Dietary Inflammatory Index in relation to bone mineral density, osteoporosis risk and fracture risk: a systematic review and meta-analysis

The Relationship of Certain Diseases and Dietary Inflammatory Index in Older Adults: A Narrative Review

PURPOSE OF REVIEW

One of the important markers affecting aging processes is the increase in inflammatory markers. Many chronic diseases are associated with inflammation and chronic inflammation increases with aging. Inflammation can change with dietary components. Foods, compounds and nutrients that have anti-inflammatory or proinflammatory properties attract attention. According to the Dietary Inflammatory Index, positive scores are obtained if the nutrient has a proinflammatory effect on cytokines, and negative scores are obtained if it has an anti-inflammatory effect.

RECENT FINDINGS

A higher proinflammatory diet is associated with cardiometabolic diseases, neurodegenerative disease, cancers and musculoskeletal health and related mortality. In this study, its relationship with type 2 diabetes mellitus, obesity, metabolic syndrome, musculoskeletal diseases, dementia, depression and cancer, which are more common in older adults and known to be associated with inflammation, was examined. Although studies involving under 65 years old are more prevalent, research involving older adults and Dietary Inflammatory Index (DII) is more limited. It is known that chronic inflammation increases with aging. Diet is one of the factors affecting inflammation. In the light of these investigations, the topics of anti-inflammatory nutrition and DII for the treatment of inflammation-related diseases in older adults are strong and open to development topics of discussion. Despite the significant interest in the potential positive effects of anti-inflammatory nutrition on diseases, contributing to clearer evidence of its protective effects on health necessitates further randomized controlled trials, in vivo, in vitro, cell, animal, human and case-control studies for better risk assessment.

Health Outcome Comparison Based on Dietary Inflammatory Levels among Sample of Korean Elderly

The aim of this study was to investigate the effect of a senior-friendly diet based on the dietary inflammatory index (DII) on the nutritional status and health indicators of older people. A total of 256 participants were classified into tertiles based on their DII values and split into intervention (n = 201) and control (n = 55) groups. The intervention group was provided with a senior-friendly diet, and the control group was allowed to eat their usual diet. Before and after the trial, anthropometric measurements, blood analyses, and questionnaires were completed for both groups. The mean age of the participants was 82.49 years, and 66.4% were female. On average, participants had 2.5 medical conditions, with a notable prevalence of cardiovascular disease. Following the intervention, the energy, carbohydrate, protein, and fat intakes significantly increased in the intervention group compared to pre-intervention levels. Tertile 3 exhibited substantial improvements in total nutrition score, NQ-E balance, and DII total score, as well as in triglycerides and blood glucose, attributed to this dietary intervention compared to other groups. In comparison with Tertile 1, nutrient intake and nutritional status in Tertile 3 were closely associated with significant influencing factors of the dietary intervention. For the group with the worst DII (Tertile 3), this dietary intervention greatly improved nutritional status, nutrient intake, and clinical indicators; thus, this senior-friendly diet appears to be beneficial for elderly people with nutritional vulnerabilities.

Dietary inflammatory pattern and risk of hip fracture in the Nurses' Health Study

Our immune system activity is impacted by what we eat and can influence fracture risk under certain conditions. In this article, we show that postmenopausal women with a pro-inflammatory dietary pattern have an increased risk of hip fracture.

PURPOSE

The immune system influences bone homeostasis and can increase the risk of fracture under certain pro-inflammatory conditions. Immune system activity is impacted by dietary patterns. Using the empirical dietary inflammatory pattern (EDIP), we investigated whether postmenopausal women with a pro-inflammatory dietary pattern had an increased risk of hip fracture.

METHODS

The study population consisted of postmenopausal women participating in the Nurses' Health Study from 1980 to 2014, who reported information on lifestyle and health, including hip fractures, on biennial questionnaires, while semiquantitative food frequency questionnaires (FFQs) were completed every fourth year. Hazard ratios (HR) for hip fracture were computed using Cox proportional hazards models, adjusting for potential confounders.

RESULTS

EDIP was calculated using intake information from the FFQ for 87,955 postmenopausal participants, of whom 2348 sustained a non-traumatic hip fracture during follow-up. After adjustment for confounders, there was a 7% increase in the risk of hip fracture per 1 SD increase in EDIP (HR 1.07, 95% CI 1.02-1.12), and the uppermost quintile had a 22% greater risk compared to the lowest (HR 1.22, 95% CI 1.06-1.40). For the separate components of the EDIP, we found that higher intakes of low-energy beverages (diet sodas) were independently associated with an increased risk of hip fracture, while higher intakes of green leafy vegetables were associated with a reduced risk.

