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Lerner UH. Vitamin A - discovery, metabolism, receptor signaling and effects on bone mass and fracture susceptibility. Front Endocrinol (Lausanne) 2024; 15:1298851. [PMID: 38711977 PMCID: PMC11070503 DOI: 10.3389/fendo.2024.1298851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
The first evidence of the existence of vitamin A was the observation 1881 that a substance present in small amounts in milk was necessary for normal development and life. It was not until more than 100 years later that it was understood that vitamin A acts as a hormone through nuclear receptors. Unlike classical hormones, vitamin A cannot be synthesized by the body but needs to be supplied by the food as retinyl esters in animal products and ß-carotene in vegetables and fruits. Globally, vitamin A deficiency is a huge health problem, but in the industrialized world excess of vitamin A has been suggested to be a risk factor for secondary osteoporosis and enhanced susceptibility to fractures. Preclinical studies unequivocally have shown that increased amounts of vitamin A cause decreased cortical bone mass and weaker bones due to enhanced periosteal bone resorption. Initial clinical studies demonstrated a negative association between intake of vitamin A, as well as serum levels of vitamin A, and bone mass and fracture susceptibility. In some studies, these observations have been confirmed, but in other studies no such associations have been observed. One meta-analysis found that both low and high serum levels of vitamin A were associated with increased relative risk of hip fractures. Another meta-analysis also found that low levels of serum vitamin A increased the risk for hip fracture but could not find any association with high serum levels of vitamin A and hip fracture. It is apparent that more clinical studies, including large numbers of incident fractures, are needed to determine which levels of vitamin A that are harmful or beneficial for bone mass and fracture. It is the aim of the present review to describe how vitamin A was discovered and how vitamin A is absorbed, metabolized and is acting as a ligand for nuclear receptors. The effects by vitamin A in preclinical studies are summarized and the clinical investigations studying the effect by vitamin A on bone mass and fracture susceptibility are discussed in detail.
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Affiliation(s)
- Ulf H. Lerner
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre and Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zeraattalab‐Motlagh S, Ghoreishy SM, Arab A, Mahmoodi S, Hemmati A, Mohammadi H. Fruit and Vegetable Consumption and the Risk of Bone Fracture: A Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)-Assessed Systematic Review and Dose-Response Meta-Analysis. JBMR Plus 2023; 7:e10840. [PMID: 38130771 PMCID: PMC10731112 DOI: 10.1002/jbm4.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023] Open
Abstract
Researchers have examined the link between consuming fruit and vegetables and the incidence of fractures for many years. Nevertheless, their findings have been unclear. Furthermore, the dose-dependent relationship has not been examined, and the level of certainty in the evidence was not evaluated. We carried out a dose-dependent meta-analysis examining the relation between fruit and vegetables intake and fracture incidence. PubMed, Web of Sciences, and Scopus were searched until April 2023 for cohort studies evaluating the relation between fruit and vegetables and fracture incidence. Summary relative risks (RRs) were computed from complied data by applying random effects analysis. To examine the level of evidence, we utilized the approach called the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Ten cohort studies comprising 511,716 individuals were entered. There was a nonsignificant relation between fruit and vegetables, as well as only fruit intake and any fracture risk. In contrast, high versus low analysis presented that vegetables consumption was linked to a 16% decrease in any type of fracture incidence (RR 0.84; 95% confidence interval [CI], 0.75 to 0.95; I 2 = 83.1%; n = 6). Also, per one serving/day (200 g/day) increments in vegetables consumption, there was a 14% decline in the fracture risk (RR 0.86; 95% CI, 0.77 to 0.97; I 2 = 84.7%; n = 5; GRADE = moderate). With moderate certainty, a greater consumption of only vegetables, but not total fruit and vegetables or only fruit, might reduce the risk of fracture. These associations were also evident in dose-response analysis. Large intervention trials are demanded to approve our findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sheida Zeraattalab‐Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public HealthIran University of Medical SciencesTehranIran
- Student Research Committee, School of Public HealthIran University of Medical SciencesTehranIran
| | - Arman Arab
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Medical Chronobiology Program, Division of Sleep and Circadian DisordersDepartments of Medicine and Neurology, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Sara Mahmoodi
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Amirhossein Hemmati
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
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Solgi S, Zayeri F, Abbasi B. The reverse association of dietary antioxidant index with osteoporosis in postmenopausal iranian women: A case-control study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:64. [PMID: 38024517 PMCID: PMC10668208 DOI: 10.4103/jrms.jrms_143_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/18/2023] [Accepted: 05/18/2023] [Indexed: 12/01/2023]
Abstract
Background Osteoporosis, a prevalent bone malady, is prevalent in Iran. Several studies have represented the role of dietary antioxidants on osteoporosis. The dietary antioxidant index (DAI) is a valid and reliable index, which indicates a comprehensive view of dietary antioxidant capacity. This study aimed to survey the relationship of the DAI with the risk of osteoporosis in postmenopausal women in Iran. This research aimed to examine the association between the DAI and the risk of osteoporosis among postmenopausal women in Iran. Materials and Methods In this case-control study, 440 postmenopausal women (220 cases and 220 controls) were enrolled. The dietary intake of contributors was evaluated using a 147-item food frequency questionnaire. To estimate the DAI, the amount of six antioxidant micronutrients such as Vitamins A, C, and E, selenium, manganese, and zinc was standardized. Then, the DAI was estimated by collecting the standardized consumption of these antioxidant micronutrients. Results Our findings represented the participants in the first (crude odds ratio [OR] = 1.79, 95% confidence interval [CI]: 1.13-2.85, P = 0.013) and second (crude OR = 1.60, 95% CI: 1.01-2.55, P = 0.043) tertiles of the DAI scores had significantly higher odds of osteoporosis compared to those in the third one; while after modifying for confounding factors, this significant reverse relationship was observed just between women in the first and third tertiles of the DAI scores (adjusted OR = 1.90, 95% CI: 1.34-3.18, P = 0.015). Conclusion The consequence of this study suggested that adherence to a diet rich in antioxidant compounds may have protective effects against osteoporosis.
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Affiliation(s)
- Shakiba Solgi
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Proteomics Research Center, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnood Abbasi
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Grili PPDF, Vidigal CV, Cruz GFD, Albergaria BH, Marques-Rocha JL, Pereira TSS, Guandalini VR. Nutrient Patterns and Risk of Osteopenia in Postmenopausal Women. Nutrients 2023; 15:nu15071670. [PMID: 37049510 PMCID: PMC10096860 DOI: 10.3390/nu15071670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
Nutrient patterns (NPs) and the synergistic effect between nutrients have been shown to be associated with changes in bone mineral density (BMD). This study aimed to identify NPs and to associate them with BMD categories in postmenopausal women. This cross-sectional, observational, analytical study was carried out with women in menopause for at least 12 months, aged ≥50 years. Sociodemographic, lifestyle, and clinical variables were investigated. BMD was assessed using dual energy X-ray absorptiometry. A dietary assessment was conducted using a food frequency questionnaire, and three nutrient patterns (NP1, NP2, and NP3) were extracted from the principal component analysis. Multivariate logistic regression was applied to investigate the association between BMD classifications and NP consumption. A total of 124 women, aged on average, 66.8 ± 6.1 years, were evaluated. Of these, 41.9% had osteopenia and 36.3% had osteoporosis. The NP1 (OR: 6.64, [CI95%: 1.56-28.16]; p = 0.010), characterized by vitamin B12, pantothenic acid, phosphorus, riboflavin, protein (total and animal), vitamin B6, potassium, vitamin D, vitamin E, calcium, cholesterol, β-carotene, omega 3, magnesium, zinc, niacin, and selenium; and the NP2 (OR: 5.03, [CI95%: 1.25-20.32]; p = 0.023), characterized by iron, vegetable protein, thiamine, folate, fibers (soluble and insoluble), PUFA, vitamin A, vitamin K, alpha-tocopherol, copper, sodium, and retinol, was inversely associated with osteopenia. The lower consumption of NP1 and NP2 by postmenopausal women was associated with a higher risk of osteopenia, but not osteoporosis.
