DAS) and evaluated their associations with the risk of all-cause and cause-specific mortality. Data from the NHANES 1999-2010 study were used. Vital status through the 31 December 2011 was ascertained. Reduced rank regression models followed by stepwise linear regression analyses were applied on 39 macro/micronutrients to identify a dietary pattern most predictive of SUA (DUS) and apoB (DAS). Overall, 20,256 participants were included (mean age: 47.5 years; 48.7% men). DUS consists of 14 contributors (eight positive, six negative), whereas DAS consists of 23 contributors (six positive, 17 negative). An increasing risk of cause-specific mortality was found across the quartiles (Q) of DUS, i.e., participants with the highest score of DUS (Q4) had a greater risk of all-cause (hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.07-1.30), cardiovascular disease (CVD) (HR: 1.36, 95%CI: 1.21-1.59) and cancer (HR: 1.06, 95%CI: 1.01-1.14) mortality compared with Q1. Similarly, participants at the highest DAS quartile had 25, 40 and 11% greater risk of all-cause, CVD and cancer mortality, respectively, compared with Q1. For the first time, we reported an underlying shared link between two atherosclerosis factors (SUA and apoB) and nutrients, as well as their joint adverse impact on all-cause and cause-specific mortality.

Association between Inflammatory Potential of Diet and Bone-Mineral Density in Korean Postmenopausal Women: Data from Fourth and Fifth Korea National Health and Nutrition Examination Surveys

Post menopause is considered a critical period for bone-mass loss. Impaired bone metabolism during this phase can increase the risk of fractures in old age. Inflammation is a risk factor for bone health, and diet is a potential source of inflammation. However, few studies have examined the association between the dietary inflammatory index (DII®) and bone-mineral density (BMD) in postmenopausal women in Korea. The objective of this study was to determine, by means of a Korean cross-sectional investigation, whether higher DII scores are associated with decreased BMD in postmenopausal women. To that end, the raw data from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES, 2009-2011) for 2778 postmenopausal women aged over 50 years were analyzed. The subjects' BMD were measured by dual-energy x-ray absorptiometry, and their DII® scores were calculated from a single 24-h dietary recall. Further, the participants were classified into three groups according to DII® score. Women with more pro-inflammatory diets (i.e., those in the highest tertile of DII®) had significantly lower BMD in the femoral neck as compared with women in the lowest tertile (p for trend <0.05) after adjustment for age, body-mass index (BMI), household income, education status, smoking habits, physical activity, total calcium intake, female-hormone use, age at menopause, and blood vitamin D levels. Multiple logistic regression analyses revealed that the odds ratio (OR) of total femur osteopenia/osteoporosis was higher in women in the highest tertile of DII® than in those in the lowest (OR 1.27, 95% CI 1.00-1.62, p for trend < 0.05). This study established that more pro-inflammatory diets might be associated with lower BMD in postmenopausal Korean women.

Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis

Low bone mineral density (BMD) and osteoporosis-related fractures constitute a considerable public health burden. Several studies have demonstrated the association between diet and bone health. We performed a systematic review to provide an estimate of the association between different dietary patterns defined through the use of a posteriori methods and fracture or low BMD risk. A literature search on PubMed, Web of Science, and Scopus databases, up to March 2018, was performed to identify all eligible case-control, prospective, or cross-sectional studies involving subjects of both sexes and any age. Random-effects models were used. Heterogeneity and publication bias were evaluated. Stratified analyses were conducted on study characteristics. The meta-analysis includes 20 studies and identifies 3 prevalent dietary patterns: "Healthy," "Milk/dairy," and "Meat/Western." From the 10 studies on fracture, adherence to the "Healthy" pattern reduced the risk, particularly in older people (OR: 0.79; 95% CI: 0.66, 0.95; P = 0.011) and in Eastern countries (OR: 0.64; 95% CI: 0.43, 0.97; P = 0.037), whereas the risk increased with the "Meat/Western" pattern, especially for older people (OR: 1.11; 95% CI: 1.04, 1.18, P = 0.001), in those with hip fractures (OR: 1.15; 95% CI: 1.05, 1.25; P = 0.002), and in Western countries (OR: 1.10; 95% CI: 1.07, 1.14; P < 0.0001). Analyses on low BMD showed a reduced risk in the "Healthy" pattern, particularly for younger people (OR: 0.62; 95% CI: 0.44, 0.89; P = 0.009). The "Meat/Western" pattern increased low BMD risk, especially in older people (OR: 1.31; 95% CI: 1.05, 1.64; P = 0.015). The "Milk/dairy" pattern resulted in the strongest reduction in low BMD risk; when stratifying, this effect remained significant (e.g., older women-OR: 0.57; 95% CI: 0.46, 0.70; P < 0.0001). Nutrition is an important modifiable factor affecting bone health. The "Healthy" and "Milk/dairy" patterns are associated with a reduced risk of low BMD and fracture. In contrast, the "Western" pattern is inversely associated.