CONCLUSION

A pro-inflammatory dietary pattern was associated with an increased risk of hip fracture among postmenopausal women.

Vascular endothelial cells-derived exosomes synergize with curcumin to prevent osteoporosis development

Osteoporosis has gradually become a major public health problem. Further elucidation of the pathophysiological mechanisms that induce osteoporosis and identification of more effective therapeutic targets will have important clinical significance. Experiments in vitro on bone marrow stem cells (BMSCs) subjected to osteogenic and adipogenic differentiation and in vivo on surgical bilateral ovariectomy (OVX) mouse models revealed that exosomes of vascular endothelial cells (EC-EXOs) can promote osteogenic differentiation of BMSCs and inhibit BMSC adipogenic differentiation through miR-3p-975_4191. Both miR-3p-975_4191 and curcumin can target tumor necrosis factor (TNF) and act synergistically to regulate BMSCs fate differentiation and delay the progression of osteoporosis. Our findings suggest that EC-EXOs may exert a synergistic effect with curcumin in reversing the progression of osteoporosis by targeting TNF via miR-3p-975_4191. Our study may provide therapeutic options and potential therapeutic targets for osteoporosis and thus has important clinical implications.

Lacto-ovo-vegetarian diet is inversely associated with the osteosarcopenia in older adults

OBJECTIVE

Osteosarcopenia adversely affects the quality of life and physical health of older adults. We sought to explore the association between dietary patterns and osteosarcopenia in community-dwelling older adults.

METHODS

This is a cross-sectional study from Northeast China, in which, we included older community adults aged 60 and above. Through face-to-face interviews, we collected dietary information from participants using a food frequency questionnaire. Subsequently, principal component analysis (PCA) was used to obtain the dietary patterns of the participants. Through physical examination, we obtained the participants' information on osteosarcopenia, which was defined by the coexist of osteopenia and sarcopenia. We analysed the association between dietary patterns and dietary compositions with ostesarcopenia.

RESULTS

In this study, a total of 9429 participants were included, and the prevalence of osteosarcopenia in community-dwelling older adults was 6.2%. PCA identified three main dietary patterns, and the lacto-ovo-vegetarian dietary pattern was inversely associated with osteosarcopenia. Compared to the lowest lacto-ovo-vegetarian quartile (Q1), the Q4 group (OR = 0.64, 95% CI:0.49-0.83) was inversely associated with osteosarcopenia. Through the weighted quantile sum regression model, we also found that the overall effect of the lacto-ovo-vegetarian dietary components was inversely associated with osteosarcopenia (OR = 0.58, 95% CI: 0.37-0.92); the largest contributors were vegetables, fresh milk, eggs, and dairy products.

CONCLUSION

Overall, we found that a lacto-ovo-vegetarian dietary pattern, particularly the consumption of vegetables, fresh milk, eggs, and dairy products, was inversely associated with osteosarcopenia in older adults. And this might provide new insights for the prevention and treatment of osteosarcopenia.

Positive relation between dietary inflammatory index and osteoporosis in postmenopausal women

Background: Previous studies have shown that some dietary components may be implicated in the aetiology of postmenopausal osteoporosis. Objective: We examined the relationship between Dietary Inflammatory Index (DII®) and osteoporosis in postmenopausal women. Study design: Eight hundred and fifty postmenopausal women aged 50-65 years were randomly selected from 87 health care centers. Bone mineral density (BMD) was measured using the anterior-posterior lumbar spine (L1-L4) and proximal femur neck through Hologic QDR 4500W (S/N 50266) dual-energy X-ray absorptiometry device. After checking inclusion and exclusion criteria and diagnosis of osteoporosis, 124 women with normal bone mineral density (normal-BMD) and 108 women with osteoporosis were selected. Demographic, anthropometric, physical activity, midwifery, and dietary intake questionnaires were completed. DII was calculated based on a valid and reliable 168-item semi-quantitative food frequency questionnaire using 37 (out of 45) food parameters. A Logistic regression model adjusted for confounders was applied to estimate osteoporosis's odds ratio (OR) based on modeling DII as a continuous and dichotomous variable. Results: In this study, DII scores ranged from -3.71 (the most anti-inflammatory score) to +4.16 (the most pro-inflammatory score). The median DII value among the osteoporosis group was 0.97, among the normal group it was -0.31, indicating a more pro-inflammatory diet for osteoporosis. There were positive associations between osteoporosis and DII based on both continuous (Adjusted OR=3.467, 95% confidence interval (CI): 2.280-5.272, P-value<0.001) and dichotomous (Adjusted OR: DII ≤-0.31 / >-0.31=0.248, 95% CI: 0.110-0.561, P-value=0.001) measures in modeling adjusted for age, BMI, post-menopausal years, parity, education, total energy intake, and physical activity. Conclusions: These data suggest a pro-inflammatory diet, as indicated by increasing the DII score, may be a risk factor for osteoporosis in postmenopausal Iranian women.