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Affiliation(s)
- Patricia Paula da Fonseca Grili
- Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
| | - Camila Vilarinho Vidigal
- Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
| | - Geise Ferreira da Cruz
- Department of Integrated Education, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
| | - Ben-Hur Albergaria
- Department of Social Medicine, Federal University of Espirito Santo, Vitória 29047-105, Brazil
| | - José Luiz Marques-Rocha
- Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
- Department of Integrated Education, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
| | | | - Valdete Regina Guandalini
- Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
- Department of Integrated Education, Health Sciences Center, Federal University of Espirito Santo, Vitória 29047-105, Brazil
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Risk of Environmental Chemicals on Bone Fractures Is Independent of Low Bone Mass in US Adults: Insights from 2017 to 2018 NHANES. Metabolites 2023; 13:metabo13030346. [PMID: 36984786 PMCID: PMC10053128 DOI: 10.3390/metabo13030346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
(1) Objective: To assess the association of environmental chemical factors with osteopenia and/or bone fractures. (2) Methods: All data were extracted from the National Health and Nutrition Survey (NHANES) 2017–2018 of American adults aged 20–59 years old; invalid data were excluded based on dual-energy X-ray absorptiometry. For the ultimate valid data set, multivariate logistic regression models were applied to evaluate the association of environmental chemical factors with osteopenia and bone fractures. (3) Results: The valid dataset was obtained from 2640 individuals, who completed a questionnaire of demographic characteristics. Urinary manganese and monomethylarsonic acid were positively associated with osteopenia in American adults, but not bone fracture. However, several environmental factors (e.g., arsenous acid, arsenocholine, dimethylarsinic acid, and 2-thioxothiazolidine-4-carboxylic acid) did not affect bone mineral density, but were significantly associated with bone fracture. (4) Conclusions: Multiple environmental chemical factors significantly affect bone mass or fracture risk. However, the risk of environmental chemical factors on fractures is independent of osteopenia in US Adults. The influence of environmental chemical factors on bone quality should be considered and monitored.
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Wei M, Huang Q, Dai Y, Zhou H, Cui Y, Song W, Di D, Zhang R, Li C, Wang Q, Jing T. Manganese, iron, copper, and selenium co-exposure and osteoporosis risk in Chinese adults. J Trace Elem Med Biol 2022; 72:126989. [PMID: 35512597 DOI: 10.1016/j.jtemb.2022.126989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIMS Previous experimental studies demonstrated that either deficient or excessive trace elements, such as manganese (Mn), iron (Fe), copper (Cu) and selenium (Se), are detrimental to bone health. Epidemiologic evidence for the effect of the four trace elements on osteoporosis (OP) risk remains inadequate. This cross-sectional study aimed to examine their associations with the OP risk among Chinese adults. METHODS Concentrations of Mn, Fe, Cu, and Se were measured in plasma using an inductively coupled plasma mass spectrometer among 627 Chinese adults aged ≥ 50 years. Individual effect of the four elements on OP risk was analyzed by logistic regression and Bayesian Kernel Machine Regression (BKMR) models. The latter model was also adopted to examine the exposure-response relationships and joint effects of the four elements on OP risk. RESULTS The median Mn, Fe, Cu, and Se levels were 4.78, 1026.63, 904.55, and 105.39 μg/L, respectively, in all participants. Inverse associations of Fe and Se levels with OP risk were observed in the logistic regression model. BKMR analysis revealed a U-shape pattern for the Fe-OP association, and a reduced OP risk in response to co-exposure of the four elements above the 50th percentiles but an elevated one in response to that below the 50th percentiles. Sex discrepancy existed in the findings. No interactions were found for the four elements affecting OP risk. CONCLUSIONS Co-exposure to Mn, Fe, Cu, and Se was associated with improved bone density, where Fe contributed most to the beneficial effect. Further studies are needed to verify these findings and explore the underlying biological mechanism.
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Affiliation(s)
- Muhong Wei
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qin Huang
- Department of Rehabilitation Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu Dai
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haolong Zhou
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuan Cui
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenjing Song
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dongsheng Di
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ruyi Zhang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Can Li
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qi Wang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Tao Jing
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Taheri E, Mahdavi-Gorabi A, Moludi J, Asayesh H, Qorbani M. A meta-analysis of dietary inflammatory index and bone health status. J Diabetes Metab Disord 2022; 21:109-121. [PMID: 35673467 PMCID: PMC9167420 DOI: 10.1007/s40200-021-00945-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/24/2021] [Indexed: 01/13/2023]
Abstract
Background The inflammatory potential of diets is associated with several diseases and can affect bone health. We aimed to systematically review and pool the current evidence on the association of DII with bone health in observational studies. Methods We searched PubMed and NLM Gateway (for Medline), Web of Science, Scopus and EMBASE up to December 16, 2020 for studies that examined the relationship between DII score and bone mineral density (BMD) or fracture. All observational studies were included in this meta-analysis. Heterogeneity between studies was evaluated using Cochran Q-statistic and I2 statistics. Random effect meta-analysis method was used to pool the effect size. Stratified meta-analysis according to the type of study (cohort/ non-cohort) was performed to assess the relationship of DII with BMD and fracture. Results In total, 13 articles were included in the present systematic review, including five cohorts, five cross-sectional, and three case-control studies. The total sample size of these studies was 211,938 individuals aged 5 to 85 years. According to random-effect meta-analysis, DII was associated with increased odds of fracture in non-cohort studies (pooled OR=1.42, 95%CI: 1.17, 1.67), but this association was not statistically significant in cohort studies (pooled OR=1.03, 95%CI: 0.97, 1.09). Moreover, only in non-cohort studies, the mean of BMD in subjects in the highest DII category was significantly lower than those in the lowest DII category (SMD: -9.59, 95%CI: -10.84,-8.33). Conclusions Our findings showed that high score of DII can have devastating effects on bone health. Further longitudinal studies are necessary to confirm these findings among more diverse populations.