Milk consumption, dietary calcium intake and nutrient patterns from adolescence to early adulthood and its effect on bone mass: the 1993 Pelotas (Brazil) birth cohort

The objective of this study is to evaluate the effect of milk consumption, dietary calcium intake and nutrient patterns (bone-friendly and unfriendly patterns) from late adolescence to early adulthood, on bone at 22 years of age. Cross-sectional analysis was performed with 3,109 participants from 1993 Pelotas (Brazil) birth cohort in the follow-ups of 18 and 22 years of age. Bone mineral density (BMD) of the lumbar spine, right femur and whole body were assessed at 22 years using a dual-energy X-ray absorptiometry (DXA). The exposure variables (dietary calcium, milk and nutrient patterns) were created by combining the consumption frequencies between the two follow-ups (always low, moderate, high, increase or decrease). Multiple linear regressions were performed, stratified by sex. In the right femur site, men classified into the “always high” (mean = 1.148g/cm²; 95%CI: 1.116; 1.181) and “increased” categories of milk consumption (mean = 1.154g/cm²; 95%CI: 1.135; 1.174) presented a slightly low BMD comparing with low (mean = 1.190g/cm²; 95%CI: 1.165; 1.215) and moderate (mean = 1.191g/cm²; 95%CI: 1.171; 1.210) categories. In addition, men always classified in the highest tertile of the “bone-unfriendly” pattern presented the lowest mean of whole body BMD (mean = 1.25g/cm²; 95%CI: 1.243; 1.266). No associations were observed between the categories of dietary calcium intake and “bone-friendly” pattern and each of the three BMD outcomes. These results point to the fact that diets composed of inhibiting foods/nutrients can contribute negatively to bone health.

A dietary pattern rich in calcium, potassium, and protein is associated with tibia bone mineral content and strength in young adults entering initial military training

Background

Stress fracture risk is elevated during initial military training (IMT), particularly in lower-extremity bones such as the tibia. Although the etiology of stress fractures is multifactorial, lower bone strength increases risk.

Objective

The objective of this study was to assess, through the use of peripheral quantitative computed tomography, whether adherence to a dietary pattern rich in calcium, potassium, and protein before IMT is positively associated with bone indexes in young adults entering IMT.

Design

A cross-sectional analysis was performed with the use of baseline data from 3 randomized controlled trials in Army, Air Force, and Marine recruits (n = 401; 179 men, 222 women). Dietary intake was estimated from a food-frequency questionnaire. A dietary pattern characterized by calcium, potassium, and protein was derived via reduced rank regression and a pattern z score was computed for each volunteer, where higher scores indicated greater adherence to the pattern. At the 4% (metaphysis) and 14% (diaphysis) sites of the tibia, bone mineral content (BMC), volumetric bone mineral density, robustness, and strength indexes were evaluated. Associations between dietary pattern z score as the predictor variable and bone indexes as the response variables were evaluated by multiple linear regression.

Results

Pattern z score was positively associated with BMC (P = 0.004) and strength (P = 0.01) at the metaphysis and with BMC (P = 0.0002), strength (P = 0.0006), and robustness (P = 0.02) at the diaphysis when controlling for age, sex, race, energy, smoking, education, and exercise. Further adjustment for BMI attenuated the associations, except with diaphyseal BMC (P = 0.005) and strength (P = 0.01). When height and weight were used in place of body mass index, the association with BMC remained (P = 0.046).

Conclusions

A dietary pattern rich in calcium, potassium, and protein is positively associated with measures of tibia BMC and strength in recruits entering IMT. Whether adherence to this dietary pattern before IMT affects injury susceptibility during training remains to be determined. These trials were registered at clinicaltrials.gov as NCT01617109 and NCT02636348.