The relationship between dietary inflammatory index and bone mineral density in CKD patients

INTRODUCTION

Chronic systemic inflammation was proposed as a critical factor in the development of osteoporosis. We aim to investigate the effect of the DII on bone mineral density (BMD) in CKD patients.

METHODS

2276 participants from NHANES were enrolled. The DII score was calculated based on a single 24-h dietary recall. Total BMD was measured using Dual-energy x-ray absorptiometry. A multiple-stepwise linear regression model was used to determine associations between BMD and DII in CKD patients.

RESULTS

When DII >0.35, a negative correlation was obtained between DII and BMD (all β = -0.008 and p < 0.05). In subgroup analysis, BMD levels decreased across increasing tertiles of the DII for patients with non-osteoporosis, postmenopause, and low eGFR (p for trend ≤0.01).

CONCLUSION

Higher consumption of pro-inflammatory diet correlates negatively with the BMD levels in CKD patients.

Role of diet quality in bone health in children and adolescents: a systematic review

CONTEXT

Poor diet quality and unhealthy dietary patterns have been linked to poor bone health, yet few studies have investigated the role of diet quality in bone health in pediatric populations.

OBJECTIVE

This systematic review aims to assess the available evidence on the association between diet quality and bone health markers in children and adolescents.

DATA SOURCES

The PubMed, Scopus, and Virtual Health Library databases were searched electronically from October to November 2022, without any restrictions on date or language. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was used to assess the quality of the studies.

DATA EXTRACTION

Published observational studies in children and adolescents (ages 2 to 19 years) that investigated the association between diet quality and bone health were eligible for inclusion. Two researchers independently analyzed and selected all articles using the Rayyan app. Initially, 965 papers were identified. A total of 12 observational studies qualified, including 8 cross-sectional and 4 longitudinal studies. The sample comprised 7130 individuals aged 3 to 17.9 years, representing both sexes. Bone health was evaluated by measures of bone mineral density and bone mineral content.

DATA ANALYSIS

Seven studies (58.3%) showed significant associations between diet quality and bone health markers, all of which evaluated diet quality by identifying dietary patterns. Diet quality as evaluated by all dietary indexes was not associated with bone health markers.

CONCLUSIONS

Adherence to a healthy diet may benefit bone health in children and adolescents. These findings emphasize the importance of developing effective public health policies that encourage healthy eating habits from childhood to preserve bone health. Longitudinal research using a specific tool to assess diet quality in relation to bone health is warranted. Future studies should also measure bone-regulating hormones and markers of bone turnover.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022368610.

The association between dietary inflammation index and bone mineral density: results from the United States National Health and nutrition examination surveys

OBJECTIVE

To investigate the associations of dietary inflammation index (DII) with bone density and osteoporosis in different femoral areas.

METHODS

The study population was selected from the National Health and Nutrition Examination Survey (NHANES) with the exclusion criteria of age 18, pregnancy, or missing information on DII, femoral bone marrow density (BMD), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR), or had diseases which may influence systemic inflammation. DII was calculated based on the questionnaire interview of dietary recall within 24 h. Subjects' baseline characteristics were collected. The associations between DII and different femoral areas were analyzed.

RESULTS

After applying exclusion criteria, 10,312 participants were included in the study. Significant differences among DII tertiles were found in BMD or T scores (p < .001) of the femoral neck, the trochanter, the intertrochanter, and the total femur. High DII was associated with low BMDs and T scores in all the femoral areas (all p < .01). Compared to low DII (tertile1, DII < 0.380 as reference), in the femoral neck, the intertrochanter, and the total femur, increased DII is independently associated with increased the possibility of the presence of osteoporosis (OR, 95% CI: 1.88, 1.11-3.20; 2.10, 1.05-4.20; 1.94, 1.02-3.69, respectively). However, this positive association was only observed in the trochanteric area of the non-Hispanic White population after full adjustment (OR, 95% CI: 3.22 (1.18, 8.79)). No significant difference in the association of DII and the presence of osteoporosis were found in subjects with or without impaired kidney function (eGFR < 60 ml/min/1.73 m²).