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Affiliation(s)
- Ehsaneh Taheri
- grid.411600.2Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armita Mahdavi-Gorabi
- grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalal Moludi
- grid.412112.50000 0001 2012 5829School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamid Asayesh
- grid.444830.f0000 0004 0384 871XDepartment of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Qorbani
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Li R, Zhan W, Huang X, Wang J, Lv S, Liang L, Zhang F, Ma Y. Associations between Dietary Inflammatory Index (DII) and bone health among postmenopausal women in the United States. Int J Gynaecol Obstet 2021; 158:663-670. [PMID: 34767250 DOI: 10.1002/ijgo.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Ruiqiang Li
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Wenqiang Zhan
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xin Huang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Jiaqi Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - ShuaiShuai Lv
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Luyao Liang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Fan Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
| | - Yuxia Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Province Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China
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Cao JJ, Roemmich JN, Sheng X, Jahns L. Increasing Vegetable Intake Decreases Urinary Acidity and Bone Resorption Marker in Overweight and Obese Adults: An 8-Week Randomized Controlled Trial. J Nutr 2021; 151:3413-3420. [PMID: 34386816 DOI: 10.1093/jn/nxab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Controlled intervention trials are needed to confirm a positive association from epidemiological studies between vegetable consumption and bone health. OBJECTIVE We investigated whether providing vegetables at the Dietary Guidelines for Americans (DGA) recommended amount affects excretion of acid and calcium in urine and bone turnover markers in serum in adults with low vegetable intake. METHODS In total, 102 adults (19 males and 83 females, age 18-65 y, BMI ≥25 kg/m2) consuming ≤1 serving of vegetables (128 g raw leafy or 64 g cooked vegetables) per d were recruited in a 2-arm, parallel, randomized, controlled, and community-based 8-wk feeding intervention trial. The 2 arms included a vegetable intervention (VI) during which participants received extra vegetables (∼270 g/d) and an attention control (CON) group that conducted only the testing visits. Measurements included nutrient intake, plasma carotenoids, and bone-related markers in serum and urine. Differences between CON and VI at week 8 were tested using the ANCOVA with baseline values as a covariate. RESULTS Compared with CON, carotenoid intake (mean ± SD) was higher (6.4 ± 3.4 compared with 2.0 ± 1.2 mg/d) (P < 0.01) and dietary potential renal acid load was lower (20 ± 13 compared with 3.4 ± 14 mEq/d) (P < 0.01) in VI. Compared with CON at week 8, urine titratable acid and Mg were 24 and 26% lower, respectively, while urine pH was 3% greater (P < 0.05) and serum C-terminal telopeptide of type I collagen (CTX) was 19% lower in VI. There were no group differences in serum concentrations of propeptide of type 1 procollagen and tartrate-resistant acid phosphatase or urinary excretion of deoxypyridinoline and CTX. CONCLUSIONS Consumption of vegetables at the DGA-recommended amount by adults with low vegetable intake potentially benefits bone health. This trial was registered at clinicaltrials.gov as NCT02585102.
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Affiliation(s)
- Jay J Cao
- USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND, USA
| | - James N Roemmich
- USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND, USA
| | - Xiaoming Sheng
- Applied Statistics, University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Lisa Jahns
- USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND, USA
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Wei MH, Cui Y, Zhou HL, Song WJ, Di DS, Zhang RY, Huang Q, Liu JA, Wang Q. Associations of multiple metals with bone mineral density: A population-based study in US adults. CHEMOSPHERE 2021; 282:131150. [PMID: 34470175 DOI: 10.1016/j.chemosphere.2021.131150] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Epidemiologic studies focus on combined effects of multiple metals on bone mineral density (BMD) are scarce. Therefore, this study was conducted to examine associations of multiple metals exposure with BMD. Data of adults aged ≥20 years (n = 2545) from the US National Health and Nutrition Examination Survey (NHANES, 2011-2016) were collected and analyzed. Concentrations of metals were measured in blood (cadmium [Cd], lead [Pb], mercury [Hg], and manganese [Mn]) and serum (copper [Cu], selenium [Se], and zinc [Zn]) using inductively coupled plasma mass spectrometry and inductively coupled plasma dynamic reaction cell mass spectrometry, respectively. The weighted quantile sum (WQS) and Bayesian kernel machine regression (BKMR) models were performed to determine the joint effects of multiple metals exposure on lumbar and total BMD. The linear regression analyses showed Pb was negatively associated with BMDs. The WQS regression analyses revealed that the WQS index was inversely related to lumbar (β = -0.022, 95% CI: -0.036, -0.008) and total BMD (β = -0.015, 95% CI: -0.024, -0.006), and Se, Mn, and Pb were the main contributors for the combined effects. Additionally, nonlinear dose-response relationships between Pb, Mn, and Se and BMD, as well as a synergistic interaction of Pb and Mn, were found in the BKMR analyses. Our findings suggested co-exposure to Cd, Pb, Hg, Mn, Cu, Se, and Zn (above their 50th percentiles) was associated with reduced BMD, and Pb, Mn, and Se were the main contributors driving the overall effects.
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Affiliation(s)
- Mu-Hong Wei
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuan Cui
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hao-Long Zhou
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wen-Jing Song
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dong-Sheng Di
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ru-Yi Zhang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qin Huang
- Department of Rehabilitation Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun-An Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Qi Wang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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11
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Yee MMF, Chin KY, Ima-Nirwana S, Wong SK. Vitamin A and Bone Health: A Review on Current Evidence. Molecules 2021; 26:molecules26061757. [PMID: 33801011 PMCID: PMC8003866 DOI: 10.3390/molecules26061757] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Vitamin A is a fat-soluble micronutrient essential for growth, immunity, and good vision. The preformed retinol is commonly found in food of animal origin whereas provitamin A is derived from food of plant origin. This review summarises the current evidence from animal, human and cell-culture studies on the effects of vitamin A towards bone health. Animal studies showed that the negative effects of retinol on the skeleton were observed at higher concentrations, especially on the cortical bone. In humans, the direct relationship between vitamin A and poor bone health was more pronounced in individuals with obesity or vitamin D deficiency. Mechanistically, vitamin A differentially influenced the stages of osteogenesis by enhancing early osteoblastic differentiation and inhibiting bone mineralisation via retinoic acid receptor (RAR) signalling and modulation of osteocyte/osteoblast-related bone peptides. However, adequate vitamin A intake through food or supplements was shown to maintain healthy bones. Meanwhile, provitamin A (carotene and β-cryptoxanthin) may also protect bone. In vitro evidence showed that carotene and β-cryptoxanthin may serve as precursors for retinoids, specifically all-trans-retinoic acid, which serve as ligand for RARs to promote osteogenesis and suppressed nuclear factor-kappa B activation to inhibit the differentiation and maturation of osteoclasts. In conclusion, we suggest that both vitamin A and provitamin A may be potential bone-protecting agents, and more studies are warranted to support this hypothesis.
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12
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Shahriarpour Z, Nasrabadi B, Hejri-Zarifi S, Shariati-Bafghi SE, Yousefian-Sanny M, Karamati M, Rashidkhani B. Oxidative balance score and risk of osteoporosis among postmenopausal Iranian women. Arch Osteoporos 2021; 16:43. [PMID: 33634327 DOI: 10.1007/s11657-021-00886-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/07/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED To our knowledge, this is the first study to examine the association of oxidative balance score (OBS) and risk of osteoporosis. Findings suggest that a predominance of anti- over pro-oxidant exposures, as reflected by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women. PURPOSE The oxidative balance score (OBS) is a combined measure of pro- and anti-oxidant exposure status, with a higher OBS indicating a predominance of anti- over pro-oxidant exposures. We aimed to examine the potential association of OBS and risk of osteoporosis among postmenopausal Iranian women, hypothesizing that a higher OBS is associated with lower risk of postmenopausal osteoporosis. METHODS This cross-sectional study was conducted among 151 postmenopausal Iranian women aged 50-85 y. Bone mineral density (BMD) at lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry, and osteoporosis was defined using the WHO criteria as a BMD T-score of ≤ - 2.5 standard deviations. The OBS was calculated by combining information from 17 a-priori selected pro- and anti-oxidant components classified in the following four categories: non-dietary pro-oxidants (i.e., obesity and smoking); non-dietary anti-oxidants (i.e., physical activity); dietary pro-oxidants (i.e., saturated fatty acid, poly-unsaturated fatty acid, and iron); and dietary anti-oxidants (i.e., fiber, vitamin E, folate, vitamin C, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, zinc, and selenium). RESULTS After controlling for several potential covariates in the multivariable-adjusted binary logistic regression analysis, subjects in the highest tertile of OBS had a lower risk of lumbar spine osteoporosis than those in the lowest tertile (odds ratio = 0.14; 95% confidence interval, 0.04-0.45; p = 0.001). The OBS was not associated with risk of femoral neck osteoporosis. CONCLUSION Findings suggest that a predominance of anti- over pro-oxidant exposures, as indicated by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women.
