A milk and cereal dietary pattern is associated with a reduced likelihood of having a low bone mineral density of the lumbar spine in Korean adolescents

Association between the Dietary Inflammatory Index and fracture risk in older adults: a systematic review and meta-analysis

OBJECTIVE

We explored correlations between the Dietary Inflammatory Index (DII) and fracture risk in older adults.

METHODS

We systematically searched MEDLINE, PubMed, Science Direct, Scopus, and CNKI for all relevant epidemiological studies published through October 16, 2023. Because observational studies were included in the meta-analysis, we used a random-effects model to pool the study-specific effect sizes and 95% confidence intervals (CIs). We assessed study quality using the Newcastle-Ottawa scale. This meta-analysis was registered in PROSPERO.

RESULTS

Eight studies with 462,986 participants were included, with five cohort studies, two cross-sectional studies, and one case-control study. An analysis of heterogeneity among the eight included studies resulted in I2 = 87.1%, indicating significant between-study heterogeneity; hence, the random-effects model was adopted to generate the combined effect size. We found that the DII was positively associated with fracture (relative risk: 1.188, 95% CI: 1.043-1.354). This result was further confirmed in leave-one-out sensitivity analysis.

CONCLUSIONS

Our study provides evidence suggesting that diets high in pro-inflammatory components might increase the fracture risk among older people. Decreased consumption of pro-inflammatory foods and increased consumption of anti-inflammatory foods are suggested to prevent adverse fracture outcomes. More prospective studies involving both sexes are warranted to verify the results.

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

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

DATA EXTRACTION

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

DATA ANALYSIS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022368610.

Adherence to the dietary approaches to stop hypertension and bone health in the Chinese elderly

INTRODUCTION

Many studies have demonstrated the relationship between diet and bone health, but research on the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and bone health across populations is rare. The purpose of this study was to examine associations between the DASH dietary pattern and bone health outcomes in Chinese elders, to verify whether higher adherence to the DASH was associated with better bone health in elderly populations.

MATERIALS AND METHODS

A total of 839 Chinese adults aged 50 years and above participated in this cross-sectional study. Bone mineral density (BMD) at calcaneus was measured via ultrasonic bone densitometer. A semiquantitative food frequency questionnaire (FFQ) was used to assess the usual dietary intake in the past 12 months. The DASH score was calculated based on energy-adjusted intakes of nine dietary components, including whole grains, beans, vegetables, fruits, dairy, red meat, total fat, sodium, and sugar-sweetened beverages.

RESULTS

In postmenopausal women, DASH score was significantly and positively correlated with BMD T-score after controlling potential covariates (β: 0.027 ± 0.012, P = 0.031) in multivariable linear regression models. In binary logistic regression analysis, male participants in the highest tertile of DASH score had lower risk of osteoporosis than those in the lowest tertile (odds ratio = 0.499; 95% confidence interval, 0.262-0.951; P = 0.035) after adjusting potential covariates.

CONCLUSION

Adherence to the DASH dietary pattern was associated with better bone health in Chinese elderly adults.

The Relationship between Dietary Pattern and Bone Mass in School-Age Children

Early bone accrual significantly influences adult bone health and osteoporosis incidence. We aimed to investigate the relationship between dietary patterns (DPs), bone mineral content (BMC) and bone mineral density (BMD) in school-age children in China. Children aged six-nine years (n = 465) were enrolled in this cross-sectional study. DPs were identified by principal component factor analysis. Total body (TB) and total body less head (TBLH) BMC and BMD were measured using dual-energy X-ray absorptiometry. Five DPs were identified. After adjustment for covariates, multiple linear regression analysis showed that the "fruit-milk-eggs" dietary pattern was positively associated with TB (β = 10.480; 95% CI: 2.190, 18.770) and TBLH (β = 5.577; 95% CI: 0.214, 10.941) BMC, the "animal organs-refined cereals" pattern was associated with low TB BMC (β = -10.305; 95% CI: -18.433, -2.176), TBLH BMC (β = -6.346; 95% CI: -11.596, -1.096), TB BMD (β = -0.006; 95% CI: -0.011, -0.001) and TBLH BMD (β = -0.004; 95% CI: -0.007, -0.001). In conclusion, our study recommends home or school meals should be rich in fruit, milk, eggs with a moderate amount of vegetables, coarse grains and meat to promote bone development for school-age children.