CONCLUSION

High DII is independently related to declined femoral BMD of femoral areas.

Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review

PURPOSE

Although the Mediterranean diet has been associated with a lower risk of hip fracture, the effect of other dietary patterns on bone density and risk of fracture is unknown. This scoping review aims to investigate the association between adherence to alternative dietary patterns (other than the traditional Mediterranean diet) and osteoporosis or osteoporotic fracture risk in older people.

METHODS

A systematic search was carried out on three electronic databases (Medline, EMBASE, and Scopus) to identify original papers studying the association between alternative dietary patterns (e.g., Baltic Sea Diet (BSD), modified/alternative Mediterranean diet in non-Mediterranean populations, Dietary Approaches to Stop Hypertension (DASH)) assessed using 'prior' methods (validated scores) and the risk of osteoporotic fracture or Bone Mineral Density (BMD) in people aged ≥50 (or reported average age of participants ≥ 60). Results from the included studies were presented in a narrative way.

RESULTS

Six observational (four prospective cohort and two cross-sectional) studies were included. There was no significant association between BMD and BSD or DASH scores. Higher adherence to DASH was associated with a lower risk of lumbar spine osteoporosis in women in one study, although it was not associated with the risk of hip fracture in another study with men and women. Higher adherence to aMED (alternative Mediterranean diet) was associated with a lower risk of hip fracture in one study, whereas higher adherence to mMED (modified Mediterranean diet) was associated with a lower risk of hip fracture in one study and had no significant result in another study. However, diet scores were heterogeneous across cohort studies.

CONCLUSIONS

There is some evidence that a modified and alternative Mediterranean diet may reduce the risk of hip fracture, and DASH may improve lumbar spine BMD. Larger cohort studies are needed to validate these findings.

Association Between the Dietary Inflammatory Index and the Risk of Fracture in Chinese Adults: Longitudinal Study

BACKGROUND

Chronic inflammation plays a crucial role in tissue injury, osteoporosis, and fracture. The dietary inflammatory index (DII) is a tool for assessing the potential for inflammation in the diet. However, the association between the DII and fractures remains controversial from previous studies.

OBJECTIVE

We aimed to explore the correlation between the DII and fracture risk in Chinese adults.

METHODS

We included 11,999 adults (5519 men and 6480 women) who were a part of the China Health and Nutrition Survey (1997-2015) prospective cohort. A 3-day, 24-hour meal review method was used to calculate the DII score. The fractures were identified using a questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for fractures. Subgroup, sensitivity, and restricted cubic spline analyses were performed.

RESULTS

During the 18 years of follow-up (median follow-up 9.0 years), 463 men and 439 women developed fractures. The median DII score was 0.64 (IQR -1.74 to 1.46) for the total sample, 0.75 (IQR -1.68 to 1.50) for men, and 0.53 (IQR -1.79 to 1.42) for women. The DII score had a positive correlation with the risk of fracture among women but not among men. For men, after adjusting for covariates, the HRs for quintiles of DII were 1, 0.96 (95% CI 0.66-1.41), 1.05 (95% CI 0.74-1.49), 0.89 (95% CI 0.62-1.26), and 0.94 (95% CI 0.67-1.34; trend: P=.62). The HRs for women were 1, 1.13 (95% CI 0.72-1.79), 1.24 (95% CI 0.83-1.86), 1.51 (95% CI 1.02-2.22), and 1.62 (95% CI 1.10-2.39; trend: P=.004). The restricted cubic spline analysis showed a significant association between fracture risk and DII score in women (overall association: P=.01); as the DII scores were >0.53, HRs showed a significant upward trend. Women aged <50 years or who are nonsmokers, who are nondrinkers, or with nonabdominal obesity had a positive association between fracture risk and the DII score. In sensitivity analyses, after excluding people with diabetes or hypertension, there was still a positive association between fracture risk and the DII score in women. Among the DII components, the DII scores of protein (trend: P=.03), niacin (trend: P=.002), and iron (trend: P=.02) showed significant associations with the risk of fracture in women.

CONCLUSIONS

Proinflammatory diet consumption increased the fracture risk in Chinese women aged <50 years. The high consumption of anti-inflammatory foods and low consumption of proinflammatory foods may be an important strategy to prevent fractures in women.