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Affiliation(s)
- Zahra Shahriarpour
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Bita Nasrabadi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Islamic Azad University, Karaj Branch, Karaj, Iran
| | - Sudiyeh Hejri-Zarifi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahboobe Yousefian-Sanny
- Department of Physical Education and Sport Sciences, Faculty of Literature, Humanities, and Social Sciences, Science and Research Branch of Islamic Azad University, Tehran, Iran
| | - Mohsen Karamati
- Department of Community Nutrition, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Bahram Rashidkhani
- Department of Community Nutrition, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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13
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Zhou T, Wang M, Ma H, Li X, Heianza Y, Qi L. Dietary Fiber, Genetic Variations of Gut Microbiota-derived Short-chain Fatty Acids, and Bone Health in UK Biobank. J Clin Endocrinol Metab 2021; 106:201-210. [PMID: 33051670 PMCID: PMC8186524 DOI: 10.1210/clinem/dgaa740] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Dietary fiber intake may relate to bone health. OBJECTIVE To investigate whether dietary fiber intake is associated with bone mineral density (BMD), and the modification effect of genetic variations related to gut microbiota-derived short-chain fatty acids (SCFAs). DESIGN The associations of dietary fiber intake with estimated BMD derived from heel ultrasound and fractures were assessed in 224 630 and 384 134 participants from the UK Biobank. SETTING UK Biobank. MAIN OUTCOME MEASURES Estimated BMD derived from heel ultrasound. RESULTS Higher dietary fiber intake (per standard deviation) was significantly associated with higher heel-BMD (β [standard error] = 0.0047 [0.0003], P = 1.10 × 10-54). Similarly significant associations were observed for all the fiber subtypes including cereal, fruit (dried and raw), and vegetable (cooked and raw) (all P < .05). A positive association was found in both women and men but more marked among men except for dietary fiber in cooked vegetables (all Pinteraction < .05). A protective association was found between dietary fiber intake and hip fracture (hazard ratio, 95% confidence interval: 0.94, 0.89-0.99; P = 3.0 × 10-2). In addition, the association between dietary fiber and heel BMD was modified by genetically determined SCFA propionate production (Pinteraction = 5.1 × 10-3). The protective association between dietary fiber and heel BMD was more pronounced among participants with lower genetically determined propionate production. CONCLUSIONS Our results indicate that greater intakes of total dietary fiber and subtypes from various food sources are associated with higher heel-BMD. Participants with lower genetically determined propionate production may benefit more from taking more dietary fiber.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical
Medicine, Tulane University, New Orleans, Louisiana
| | - Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical
Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology and Biostatistics, School of Public Health,
Peking University Health Science Center, Beijing, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical
Medicine, Tulane University, New Orleans, Louisiana
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical
Medicine, Tulane University, New Orleans, Louisiana
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical
Medicine, Tulane University, New Orleans, Louisiana
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical
Medicine, Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard TH Chan School of Public
Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham
and Women’s Hospital and Harvard Medical School, Boston,
Massachusetts
- Correspondence and Reprint Requests: Dr Lu Qi, Department of Epidemiology, School of Public Health and
Tropical Medicine, Tulane University, New Orleans, LA 70112, USA. E-mail:
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14
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Nutrient and Dietary Patterns in Relation to the Pathogenesis of Postmenopausal Osteoporosis-A Literature Review. Life (Basel) 2020; 10:life10100220. [PMID: 32992740 PMCID: PMC7600848 DOI: 10.3390/life10100220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 01/16/2023] Open
Abstract
Postmenopausal women tend to be susceptible to primary osteoporosis due to its association with oestrogen deficiency. There is emerging evidence that an unhealthy dietary pattern drives an increase in the risk of postmenopausal osteoporosis (PO), whereas a healthy dietary pattern may decrease its occurrence. In this narrative literature review, we sought to review the role of nutrient and dietary patterns in the pathogenesis of PO. Therefore, we searched and reported all research articles from 2001 to May 2020 in Web of Science, Cinahl and Scopus that have researched a relationship between nutrient and/or dietary patterns and postmenopausal osteoporosis. Nutrients such as calcium, phosphorus, magnesium and vitamin D have been proven to be beneficial for bone health. Meanwhile, for the dietary patterns, foods such as dairy products especially milk, fibre and protein-rich foods, e.g., meat were directly linked to a positive association with bone mineral density (BMD). Likewise, fruits, vegetables and probiotic and prebiotic foods were reported for its positive relationship with BMD. Therefore, aside from physical activity, nutrition and diet in adequate proportions are suggested to be an important tool for ameliorating osteoporosis and bone health issues in older age.
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15
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Role of Vitamin C in Osteoporosis Development and Treatment-A Literature Review. Nutrients 2020; 12:nu12082394. [PMID: 32785080 PMCID: PMC7469000 DOI: 10.3390/nu12082394] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis and associated low energy fractures are a significant clinical problem, especially in the elderly population. The occurrence of a hip fracture is associated with significant mortality and a high risk of disability. For this, apart from the treatment of osteoporosis, effective prevention of both the development of the disease and related fractures is extremely important. One aspect of osteoporosis prevention is proper dietary calcium intake and normal vitamin D3 levels. However, there is some evidence for a potential role of vitamin C in osteoporosis and fracture prevention, too. This review aims to summarize the current knowledge about the role of vitamin C in osteoporosis development, prevention and treatment. The PubMed/Medline search on the role of vitamin C in bone metabolism database was performed for articles between 2000 and May 2020. Reports from in vitro and animal studies seem promising. Epidemiological studies also indicate the positive effect of high vitamin C content in the daily diet on bone mineral density. Despite promising observations, there are still few observational and intervention studies and their results do not allow for unequivocal determination of the benefits of high daily intake of vitamin C or its long-term supplementation.
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16
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Yarizadeh H, Setayesh L, Roberts C, Yekaninejad MS, Mirzaei K. Nutrient pattern of unsaturated fatty acids and vitamin E increase resting metabolic rate of overweight and obese women. INT J VITAM NUTR RES 2020; 92:214-222. [PMID: 32672509 DOI: 10.1024/0300-9831/a000664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Obesity plays an important role in the development of chronic diseases including cardiovascular disease and diabetes. A low resting metabolic rate (RMR) for a given body size and composition is a risk factor for obesity, however, there is limited evidence available regarding the association of nutrient patterns and RMR. The aim of this study was to determine the association of nutrient patterns and RMR in overweight and obese women. Study design: This cross-sectional study was conducted on 360 women who were overweight or obese. Method: Dietary intake was assessed using a semi-quantitative standard food frequency questionnaire (FFQ). Nutrient patterns were also extracted by principal components analysis (PCA). All participants were evaluated for their body composition, RMR, and blood parameters. Result: Three nutrient patterns explaining 64% of the variance in dietary nutrients consumption were identified as B-complex-mineral, antioxidant, and unsaturated fatty acid and vitamin E (USFA-vit E) respectively. Participants were categorized into two groups based on the nutrient patterns. High scores of USFA-vit E pattern was significantly associated with the increase of RMR (β = 0.13, 95% CI = 0.79 to 68.16, p = 0.04). No significant associations were found among B-complex-mineral pattern (β = -0.00, 95% CI = -49.67 to 46.03, p = 0.94) and antioxidant pattern (β = 0.03, 95% CI -41.42 to 22.59, p = 0.56) with RMR. Conclusion: Our results suggested that the "USFA-vit E" pattern (such as PUFA, oleic, linoleic, vit.E, α-tocopherol and EPA) was associated with increased RMR.