Mediterranean diet, diet quality, and bone mineral content in adolescents: the HELENA study

Dietary scores, rather than individual nutrients, allow exploring associations between overall diet and bone health. The aim of the present study was to assess the associations between the Mediterranean Diet Score for Adolescents (MDS-A) and the Diet Quality Index for Adolescents (DQI-A) and bone mineral content (BMC) among Spanish adolescents. Our results do not support an association between dietary scores or indices and BMC in adolescents.

INTRODUCTION

To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry.

METHODS

The MDS-A and the DQI-A were calculated in 179 Spanish adolescents, based on two 24-h dietary recalls from the HELENA cross-sectional study. The associations between the diet scores and the BMC outcomes [total body less head (TBLH), femoral neck (FN), lumbar spine (LS), and hip] were analyzed using logistic regression models adjusting for several confounders.

RESULTS

Four hundred ninety-two models were included and only fruits and nuts and cereal and roots were found to provide significant ORs with regard to BMC. The risk of having low BMC reduced by 32% (OR 0.684; CI 0.473-0.988) for FN when following the ideal MDS-A, but this association lost significance when adjusting for lean mass and physical activity. For every 1-point increase in the cereal and root and the fruit and nut components, the risk of having low FN diminished by 56% (OR 0.442; CI 0.216-0.901) and by 67% (OR 0.332; CI 0.146-0.755), respectively.

CONCLUSION

An overall dietary score or index is not associated with BMC in our adolescent Spanish sample.

Association of dietary patterns of American adults with bone mineral density and fracture

OBJECTIVE

In a representative sample of US adults, we investigated the associations of nutrient patterns (NP) with bone mineral density (BMD) and fractures.

DESIGN

Cross-sectional.

SETTING

US community-based National Health and Nutrition Examination Survey (NHANES).

SUBJECTS

Participants with measured data on dietary intake and BMD from 2005 to 2010 were included. Principal components analysis was used to identify NP. BMD was measured using dual-energy X-ray absorptiometry. ANCOVA, adjusted logistic and linear regression models were employed, accounting for the complex survey design and sample weights.

RESULTS

We included a total of 18 318 participants, with 47·0 % (n 8607) being men. The mean age was 45·8 years with no sex difference. Three NP emerged, explaining 55·9 % of the variance in nutrient consumption. Multivariable-adjusted linear regressions revealed significant inverse associations between the 'high-energy' NP (rich in carbohydrates and sugar, total fat and saturated fat) and total femur, femoral neck, trochanter and intertrochanter BMD (β coefficient: -0·029, -0·025, -0·034 and -0·021, respectively, all P<0·001), while there were significant associations between the 'nutrient-dense' NP (rich in vitamins, minerals and fibre) and 'healthy fat' NP (high dietary PUFA and MUFA) and BMD at total femur, femoral neck, trochanter and intertrochanter (all P<0·001). In adjusted logistic regression models, the odds of hip, wrist or spine fractures did not vary significantly across NP quartiles.

CONCLUSIONS

Nutrient-dense and healthy fat NP are associated with higher BMD at various bone sites, while the high-energy NP is inversely associated with BMD measures.

Dietary patterns and longitudinal change in hip bone mineral density among older men

Studying dietary patterns is often more informative than individual nutrients or foods. We found that a Prudent dietary pattern (rich in vegetables and fish) was associated with reduced loss of total hip BMD in older men. A Prudent dietary pattern may be a potential lifestyle strategy for minimizing bone loss.

INTRODUCTION

This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time.

METHODS

Participants (n = 4379; mean age 72.9 ± 5.5 years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors.

RESULTS

Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed.

CONCLUSIONS

Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.

Dietary acid load and bone turnover during long-duration spaceflight and bed rest

Background

Bed rest studies document that a lower dietary acid load is associated with lower bone resorption.

Objective

We tested the effect of dietary acid load on bone metabolism during spaceflight.

Design

Controlled 4-d diets with a high or low animal protein-to-potassium (APro:K) ratio (High and Low diets, respectively) were given to 17 astronauts before and during spaceflight. Each astronaut had 1 High and 1 Low diet session before flight and 2 High and 2 Low sessions during flight, in addition to a 4-d session around flight day 30 (FD30), when crew members were to consume their typical in-flight intake. At the end of each session, blood and urine samples were collected. Calcium, total protein, energy, and sodium were maintained in each crew member's preflight and in-flight controlled diets.