Risk factors associated with low bone mineral density in children with idiopathic scoliosis: a scoping review

BACKGROUND

Children with idiopathic scoliosis (IS) have a high risk of osteoporosis and IS with low bone mineral density (BMD) are susceptible to curve progression. This review aims to explore the risk factors of low BMD in children with IS.

METHODS

Studies were retrieved from 5 databases that were published up to January 2022. Search terms are keywords in titles or abstracts, including subject headings related to "Scoliosis", "Bone Mineral Density", and "Risk Factors". Observational studies on risk factors of low BMD in children with IS were enrolled in this review. The number of studies, sample size, outcome measures, research type, endocrine, and lifestyle-related factors, gene/signal pathway, and other contents were extracted for qualitative analysis.

RESULTS

A total of 56 studies were included in this scoping review. Thirty studies involved genetic factors that may affect BMD, including the Vitamin-D receptor gene, RANK/RANKL signal pathway, the function of mesenchymal stem cells, Runx2, Interleukin-6 (IL-6), and miR-145/β-catenin pathway. Eight studies mentioned the influence of endocrine factors on BMD, and the results showed that serum levels of IL-6, leptin and its metabolites, and ghrelin in children with IS were different from the age-matched controls. In addition, there were 18 articles on lifestyle-related factors related to low BMD in children with IS, consisting of physical activity, calcium intake, Vitamin D level, and body composition.

CONCLUSIONS

Genetic, endocrine, and lifestyle-related factors might relate to low BMD and even osteoporosis in IS. To prevent osteoporosis, the effectiveness of regular screening for low BMD risk factors in children with IS needs to be investigated. Additionally, clear risk factors suggest strategies for bone intervention. Future studies should consider the effectiveness of calcium and vitamin D supplements and physical activity in BMD improvement.

BMI, socioeconomic status, and bone mineral density in U.S. adults: Mediation analysis in the NHANES

Introduction

The mechanism by which socioeconomic status (SES) affects bone mineral density (BMD) remains unknown, and body mass index (BMI) may be a potential mediator. The purpose of this study was to investigate whether BMI mediates the relationship between SES [education level and poverty income ratio (PIR)] and lumbar BMD and the proportion it mediates.

Methods

This study included a total of 11,075 adults from the National Health and Nutrition Examination Survey (NHANES). Lumbar BMD was measured at the lumbar spine by dual-energy X-ray absorptiometry (DXA). Multivariate linear regression and smoothing curve fitting were used to investigate the relationship between SES and lumbar BMD. Mediator analysis was used to investigate the proportion of BMI mediating the association between SES and BMD.

Results

In the fully adjusted model, there was a positive correlation between SES and BMD (education level: β = 0.025, 95% CI: 0.005, 0.045; PIR: β = 0.007, 95% CI: 0.002, 0.011). Mediation analysis showed that BMI mediated the relationship between PIR, education level, and lumbar BMD with a range of mediation proportions from 13.33 to 18.20%.

Conclusion

BMI partially mediated the positive association between SES and BMD, and this association may be largely mediated by factors other than BMI.

Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors

PURPOSE OF REVIEW

There is strong evidence that poor dietary intake of certain micro- and macro-nutrients can negatively affect bone health. It is unclear if diet is the primary culprit for poor bone health in the vegan population.

RECENT FINDINGS

Plant-based diets are gaining public interest since they may improve metabolic health. Studies that examine vegetarians and vegans together show a lower bone mineral density (BMD), but not always increased fracture risk compared to omnivores. However, vegans consistently have higher risk of fracture at multiple bone sites, especially at the hip. There is higher fracture risk in vegans which may be due to calcium and vitamin D intake, as well as amount of dietary protein and quality. Other nutrients (B vitamins, Se, Zn, Fe, iodine) or physiological factors (lower body mass index, microbiome, or endocrine profile) may also play a role but have not been examined and require further study.

Dietary inflammatory index and osteoporosis: the National Health and Nutrition Examination Survey, 2017-2018

PURPOSE

The dietary inflammatory index (DII) is a scoring system to quantify the inflammatory effects of nutrients and foods. Inflammation may affect bone health. The purpose of this study was to explore the relationships of DII with bone mineral density (BMD) and osteoporosis.

METHODS

This study involved 1023 women and 1080 men (age ≥ 50) in the US National Health and Nutrition Survey (NHANES), 2017-2018. Multivariable linear regression models were used to estimate the associations between DII and BMD. Association between DII and osteoporosis was tested with multivariable logistic regression models.