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Affiliation(s)
- Habib Yarizadeh
- Students' Scientific Center, Tehran University of Medical Sciences, PO Box 1417755331, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Leila Setayesh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Caroline Roberts
- Department of Nutritional Sciences School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, Franklin-Wilkins Building room 4.108
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Medical Sciences/University of Tehran, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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17
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Lanyan A, Marques-Vidal P, Gonzalez-Rodriguez E, Hans D, Lamy O. Postmenopausal women with osteoporosis consume high amounts of vegetables but insufficient dairy products and calcium to benefit from their virtues: the CoLaus/OsteoLaus cohort. Osteoporos Int 2020; 31:875-886. [PMID: 31848641 DOI: 10.1007/s00198-019-05225-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/05/2019] [Indexed: 02/05/2023]
Abstract
UNLABELLED We evaluated the associations between nutrients, dietary patterns or compliance to dietary guidelines and bone health among postmenopausal women from the CoLaus/OsteoLaus cohort. Postmenopausal women with osteoporosis consume a high amount of vegetables but insufficient amount of dairy products and calcium to benefit from their adherence to dietary guidelines. INTRODUCTION Diet plays a significant role in the prevention of osteoporosis (OP). We evaluated the associations between nutrients, dietary patterns or compliance (expressed in odds of meeting) to dietary Swiss guidelines and bone health (T score < - 2.5 SD, TBS < 1230) among postmenopausal women. METHODS One thousand two hundred fifteen women (64.3 ± 7.5 years) from the CoLaus/OsteoLaus cohort (Lausanne, Switzerland) had their dietary intake assessed using a validated food frequency questionnaire. Bone mineral density (BMD), trabecular bone score (TBS) and vertebral fractures were evaluated with DXA. OP risk factors, calcium supplements (> 500 mg) and prevalent major OP fractures were assessed by questionnaire. RESULTS One hundred eighty of 1195 women had OP according to BMD, 87/1185 a low TBS and 141/1215 prevalent major OP fractures. In multivariate analysis (adjusted for total energy intake, age, antiosteoporotic treatment, educational level, BMI, sedentary status and diabetes), OP women consumed more vegetable proteins (21.3 ± 0.4 vs 19.6 ± 0.2 g/day), more fibres (18.2 ± 0.5 vs 16.5 ± 0.2 g/day), less animal proteins (40.0 ± 1.1 vs 42.8 ± 0.4 g/day), less calcium (928 ± 30 vs 1010 ± 12 mg/day) and less dairy products (175 ± 12 vs 215 ± 5 g/day), all p ≤ 0.02. According to guidelines, OP women had a tendency to higher compliance for vegetables (OR (95% CI) 1.50 (0.99-2.26)) and a lower compliance for dairy (OR (95% CI) 0.44 (0.22-0.86)) than those without OP. Women taking calcium supplements consumed significantly higher amounts of dairy products. No association was found between TBS values or prevalent OP fractures and any dietary components. CONCLUSION Postmenopausal women with OP consume a high amount of vegetables but insufficient amount of dairy products and calcium. TBS does not seem to be influenced by diet.
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Affiliation(s)
- A Lanyan
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - P Marques-Vidal
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - E Gonzalez-Rodriguez
- Bone Unit, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - D Hans
- Bone Unit, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - O Lamy
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
- Bone Unit, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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18
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Shakya PR, Melaku YA, Page AJ, Gill TK. Nutrient patterns and depressive symptoms among Australian adults. Eur J Nutr 2020; 60:329-343. [PMID: 32328747 DOI: 10.1007/s00394-020-02243-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Much of the current literature on the associations between diet and depression focus on single nutrients rather than nutrient patterns (NPs). We investigated the association between NPs and depressive symptoms (DepS) in an Australian adult population. METHODS DepS were examined at two different time points, in 2010 (Stage 3, n = 1743, 49.0% males) and 2015 [North West 2015 (NW15), n = 1,024, 46.6% males] of the North West Adelaide Health Study (NWAHS). Dietary habits were evaluated using a food frequency questionnaire (FFQ) at Stage 3. DepS were assessed using the Center for Epidemiological Studies Depression (CES-D) scale at Stage 3 and NW15. Principal component analysis was used to identify NPs as well as the factor structure of the CES-D. Log- and negative binomial regression analyses were used to assess the association between NPs and DepS scores. Ordinal logistic regression analysis was undertaken between the NPs and identified factors of the CES-D score. RESULTS Three NPs (from the FFQ) and two-factors (from the CES-D score) were obtained. After adjusting for known confounding variables, a 'plant-sourced' NP (β-carotene, fibre, vitamin C, potassium and α-carotene) was inversely associated with DepS at Stage 3 [prevalence ratio (PR)Q4VsQ1, 0.78; 95% CI 0.66-0.92; p = 0.003], whereas an 'animal-sourced' (ω-3 fatty acid, monounsaturated fat, vitamin E and cholesterol) or 'mixed-source' (phosphorous, protein, vitamin B2, iodine and zinc) NP was not associated with DepS. There was an inverse relationship between the 'plant-sourced' NP and the '(absence of) positive-affect' factor from the CES-D in both stages. CONCLUSION The 'plant-sourced' NP is consistently and inversely associated with DepS; however, longitudinal studies are recommended to confirm these results.
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Affiliation(s)
- Prem R Shakya
- Vagal Afferent Research Group, University of Adelaide, Adelaide, 5005, SA, Australia.,Diabetes, Nutrition and Gut Health, Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, 5005, SA, Australia
| | - Yohannes A Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, 5042, SA, Australia
| | - Amanda J Page
- Vagal Afferent Research Group, University of Adelaide, Adelaide, 5005, SA, Australia.,Diabetes, Nutrition and Gut Health, Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, 5005, SA, Australia
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, SA, Australia.
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19
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Najafi A, Babajafari S, Dabbaghmanesh MH, Akhlaghi M, Shafiee F, Moein-Jahromi Z. Prudent and traditional dietary patterns are positively and negatively associated with bone mineral density in Iranian adults, respectively. INT J VITAM NUTR RES 2020; 91:224-234. [PMID: 32319359 DOI: 10.1024/0300-9831/a000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Aida Najafi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Siavash Babajafari
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Masoumeh Akhlaghi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Shafiee
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Moein-Jahromi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Li D, Ge X, Liu Z, Huang L, Zhou Y, Liu P, Qin L, Lin S, Liu C, Hou Q, Li L, Cheng H, Ou S, Wei F, Shen Y, Zou Y, Yang X. Association between long-term occupational manganese exposure and bone quality among retired workers. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:482-489. [PMID: 31797269 DOI: 10.1007/s11356-019-06694-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
Despite well documents for manganese-induced neurological deficits, limited researches are available for effects of manganese (Mn) exposure on the bone. Here we aimed to explore the associations between long-term occupational Mn exposure and bone quality among retired workers. We conducted a cross-sectional study of 304 exposed subjects (n, male = 161 and female = 143) and 277 control retired workers (n, male = 65 and female = 212) recruited from a ferromanganese refinery. Self-reported occupation types were used as exposure classification confirmed by expert consultation. Bone quality was measured by quantitative ultrasound (QUS). In sex-stratified analyses throughout, stiffness index (SI) and T-score levels of the participants in the highest exposed group [tertile 3 of Mn cumulative exposure index (Mn-CEI)] were significantly lower as compared with the control group among female workers (SI, mean, 61.60 vs. 68.17; T-score, mean, -3.01 vs. -2.34, both P < 0.05). In addition, SI and T-score were found to be negatively associated with Mn-CEI only in the highest exposure group as compared with the female controls (both P = 0.01). However, we did not find the significant difference for SI or T-score among the male subjects in exposure models and the male controls (P > 0.05). Our results suggest that female retired workers in the highest Mn-exposed model (tertile 3 of Mn-CEI) potentially experience a higher risk of developing osteoporosis compared with the female controls. Further investigations on possible mechanisms on bone quality alteration are needed in the future.