Results

Relative to preflight values, N-telopeptide (NTX) and urinary calcium were higher during flight, and bone-specific alkaline phosphatase (BSAP) was higher toward the end of flight. The High and Low diets did not affect NTX, BSAP, or urinary calcium. Dietary sulfur and age were significantly associated with changes in NTX. Dietary sodium and flight day were significantly associated with urinary calcium during flight. The net endogenous acid production (NEAP) estimated from the typical dietary intake at FD30 was associated with loss of bone mineral content in the lumbar spine after the mission. The results were compared with data from a 70-d bed rest study, in which control (but not exercising) subjects' APro:K was associated with higher NTX during bed rest.

Conclusions

Long-term lowering of NEAP by increasing vegetable and fruit intake may protect against changes in loss of bone mineral content during spaceflight when adequate calcium is consumed, particularly if resistive exercise is not being performed. This trial was registered at clinicaltrials.gov as NCT01713634.

Dietary food patterns and glucose/insulin homeostasis: a cross-sectional study involving 24,182 adult Americans

Aim

To investigate the association of major dietary patterns with glucose and insulin homeostasis parameters in a large American sample. The association between dietary patterns (DP) derived via principal components analysis (PCA), with glucose/insulin homeostasis parameters was assessed. The likelihood of insulin resistance (IR) across the DPs quarters was also explored.

Method

The United States National Health and Nutrition Examination Survey (NHANES) participants during 2005–2012 were included if they underwent measurement of dietary intake as well as glucose and insulin homeostasis parameters. Analysis of covariance (ANCOVA) and adjusted logistic and linear regression models were employed to account for the complex survey design and sample weights.

Results

A total of 24,182 participants were included; 48.9% (n = 11,815) were men. Applying PCA revealed three DP (56.8% of variance): the first was comprised mainly of saturated fat (SFA), total fat, mono-unsaturated fatty acids (MUFA) and carbohydrate (CHO); the second is highly enriched with vitamins, trace elements and dietary fiber; and the third was composed of polyunsaturated fatty acids (PUFA), cholesterol and protein. Among the total population, after adjustment for age, sex, race, C-reactive protein, smoking, and physical activity, glucose homeostasis factors, visceral adiposity index and lipid accumulation product improved across the quarters of the first and third DP; and a reverse pattern with the second DP. The same trend was observed for the non-diabetic subjects. Moreover, subjects with higher adherence to the first and third DP had higher likelihood for developing IR, whereas there was a lower likelihood for the second DP.

Conclusion

This study shows that the DP heavily loaded with CHO, SFA, PUFA, protein, total fat and MUFA as well as high-cholesterol-load foods is associated with impaired glucose tolerance; in contrast, the healthy pattern which is high in vitamins, minerals and fiber may have favourable effects on insulin sensitivity and glucose tolerance.

Tracking Dietary Patterns over 20 Years from Childhood through Adolescence into Young Adulthood: The Saskatchewan Pediatric Bone Mineral Accrual Study

Dietary patterns established during adolescence might play a role in adulthood disease. We examined the stability of dietary patterns (DPs) from childhood through adolescence and into young adulthood (from age 8 to 34 years). Data from 130 participants (53 females) of Saskatchewan Pediatric Bone Mineral Accrual Study (aged 8–15 years, at baseline) were included. Multiple 24-h recalls were collected annually from 1991 to 1997, 2002 to 2005, and 2010 and 2011. Using principal component analysis, “Vegetarian-style”, “Western-like”, “High-fat, high-protein”, “Mixed”, and “Snack” DPs were derived at baseline. Applied DP scores for all annual measurements were calculated using factor loading of baseline DPs and energy-adjusted food group intakes. We analyzed data using generalized estimating equations. The tracking coefficient represents correlation between baseline dietary pattern scores and all other follow-up dietary pattern scores. We found a moderate tracking for the “Vegetarian-style” (β = 0.44, p < 0.001) and “High-fat, high-protein” (β = 0.39, p < 0.001) DPs in females and “Vegetarian-style” DP (β = 0.30, p < 0.001) in males. The remaining DPs showed poor-to-fair tracking in both sexes. No tracking for “Western-like” DP in females was observed. Assessing overall change in DP scores from childhood to young adulthood showed an increasing trend in adherence to “Vegetarian-style” DP and decreasing trend in adherence to “High-fat, high-protein” DP by age in both sexes (p < 0.001), while “Western-like” and “Mixed” DP scores increased only in males (p < 0.001). These findings suggest that healthy dietary habits established during childhood and adolescence moderately continue into adulthood.