RESULTS

In women, DII was negatively associated with total hip and femoral neck BMD after adjusting for covariates (P &lt; 0.05). In men, DII was negatively associated with lumbar spine BMD (P &lt; 0.05). DII was positively associated with osteoporosis in women (P &lt; 0.05). The odds ratios (ORs) (95% CI) for osteoporosis associated with DII quartiles 2, 3 and 4 vs. quartile 1 were 2.95 (1.08, 8.09), 5.63 (2.87, 11.04), and 6.14(2.55, 14.78), respectively. No significant association was observed in men.

CONCLUSIONS

Higher DII scores were associated with increase osteoporosis risk in women, while no association was found in men. Greater pro-inflammatory diets might be associated with lower BMD in both women and men.

Dietary inflammatory index and bone mineral density in Mexican population

Dietary inflammatory index has been associated with bone loss. In this longitudinal study, we reported that changes in dietary inflammatory index were associated with a reduction in bone mineral density of the total hip and femoral neck in males and females ≥ 45 years, but not in individuals < 45 years.

PURPOSE

Previous studies have suggested that an inflammatory environment can affect bone mineral density (BMD). However, most of the studies have been done in postmenopausal women. Thus, longitudinal studies in different age groups and sex are necessary to evaluate the longitudinal association between dietary inflammatory index (DII) and BMD in Mexican adults.

METHODS

A total of 1,486 participants of the Health Workers Cohort Study were included in this study. The DII was estimated with data retrieved through a semi-quantitative food frequency questionnaire. Total hip, femoral neck, and lumbar spine BMD were measured by dual-energy X-ray absorptiometry. Linear regression models for cross-sectional associations and fixed effects linear regression models for longitudinal association were estimated, and both models were stratified by sex and age groups (< 45 and ≥ 45 years).

RESULTS

We did not observe cross-sectional associations between DII and the different BMD sites at baseline. In contrast, women and men ≥ 45 years in the 25th quartile of changes in DII were associated with a gain of 0.067 g/cm² and 0.062 g/cm² of total hip BMD, while those in the 75th quartile of DII was associated with a reduction of - 0.108 g/cm² and - 0.100 g/cm², respectively. These results were similar for femoral neck BMD in women. In contrast, we did not observe association with femoral neck BMD in men. We did not observe statistically significant changes for lumbar spine BMD.

CONCLUSION

Our data suggest that changes in the DII score are associated with changes in total hip and femoral neck BMD among Mexican population.

Higher modified dietary inflammatory index is associated with increased risk of osteoporosis in US adults: Data from NHANES

Objective

The aim of this study was to study the relationship between modified dietary inflammatory index (MDII) score with osteoporosis (OP) in adult Americans.

Methods

Data were extracted from the United States National Health and Nutrition Examination Survey (NHANES) (2007–2008, 2009–2010, 2013–2014, and 2017–2018). In this cross-sectional study, 5,446 participants were included and analyzed. Potential dietary inflammatory was assessed by MDII score (24-h recall), a composite method computed according to the relationship between nutrients and systemic pro-inflammatory cytokine level, and was further classified into tertiles. Weighted multivariable logistic regression analysis was employed to examine the associations between OP and MDII scores.

Results

In weighted multivariable-adjusted logistic regression models, the highest tertile of MDII score was associated with an increased risk of OP [odds ratio (OR): 1.73, 95% confidence interval (95 CI%): 1.14–2.63]. In participants aged above 59 years, a higher MDII score showed a higher risk of OP (OR: 1.92; 95 CI%: 1.16–3.15). In the sex-stratified models, the results remained significant only among women (OR: 1.80; 95% CI: 1.02–3.17). In the menopausal status stratified model, after adjusting potential confounding variables, the association between the MDII score, either as a categorical (OR: 1.88; 95% CI: 1.07–3.13) or continuous variables (OR: 1.19; 95%CI: 1.02–1.38), and OP risk was significant among postmenopausal women.

Conclusion

Our study indicates that a higher MDII score (pro-inflammatory effect) is significantly associated with an increased risk of OP in US adults, especially among those postmenopausal women more than 60 years. This study further supports that those dietary changes have the potential to prevent OP.