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Affiliation(s)
- Defu Li
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiaoting Ge
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zhenfang Liu
- Hematology Department, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Lulu Huang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yanting Zhou
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Peng Liu
- Department of Human Anatomy, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Lian Qin
- Department of Neurology, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, 545000, Guangxi, China
| | - Suzhen Lin
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, 545002, Guangxi, China
| | - Chaoqun Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Qingzhi Hou
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Longman Li
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Hong Cheng
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Songfeng Ou
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Fu Wei
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Yuefei Shen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yunfeng Zou
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, 530021, China
- Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, Guangxi Medical University, Nanning, 530021, China
| | - Xiaobo Yang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, Guangxi Medical University, Nanning, 530021, China.
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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21
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Ghorabi S, Shab-Bidar S, Sadeghi O, Nasiri M, Khatibi SR, Djafarian K. Lipid Profile and Risk of Bone Fracture: A Systematic Review and Meta-Analysis of Observational Studies. Endocr Res 2019; 44:168-184. [PMID: 31165667 DOI: 10.1080/07435800.2019.1625057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose: Earlier studies have linked lipid profile to osteoporotic fractures; however, to our knowledge, no study had summarized available data on this relationship. We aimed to summarize the current evidence on the association between lipid profile and bone fractures. Material and Methods: A systematic search of PubMed and Scopus was done to find relevant published studies until March 2018. To combine effect sizes, we applied fixed- or random-effects analysis, where appropriate. Cochran's Q test and I2 were used to assess between-study heterogeneity. Results: Overall, 11 studies (seven prospective, three cross-sectional and one case-control studies) were included in the current systematic review. Out of them, 10 studies with a total sample size of 60,484 individuals, aged 25 years or more, were used in the meta-analysis. The results showed that total cholesterol concentration was positively associated with risk of bone fracture; such that a 50-mg/dl increase in plasma level of TC was associated with 15% greater odds of bone fracture (combined effect size: 1.15, 95% CI: 1.02-1.30, P = .02). Furthermore, we found that individuals with a decreased level of HDL (<40 mg/dl) had a lower risk of bone fracture compared with those with a normal level (≥40 mg/dl) (combined effect size: 0.82, 95% CI: 0.71-0.96, P = .01). No significant association was found between plasma level of TG and LDL with the risk of bone fractures either in prospective or cross-sectional studies. Conclusions: We found that plasma levels of total cholesterol were positively associated with bone fractures. In addition, decreased levels of HDL were associated with an increased risk of osteoporotic fractures. Abbreviations: TG: triglycerides, TC: total cholesterol, HDL: high-density lipoprotein, LDL: low-density lipoprotein, OR: odds ratio, RR: relative risk, HR: hazard ratio, DXA: dual-energy X-ray absorptiometry, ICD: International Classification of Diseases, SD: standard deviation.
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Affiliation(s)
- Sima Ghorabi
- Students' Scientific Research Center, Tehran University of Medical Sciences , Tehran , Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
| | - Omid Sadeghi
- Students' Scientific Research Center, Tehran University of Medical Sciences , Tehran , Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
| | - Morteza Nasiri
- Student Research Committee, Shiraz University of Medical Sciences , Shiraz , Iran
- Department of Operating Room Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Seyed Reza Khatibi
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences , Torbat Heydariyeh , Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences , Torbat Heydariyeh , Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
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22
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The Relationship between Nutrient Patterns and Bone Mineral Density in Postmenopausal Women. Nutrients 2019; 11:nu11061262. [PMID: 31163708 PMCID: PMC6628050 DOI: 10.3390/nu11061262] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/20/2022] Open
Abstract
In women, the menopausal transition is characterized by acid-base imbalance, estrogen deficiency and rapid bone loss. Research into nutritional factors that influence bone health is therefore necessary. In this study, the relationship between nutrient patterns and nutrients important for bone health with bone mineral density (BMD) was explored. In this cross-sectional analysis, 101 participants aged between 54 and 81 years were eligible. Body composition and BMD analyses were performed using dual-energy X-ray absorptiometry (DXA). Nutrient data were extracted from a 3-day diet diary (3-DDD) using Foodworks 9 and metabolic equivalent (MET-minutes) was calculated from a self-reported New Zealand physical activity questionnaire (NZPAQ). Significant positive correlations were found between intakes of calcium (p = 0.003, r = 0.294), protein (p = 0.013, r = 0.246), riboflavin (p = 0.020, r = 0.232), niacin equivalent (p = 0.010, r = 0.256) and spine BMD. A nutrient pattern high in riboflavin, phosphorus and calcium was significantly positively correlated with spine (p < 0.05, r = 0.197) and femoral neck BMD (p < 0.05, r = 0.213), while the nutrient pattern high in vitamin E, α-tocopherol, β-carotene and omega 6 fatty acids was negatively correlated with hip (p < 0.05, r = −0.215) and trochanter BMD (p < 0.05, r = −0.251). These findings support the hypothesis that a nutrient pattern high in the intake of vitamin E, α-tocopherol and omega 6 fatty acids appears to be detrimental for bone health in postmenopausal women.
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23
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Nakayama AT, Lutz LJ, Hruby A, Karl JP, McClung JP, Gaffney-Stomberg E. 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. Am J Clin Nutr 2019; 109:186-196. [PMID: 30615068 DOI: 10.1093/ajcn/nqy199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/20/2018] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Anna T Nakayama
- Oak Ridge Institute for Science and Education supporting the Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA.,Military Performance, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Laura J Lutz
- Military Performance, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Adela Hruby
- Oak Ridge Institute for Science and Education supporting the Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.,Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - James P Karl
- Oak Ridge Institute for Science and Education supporting the Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - James P McClung
- Military Nutrition Divisions, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Erin Gaffney-Stomberg
- Military Performance, US Army Research Institute of Environmental Medicine, Natick, MA
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24
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Depletion and repletion of fruit and vegetable intake alters serum bone turnover markers: a 28-week single-arm experimental feeding intervention. Br J Nutr 2018; 120:500-507. [PMID: 30022739 DOI: 10.1017/s0007114518001642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study was designed to evaluate the effects of elevated fruit and vegetable intake on bone turnover markers. In all, twenty-nine subjects (nine male and twenty female, with a mean age of 32·1 (sem 2·5) years) participated in a 28-week single-arm experimental feeding intervention trial and consumed a prescribed low-fruit and vegetable diet for 6 weeks (depletion-1), a provided high-fruit and vegetable diet for 8 weeks (fruit: 360-560 g; vegetables: 450-705 g), another prescribed low-fruit and vegetable diet for 6 weeks (depletion-2) and then their usual diets for 8 weeks (repletion). Serum bone-related biomarkers were analysed with commercial ELISA kits. Plasma carotenoid levels decreased as a result of the depletion phase and increased with the high-fruit and vegetable diet. Compared with the baseline, depletion-1 resulted in higher serum bone resorption marker C-terminal telopeptide of type 1 collagen (CTX) and lower bone formation marker alkaline phosphatase (BAP) (CTX, 0·68 (sem 0·05) v. 0·97 (sem 0·08) ng/ml and BAP, 10·7 (sem 0·7) v. 9·5 (sem 0·8) µg/l for the baseline and the depletion-1, respectively, P<0·05). High intake of fruit and vegetables decreased serum CTX (P<0·05) to 0·60 (sem 0·04) ng/ml and increased serum BAP to 11·3 (sem 0·7) µg/l (P<0·05), compared with the depletion-1 phase. Serum concentrations of CTX were inversely correlated and those of BAP were positively correlated with blood lycopene. These data show that increased fruit and vegetable consumption at or above federal dietary guidance may be beneficial to bone health.