The Macular Carotenoids Lutein and Zeaxanthin Are Related to Increased Bone Density in Young Healthy Adults

Lutein (L) and zeaxanthin (Z) status can be quantified by measuring their concentrations both in serum and, non-invasively, in retinal tissue. This has resulted in a unique ability to assess their role in a number of tissues ranging from cardiovascular to central nervous system tissue. Recent reports using animal models have suggested yet another role, a developmental increase in bone mass. To test this, we assessed L and Z status in 63 young healthy adults. LZ status was determined by measuring LZ in serum (using HPLC) and retina tissue (measuring macular pigment optical density, MPOD, using customized heterochromatic flicker photometry). Bone density was measured using dual-energy X-ray absorptiometry (DXA). Although serum LZ was generally not related to bone mass, MPOD was significantly related to bone density in the proximal femur and lumbar spine. In general, our results are consistent with carotenoids, specifically LZ, playing a role in optimal bone health.

Long-term a posteriori dietary patterns and risk of hip fractures in a cohort of women

Dietary pattern analysis is a useful tool to study the importance of food components in the context of a diet and how they relate to health and disease. The association between dietary patterns and fractures is at present uncertain. We aimed to study associations between dietary patterns and risk of hip fracture in the Swedish Mammography Cohort, including 56,736 women (median baseline age 52 years). Diet data was collected in food frequency questionnaires at two investigations and dietary patterns were defined by principal component analysis using 31 food groups. Information on hip fractures was collected from the Swedish National Patient Register. Multivariable adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated in Cox proportional hazards regression analysis. The two patterns identified—the healthy and Western/convenience dietary patterns—were time-updated and analysed. During a median follow-up time of 25.5 years, 4997 women experienced a hip fracture. Hip fracture rate was 31% lower in the highest compared to the lowest quartile of the healthy dietary pattern [HR (95% CI) 0.69 (0.64; 0.75)]. In contrast, women in the highest compared to the lowest quartile of the Western/convenience dietary pattern had a 50% higher [HR (95% CI) 1.50 (1.38; 1.62)] hip fracture rate. Further, in each stratum of a Western/convenience dietary pattern a higher adherence to a healthy dietary pattern was associated with less hip fractures. The present results suggest that a varied healthy diet may be beneficial for the prevention of fragility fractures in women.

Dietary Patterns and Fractures Risk in the Elderly

PURPOSE

Although the role of dietary factors in the prevention of bone loss and fractures has been investigated in many studies, few studies have examined the association between dietary patterns and total body bone density. Our aim was to determine the relations between dietary patterns and whole-body bone mineral density (WB-BMD) and the association between dietary patterns, fractures, and multiple fractures in the elderly.

METHODS

This cross-sectional study included 177 individuals aged ≥65 years. A dual X-ray absorptiometry scan was performed to measure BMD. Dietary patterns were ascertained by a combination of dietary intake assessment and principal components analysis.

RESULTS

Only three dietary patterns correlated with whole-body bone density. The multivariate-adjusted mean bone density across tertiles of these dietary patterns showed that the highest tertile of both the patterns 1 and 2 had a significantly higher bone density than the lowest tertile (pattern 1: 1.021 ± 0.01 and 1.070 ± 0.01 g/cm² for T1 and T3, respectively; p = 0.043; pattern 2: 1.023 ± 0.01, and 1.081 ± 0.01 g/cm² for T1 and T3, respectively; p = 0.003). We also find significant gender difference in these results. The highest adherence to the dietary pattern 5 was associated with decreased odds of having fractures (OR = 0.20, p = 0.009), and adherence to the pattern 1 was negatively associated with multiple fractures.

CONCLUSION

A high adherence to the dietary pattern 1 (high intake of grains, fish and olive oil) was associated with a high BMD and a low number of fractures. The highest adherence to the dietary pattern 5 (legumes and wine) was associated with decreased odds of having fractures. Our finding would suggest a potential bone-preserving properties of specific dietary patterns in the elderly.