The Associations of Dietary Inflammatory Potential With Musculoskeletal Health in Chinese Community-Dwelling Older People: The Mr. OS and Ms. OS (Hong Kong) Cohort Study

Inflammation, an important contributory factor of muscle and bone aging, is potentially modulated by diet. This study examined the associations of dietary inflammatory index (DII) score with musculoskeletal parameters and related disease outcomes in 3995 community-dwelling Chinese men and women aged ≥65 years in Hong Kong. DII score at baseline was estimated from a food frequency questionnaire. Bone mineral density (BMD) and muscle mass estimated by dual-energy X-ray absorptiometry (DXA), hand grip strength, gait speed, and chair stand test were measured at baseline, year 4, and year 14. The associations of DII score with the longitudinal changes of musculoskeletal parameters, and incidence of osteoporosis, sarcopenia, and fractures were examined by using general linear model, multinomial logistic regression model, and Cox proportional hazards regression model, respectively. After multiple adjustments, each tertile increase in DII score in men was associated with 0.37 (95% confidence interval [CI], 0.10-0.64) kg loss in grip strength and 0.02 (95% CI, 0.01-0.03) m/s loss in gait speed over 4 years. In men, the highest tertile of DII was associated with a higher risk of incident fractures, with adjusted and competing death adjusted hazard ratio (HR) (95% CI) of 1.56 (1.14-2.14) and 1.40 (1.02-1.91), respectively. In women, DII score was not significantly associated with any muscle-related outcomes or incidence of fracture, but a significant association between higher DII score and risk of osteoporosis at year 14 was observed, with the highest tertile of DII score having adjusted odds ratio (OR) (95% CI) of 1.90 (1.03-3.52). In conclusion, pro-inflammatory diet consumption promoted loss of muscle strength and physical function, and increased risk of fractures in older Chinese men. Pro-inflammatory diets had no significant association with muscle related outcomes but increased the long-term risk of osteoporosis in older Chinese women. © 2022 American Society for Bone and Mineral Research (ASBMR).

Association between Dietary Inflammatory Index and Sarcopenia in Crohn's Disease Patients

Background: Chronic inflammation is a pathophysiological cause of sarcopenia in Crohn’s disease (CD) patients. However, the potential impact of diet-related inflammation on sarcopenia has not yet been adequately investigated. We examined the associations between Dietary Inflammatory Index (DII) and sarcopenia in CD patients. Methods: A total of 140 CD patients from Ruijin Hospital in Shanghai were included in this cross-sectional study. DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Sarcopenia was determined according to the Asian Working Group for Sarcopenia. Multivariable logistic regression analyses were performed to determine the association between DII and sarcopenia. Results: The mean DII score was 0.81 ± 2.13, ranging from −3.24 to 4.89. The overall prevalence of sarcopenia was 26.4%. The higher DII score significantly increased the risk of sarcopenia in CD patients (OR_Quartile4vs1: 9.59, 95% CI: 1.69, 54.42, p_trend = 0.031) in the multivariable model after adjusting for more potential confounders. Moreover, CD patients with a lower DII had a significantly higher appendicular skeletal muscle mass index (ASMI, OR_Quartile4vs1: 5.48, 95% CI: 1.51, 19.87, p_trend = 0.018) after adjusting for age, gender, BMI, smoking status and drinking status model. Yet, there were no significant differences between DII and ASMI after adjusting for more potential confounders. Additionally, no significant association was observed between DII and handgrip strength in the multivariable-adjusted models. Conclusions: Pro-inflammatory diet was associated with increased risk of sarcopenia in CD patients. CD patients should have a proper intake of energy and protein. These patients could also benefit from supplementation with enteral nutrition due to its anti-inflammatory potential.

Inflammatory potential of diet and bone mineral density in a senior Mediterranean population: a cross-sectional analysis of PREDIMED-Plus study

PURPOSE

Inflammation could play a key role in tissue damage and bone metabolism. The modified dietary inflammatory score (M-DIS) is a validated tool to estimate the inflammatory potential of the diet. In the present study, we evaluate the associations between the M-DIS and bone mineral density (BMD) in a senior Mediterranean population with overweight/obesity and metabolic syndrome.

METHODS

Baseline cross-sectional association between the M-DIS and bone mineral density was assessed in 1134 participants of the multicenter PREDIMED-Plus trial (aged 55-75 with overweight/obesity and metabolic syndrome). BMD was measured using Dual-energy X-ray Absorptiometry scans and participants answered a food frequency questionnaire to determine the M-DIS. BMD was categorized as low BMD when T score was equal or lower than -1 and normal BMD in another case. Associations between BMD and M-DIS were evaluated by using linear and logistic regressions adjusted by other co-variates.