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25
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Sadeghi O, Djafarian K, Ghorabi S, Khodadost M, Nasiri M, Shab-Bidar S. Dietary intake of fish, n-3 polyunsaturated fatty acids and risk of hip fracture: A systematic review and meta-analysis on observational studies. Crit Rev Food Sci Nutr 2017; 59:1320-1333. [DOI: 10.1080/10408398.2017.1405908] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Omid Sadeghi
- Larestan University of Medical Sciences, Larestan, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Ghorabi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Research Center of Oils and Fats, Food and Drug administration, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Nasiri
- Department of Operating Room Technology, School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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26
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Association between nutrient patterns and bone mineral density among ageing adults. Clin Nutr ESPEN 2017; 22:97-106. [DOI: 10.1016/j.clnesp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/08/2017] [Indexed: 01/16/2023]
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27
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Association between Dietary Patterns of Meat and Fish Consumption with Bone Mineral Density or Fracture Risk: A Systematic Literature. Nutrients 2017; 9:nu9091029. [PMID: 29358568 PMCID: PMC5622789 DOI: 10.3390/nu9091029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022] Open
Abstract
This systematic review aimed to investigate the association of fish and sea fish dietary patterns (FishDiet) and meat or processed meat dietary patterns (MeatDiet) with bone mineral density (BMD) and/or risk of fractures (RF). This review includes 37 studies with a total of 432,924 subjects. The results suggest that MeatDiet and FishDiet did not affect BMD or RF in 48.2% of the subjects with MeatDiet and in 86.5% of the subjects with FishDiet. Positive effects on bone were found in 3% of subjects with MeatDiet and in 12% with FishDiet. Negative effects on bone were observed in 2.7% of FishDiet and in 47.9% of MeatDiet. Major negative effects of MeatDiet were found in subjects located in the Netherlands, Greece, Germany, Italy, Norway, UK and Spain who do not sustain a Mediterranean diet (92.7%); in Korea (27.1%); in Brazil and Mexico (96.4%); and in Australia (62.5%). This study suggests that protein intake from fish or meat is not harmful to bone. Negative effects on bone linked to FishDiet are almost null. Negative effects on bone were associated to MeatDiet in the setting of a Western Diet but not in Mediterranean or Asian Diets.
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28
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Zhang X, Zhang R, Moore JB, Wang Y, Yan H, Wu Y, Tan A, Fu J, Shen Z, Qin G, Li R, Chen G. The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091043. [PMID: 28891953 PMCID: PMC5615580 DOI: 10.3390/ijerph14091043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023]
Abstract
This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I² test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability.
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Affiliation(s)
- Xinge Zhang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Rui Zhang
- College of Life Sciences, South-Central University for Nationalities, Wuhan 430074, China.
| | - Justin B Moore
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Yueqiao Wang
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Hanyi Yan
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Yingru Wu
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Anran Tan
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Jialin Fu
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Ziqiong Shen
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Guiyu Qin
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Rui Li
- School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Guoxun Chen
- Department of Nutrition, The University of Tennessee, Knoxville, TN 37996, USA.
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29
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Sadeghi O, Saneei P, Nasiri M, Larijani B, Esmaillzadeh A. Abdominal Obesity and Risk of Hip Fracture: A Systematic Review and Meta-Analysis of Prospective Studies. Adv Nutr 2017; 8:728-738. [PMID: 28916573 PMCID: PMC5593104 DOI: 10.3945/an.117.015545] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Data on the association between general obesity and hip fracture were summarized in a 2013 meta-analysis; however, to our knowledge, no study has examined the association between abdominal obesity and the risk of hip fracture. The present systematic review and meta-analysis of prospective studies was undertaken to summarize the association between abdominal obesity and the risk of hip fracture. We searched online databases for relevant publications up to February 2017, using relevant keywords. In total, 14 studies were included in the systematic review and 9 studies, with a total sample size of 295,674 individuals (129,964 men and 165,703 women), were included in the meta-analysis. Participants were apparently healthy and aged ≥40 y. We found that abdominal obesity (defined by various waist-hip ratios) was positively associated with the risk of hip fracture (combined RR: 1.24, 95% CI: 1.05, 1.46, P = 0.01). Combining 8 effect sizes from 6 studies, we noted a marginally significant positive association between abdominal obesity (defined by various waist circumferences) and the risk of hip fracture (combined RR: 1.36; 95% CI: 0.97, 1.89, P = 0.07). This association became significant in a fixed-effects model (combined effect size: 1.40, 95% CI: 1.25, 1.58, P < 0.001). Based on 5 effect sizes, we found that a 0.1-U increase in the waist-hip ratio was associated with a 16% increase in the risk of hip fracture (combined RR: 1.16, 95% CI: 1.04, 1.29, P = 0.007), whereas a 10-cm increase in waist circumference was not significantly associated with a higher risk of hip fracture (combined RR: 1.13, 95% CI: 0.94, 1.36, P = 0.19). This association became significant, however, when we applied a fixed-effects model (combined effect size: 1.21, 95% CI: 1.15, 1.27, P < 0.001). We found that abdominal obesity was associated with a higher risk of hip fracture in 295,674 individuals. Further studies are needed to test whether there are associations between abdominal obesity and fractures at other bone sites.
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Affiliation(s)
- Omid Sadeghi
- Students’ Scientific Center,,Department of Community Nutrition, School of Nutritional Sciences and Dietetics
| | | | - Morteza Nasiri
- Department of Operating Room Technology, School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, and
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics,,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; and
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30
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Associations of Baltic Sea and Mediterranean dietary patterns with bone mineral density in elderly women. Public Health Nutr 2017; 20:2735-2743. [PMID: 28803596 DOI: 10.1017/s1368980017001793] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Dietary quality in relation to bone health has been analysed in relatively few studies. The current study aimed to assess the association of the Baltic Sea diet (BSD) and the Mediterranean diet (MD) with bone mineral density (BMD) among elderly women. DESIGN Lumbar, femoral and total body BMD were measured by dual-energy X-ray absorptiometry at baseline and year 3. Dietary intake was measured by 3 d food record at baseline. BSD and MD scores were calculated from food and alcohol consumption and nutrient intake. Information on lifestyle, diseases and medications was collected by questionnaires. Longitudinal associations of BSD and MD scores with BMD were analysed using linear mixed models. SETTING Interventional prospective Kuopio Osteoporosis Risk Factor and Fracture Prevention study including women aged 65-71 years and residing in Kuopio province, Finland. SUBJECTS Women (n 554) with mean age of 67·9 (sd 1·9) years and mean BMI of 28·8 (sd 4·7) kg/m2. RESULTS Higher BSD scores were associated with higher intakes of fruit and berries, vegetables, fish and low-fat dairy products, and lower intake of sausage. Higher MD scores were associated with higher consumption of fruit and berries and vegetables. BSD and MD scores were associated with higher PUFA:SFA and higher fibre intake. Femoral, lumbar or total body BMD was not significantly different among the quartiles of BSD or MD score. CONCLUSION The lack of associations suggest that Baltic Sea and Mediterranean dietary patterns may not adequately reflect dietary factors relevant to bone health.