Characteristics of healthy German children and adolescents across tertiles of calcaneal stiffness index

Aim

Identifying risk factors for low bone stiffness index (SI) might be one crucial strategy for osteoporosis prevention. Purpose was to characterize healthy schoolchildren across tertiles of SI.

Subject and methods

In 248 girls (13.4 ± 1.9 years, BMI: 20.2 ± 4.8 kg/m2) and 231 boys (13.6 ± 1.7 years, BMI: 19.3 ± 3.3 kg/m2), the following parameters were assessed: calcaneal SI (quantitative ultrasound), body composition (bioelectrical impedance analysis), Bone Healthy Eating Index (BoneHEI; food frequency questionnaire), and physical activity level (PAL; activity questionnaire). Participants were classified according to age- and sex-specific SI tertiles (low, medium, and high). Between-group comparisons were achieved by Kruskal–Wallis-H-tests (α = 0.05).

Results

Girls with low SI had significantly lower body mass (49.2 ± 16.7 vs 54.8 ± 12.2 kg; p < 0.01), BMI (19.6 ± 5.4 vs 21.3 ± 3.9 kg/m2; p < 0.0001), fat-free mass (36.3 ± 8.3 vs 39.5 ± 6.0 kg; p < 0.01), and fat mass (23.7 ± 9.1 vs 26.8 ± 7.2%; p < 0.05) compared to those with high SI. In boys, significant differences between low and high SI were obtained for PAL (1.49 ± 0.12 vs 1.56 ± 0.14; p < 0.01). BoneHEI was not significantly different between tertiles in both sexes.

Conclusion

Girls with low body mass and boys with low PAL have a higher risk for low SI. Schoolchildren should strive for normal body mass and perform regular physical activity.

The Impact of Diet and Physical Activity on Bone Health in Children and Adolescents

There is growing recognition of the role of diet and physical activity in modulating bone mineral density, bone mineral content, and remodeling, which in turn can impact bone health later in life. Adequate nutrient composition could influence bone health and help to maximize peak bone mass. Therefore, children's nutrition may have lifelong consequences. Also, physical activity, adequate in volume or intensity, may have positive consequences on bone mineral content and density and may preserve bone loss in adulthood. Most of the literature that exists for children, about diet and physical activity on bone health, has been translated from studies conducted in adults. Thus, there are still many unanswered questions about what type of diet and physical activity may positively influence skeletal development. This review focuses on bone requirements in terms of nutrients and physical activity in childhood and adolescence to promote bone health. It explores the contemporary scientific literature that analyzes the impact of diet together with the typology and timing of physical activity that could be more appropriate depending on whether they are children and adolescents to assure an optimal skeleton formation. A description of the role of parathyroid hormone (PTH) and gut hormones (gastric inhibitory peptide (GIP), glucagon-like peptide (GLP)-1, and GLP-2) as potential candidates in this interaction to promote bone health is also presented.

Dietary Patterns and Pediatric Bone

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Association between Body Composition, Physical Activity, Food Intake and Bone Status in German Children and Adolescents

Achieving a high bone mass during childhood and adolescence is important for the prevention of osteoporosis in later life. Herein, the purpose was to assess the relationship of various lifestyle factors and bone outcomes in school children. In 248 girls (13.4 ± 1.9 years, BMI: 20.2 ± 4.8 kg m⁻²) and 231 boys (13.6 ± 1.7 years, BMI: 19.3 ± 3.3 kg m⁻²), bone mass (stiffness index, SI; calcaneal quantitative ultrasonometry), body composition (bioelectrical impedance analysis), food intake (food frequency questionnaire), and physical activity level (PAL; standardized questionnaire) were assessed. The individual food intake of eight food groups was related to the German recommendations (Bone Healthy Eating Index, BoneHEI; 0–100 points). Relationships between SI and lifestyle factors (Spearman´s rank correlation) and the influence of the factors on the variance of SI (multiple linear regression) were tested (α = 0.05). SI correlated with age, BMI, absolute fat-free mass, relative fat mass, PAL, and puberty category score in both girls and boys (r = 0.18–0.56, p < 0.01), but not with BoneHEI (p > 0.05). Age, absolute fat-free mass, sex, and PAL explained 35% of the variance of SI (p < 0.0001): SI = −0.60 + 2.97∙age (years) + 0.65∙fat-free mass (kg) + 6.21∙sex (0 = male, 1 = female) + 17.55∙PAL. Besides age and sex, PAL and fat-free mass are important factors relating to bone health. School children should perform regular physical activity to improve their bone status.