RESULTS

Participants in the top tertile of the M-DIS had a lower BMD at total femur [β (95% CI) - 0.02 (- 0.04, - 0.01)], trochanter areas [β (95% CI) - 0.03 (- 0.05, - 0.01)] and lumbar spine area [β (95% CI) - 0.03 (- 0.07, 0.01)] (but in the last case, measures were less precise and hence not statistically significant) compared to those in the lower M-DIS tertile. Multiple logistic regression analyses showed that the odds of the total femur and femoral trochanter osteopenia/osteoporosis were higher in participants in the top tertile compared to those in the lowest tertile of M-DIS [OR (95% CI) 1.71 (1.12, 2.64), P for trend 0.015; 2.02 (1.29, 3.21), P for trend 0.002, respectively].

CONCLUSION

A high pro-inflammatory diet, measured by the M-DIS, is associated with lower BMD in a senior Mediterranean population with metabolic syndrome.

Associations between Dietary Inflammatory Index (DII) and bone health among postmenopausal women in the United States

OBJECTIVE

The purpose of this study was to determine the relationship between the Dietary Inflammatory Index (DII^® ) score and the bone health of menopausal women.

METHODS

A total of 2461 participants were included in the analysis from the NHANES database 2009-2018 and 2005-2006. The association between the DII and Bone mineral density (BMD) and bone mineral content (BMC) was evaluated through a multiple linear regression model.

RESULTS

The mean DII in this study was +0.89 (SD 0.18) and the scores ranged from -5.46 (most anti-inflammatory) to +4.58 (most pro-inflammatory). After adjusting for confounding factors, higher DII is associated with an increased risk of decreased total bone density (Model III, β -0.012; 95% CI -0.023, -0.001). There is a similar correlation found in bone density content and other indicators of bone mineral density. At the same time, we used BMI as a stratified variable for subgroup analysis, we found that higher DII (continuous) was associated with a significantly higher risk of decreased total bone density in overweight/obese postmenopausal women (β -0.018; 95% CI -0.025, -0.006).

CONCLUSION

A higher DII score is significantly associated with lower bone density and bone density in postmenopausal women, especially women who are overweight/obese.

Role of diet in osteoporosis incidence: Umbrella review of meta-analyses of prospective observational studies

An umbrella review and meta-analysis were conducted to summarize evidence for the association between dietary factors and the incidence of osteoporosis in adults. Only systematic reviews or meta-analyses were eligible for this study. Two researchers independently performed reading, data extraction, and quality evaluation of the included literature. The outcomes included in this study were all associated with osteoporosis, including osteoporotic fractures and low bone density. A total of 54 studies were included in this study, with 83 adjusted hazard ratios on diet, dairy group (n = 13), alcohol (n = 2), tea (n = 6), coffee (n = 3), micronutrient (n = 31), dietary pattern (n = 21), and foods (n = 7) regarding the incidence of osteoporosis. Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) quality assessment method was used in this study. The high, medium, low and very low quality studies accounted for 27.7, 41, 21.7 and 9.6% of this study, respectively. Based on the included literature studies in this umbrella review, it was found that dietary factors have a relevant impact on the incidences of human osteoporosis, appropriate consumption of dairy products, vegetables, fruits, and micronutrients, as well as reduced intake of alcohol and coffee, can reduce the risk of osteoporosis.

Dietary inflammatory index and the risk of non-communicable chronic disease and mortality: an umbrella review of meta-analyses of observational studies

We aimed to perform an umbrella review of systematic reviews and meta-analyses (SRMAs) of observational studies of the association of the dietary inflammatory index (DII) with the risk of non-communicable chronic disease and mortality in the general population. We searched PubMed, Scopus, and ISI Web of Science to November 2020. For each outcome, the summary effect sizes with the corresponding 95%CIs were recalculated using a random-effects model. The certainty of the evidence and the quality of conduct of published SRMAs were rated using the GRADE and ASMTAR 2 tools, respectively. A total of 11 SRMAs of observational studies, reporting pooled effect sizes for 29 outcomes obtain from 60 prospective cohort and 67 case-control studies, were included. Our results demonstrated evidence of moderate certainty for a positive relation between DII and the risk cardiovascular disease, all-cause mortality, and colorectal cancer. Higher DII was also associated with site-specific cancer risk, but for cancers at most sites, existing evidence is derived from case-control studies with the certainty of evidence being rated low or very low. Our findings suggested that adherence to a diet with high inflammatory features might be associated with a higher risk of colorectal cancer, cardiovascular disease, and all-cause mortality.

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.