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31
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Movassagh EZ, Vatanparast H. Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review. Adv Nutr 2017; 8:1-16. [PMID: 28096123 PMCID: PMC5227978 DOI: 10.3945/an.116.013326] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Nutrition is an important modifiable factor that affects bone health. Diet is a complex mixture of nutrients and foods that correlate or interact with each other. Dietary pattern approaches take into account contributions from various aspects of diet. Findings from dietary pattern studies could complement those from single-nutrient and food studies on bone health. In this study we aimed to conduct a scoping review of the literature that assessed the impact of dietary patterns (derived with the use of both a priori and data-driven approaches) on bone outcomes, including bone mineral status, bone biomarkers, osteoporosis, and fracture risk. We retrieved 49 human studies up to June 2016 from the PubMed, Embase, and CINAHL databases. Most of these studies used a data-driven method, especially factor analysis, to derive dietary patterns. Several studies examined adherence to a variety of the a priori dietary indexes, including the Mediterranean diet score, the Healthy Eating Index (HEI), and the Alternative Healthy Eating Index (AHEI). The bone mineral density (BMD) diet score was developed to measure adherence to a dietary pattern beneficial to bone mineral density. Findings revealed a beneficial impact of higher adherence to a "healthy" dietary pattern derived using a data-driven method, the Mediterranean diet, HEI, AHEI, Dietary Diversity Score, Diet Quality Index-International, BMD Diet Score, Healthy Diet Indicator, and Korean Diet Score, on bone. In contrast, the "Western" dietary pattern and those featuring some aspects of an unhealthy diet were associated inversely with bone health. In both a priori and data-driven dietary pattern studies, a dietary pattern that emphasized the intake of fruit, vegetables, whole grains, poultry and fish, nuts and legumes, and low-fat dairy products and de-emphasized the intake of soft drinks, fried foods, meat and processed products, sweets and desserts, and refined grains showed a beneficial impact on bone health. Overall, adherence to a healthy dietary pattern consisting of the above-mentioned food groups can improve bone mineral status and decrease osteoporosis and fracture risk.
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Affiliation(s)
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition and
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
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32
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Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Eriksson S, Grodstein F, Wolk A, Bellavia A, Ahmed LA, Boffeta P, Trichopoulou A. Fruit and Vegetable Intake and Hip Fracture Incidence in Older Men and Women: The CHANCES Project. J Bone Miner Res 2016; 31:1743-52. [PMID: 27061845 DOI: 10.1002/jbmr.2850] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/22/2016] [Accepted: 04/07/2016] [Indexed: 12/20/2022]
Abstract
The role of fruit and vegetable intake in relation to fracture prevention during adulthood and beyond is not adequately understood. We investigated the potential association between fruit and vegetable intake and hip fracture incidence in a large sample of older adults from Europe and the United States. A total of 142,018 individuals (116,509 women) aged ≥60 years, from five cohorts, were followed up prospectively for 1,911,482 person-years, accumulating 5552 hip fractures. Fruit and vegetable intake was assessed by validated, cohort-specific, food-frequency questionnaires (FFQ). Ηip fractures were ascertained through national patient registers or telephone interviews/questionnaires. Adjusted hazard ratios (HRs) derived by Cox proportional hazards regression were estimated for each cohort and subsequently pooled using random effects meta-analysis. Intake of ≤1 serving/day of fruit and vegetables combined was associated with 39% higher hip fracture risk (pooled adjusted HR, 1.39; 95% confidence interval [CI], 1.20 to 1.58) in comparison with moderate intake (>3 and ≤5 servings/day) (pfor heterogeneity = 0.505), whereas higher intakes (>5 servings/day) were not associated with lower risk in comparison with the same reference. Associations were more evident among women. We concluded that a daily intake of 1 or <1 servings of fruits and vegetables was associated with increased hip fracture risk in relation to moderate daily intakes. Older adults with such low fruit and vegetable consumption may benefit from raising their intakes to moderate amounts in order to reduce their hip fracture risk. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Vassiliki Benetou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Health Foundation, Athens, Greece
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Health Foundation, Athens, Greece
| | - Diane Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Ulrika Pettersson-Kymmer
- Department of Pharmacology and Clinical Neurosciences, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sture Eriksson
- Department of Community Medicine, Umeå University, Umeå, Sweden
| | - Francine Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alicja Wolk
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Andrea Bellavia
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Luai A Ahmed
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT-the Arctic University of Norway, Tromsø, Norway.,Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Paolo Boffeta
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonia Trichopoulou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Health Foundation, Athens, Greece
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Farsinejad-Marj M, Saneei P, Esmaillzadeh A. Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2016; 27:1389-1399. [PMID: 26556742 DOI: 10.1007/s00198-015-3400-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/03/2015] [Indexed: 01/14/2023]
Abstract
Dietary magnesium intake has been related to osteoporosis and risk of fractures in earlier studies; however, findings were conflicting. This meta-analysis indicated that high magnesium intake was not associated with increased risk of fracture; however, a positive marginally significant correlation was found between magnesium intake and bone mineral density (BMD) in total hip as well as in femoral neck. Although there is some evidence on the association between magnesium intake, BMD and fractures, no previous study has summarized findings in this regard. We aimed to systematically review the current evidence on this association and to perform a meta-analysis of observational studies. We searched MEDLINE, Scopus, EMBASE and Google Scholar up to January 2015 for studies that examined the relationship between magnesium intake and BMD or fracture. Studies that had reported correlation coefficients between magnesium intake and BMD or those that reported odds ratios (ORs) or relative risks (RRs) for risk of fracture in different sites were included. In total, 12 studies were included in the meta-analysis. We found that high intakes of magnesium were not significantly associated with risk of total hip fracture (summary effect size 1.92; 95 % CI 0.81, 4.55) or total fractures (1.01; 0.94-1.07). Combining four effect sizes, a positive marginally significant correlation was observed between magnesium intake and total BMD (pooled r 0.16; 95 % CI 0.001, 032). Based on nine effect sizes, we found a marginally significant association between magnesium intake and femoral neck BMD (0.14; 0.001, 0.28). However, no significant correlation was found between magnesium intake and BMD in lumbar spine (0.09; -0.01, 0.19). We found that high intakes of magnesium were not associated with increased risk of hip and total fractures. There was a positive marginally significant correlation between magnesium intake and BMD in femoral neck and total hip. No significant correlations were observed between magnesium intake and BMD in lumbar spine.
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Affiliation(s)
- M Farsinejad-Marj
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, PO Box 81745-151, Iran
| | - P Saneei
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, PO Box 81745-151, Iran
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, PO Box 81745-151, Iran.
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Increased inflammatory potential of diet is associated with bone mineral density among postmenopausal women in Iran. Eur J Nutr 2015; 55:561-568. [PMID: 25778389 DOI: 10.1007/s00394-015-0875-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/06/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Diet has been shown to be associated with bone mineral density (BMD); however, the inflammatory potential of diet in modulating BMD has not yet been studied. METHODS We examined the association between a newly developed dietary inflammatory index (DII) and BMD in a sample of postmenopausal Iranian women. In this cross-sectional study, 160 postmenopausal women aged 50-85 years were studied and their femoral neck and lumbar spine BMDs were measured by dual-energy X-ray absorptiometry. The DII was computed based on dietary intake assessed using a previously validated, 168-item semiquantitative food frequency questionnaire. Logistic and linear regression models were fit to derive beta estimates and odds ratios (ORs), with DII fit as continuous and as a dichotomous variable. RESULTS After adjusting for potential confounders, women with higher DII scores were more likely to have BMD below the median in the lumbar spine with the DII being used as both a continuous variable [ORcontinuous 1.64, 95 % confidence interval (CI) 1.11-2.43, p value = 0.01; one-unit increase corresponding to ≈17 % of its range in the current study] and a categorical variable (ORDII>-0.06/≤ 2.30, 95 % CI 1.05-5.07, p value = 0.04). Similar associations were observed when lumbar spine BMD was used as a continuous outcome. No significant association was observed with BMD in femoral neck, although the direction was along expected lines. CONCLUSION These data suggest a pro-inflammatory diet, as indicated by increasing DII score, may be a risk factor for lower BMD in lumbar spine in postmenopausal Iranian women.
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