Bone loss, low height, and low weight in different populations and district: a meta-analysis between vegans and non-vegans

OBJECTIVE

The aim of this study was to- conduct a meta-analysis of the association of bone mineral density, height, and weight in different populations between vegans and non-vegans.

METHODS

Based on a search of PubMed, Web of Science, MEDLINE, the Cochrane Library, the Wanfang database, and the CNKI database, 14 relevant publications were collected by two researchers. Review Manager 5.3 and Stata 12.0 software were used for data analysis.

RESULTS

The following results were observed in this study: 1) the density of lumbar vertebrae was higher in vegans than in non-vegans (mean difference: -0.05, 95% CI: -0.09 to -0.01, P = 0.01); 2) hip bone density was higher in non-vegans than in vegans (mean difference: -0.08, 95% CI: -0.14 to -0.02, P = 0.008); 3) weight was higher in non-vegans than in vegans (mean difference: -2.21, 95% CI: -4.05 to -0.37, P = 0.02); and 4) height was higher in non-vegans than in vegans (mean difference: -1.87, 95% CI: -2.52 to -1.22, P < 0.00001).

CONCLUSION

Our study suggests that a vegetarian lifestyle may contribute to bone loss, low height, and low weight based on existing evidence.

Effect of Dairy Protein Intake on Muscle Mass among Korean Adults: A Prospective Cohort Study

This cohort study aimed to identify the associations of dairy protein intake with the risk of developing a low muscle mass during a 12-year follow-up period, using data from 4412 middle-aged Korean Genome and Epidemiology Study participants with a normal baseline muscle mass. Dairy protein intake at baseline was assessed using a semi-quantitative Food Frequency Questionnaire. Skeletal muscle mass index (SMI), defined as the weight-adjusted skeletal muscle mass, was measured biennially using multi-frequency bioelectrical impedance analyses. Cox proportional hazards regression analysis was used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Overall, 395 subjects developed a low SMI (%) during an average follow-up of 141 (19-152) months. The average consumption of milk and other dairy products was 73.6 and 104.1 g/day, respectively. In men, a higher dairy protein intake was associated with a decreased risk of developing a low SMI (tertile 3 [T3] vs. T1, HR: 0.63; 95% CI: 0.42, 0.94; p for trend = 0.029). In a stratified analysis according to a total protein intake, this association was stronger in the lower-protein intake group (HR: 0.59; 95% CI: 0.35, 0.99; p for trend = 0.036) but not detected in the higher-protein intake group. Men who consumed milk ≥1 time/day had a significantly lower risk of developing a low SMI (HR: 0.62; 95% CI: 0.39, 0.98; p for trend = 0.023). No significant associations were observed in women. In summary, dairy consumption appears to be beneficial for decreasing the risk of developing a low muscle mass in middle-aged Korean men.

Lipid Profile and Risk of Bone Fracture: A Systematic Review and Meta-Analysis of Observational Studies

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.

Determinants for low bone mineral density in pre-school children: a matched case-control study in Wuhan, China

Introduction Reduced bone mass will increase bone fragility and risk of fractures. Thus, it is better to note its determinants as early as possible. Objective This study aimed to find and determine the determinants for low bone mineral density (BMD) in pre-school children. Methods Between November 2014 and April 2015, a matched case-control study was performed to detect information on growth and development condition and consumption frequency of products of cases with low BMD and controls with normal BMD. Anthropometric data measurement and blood tests were conducted. Besides, the questionnaires concerning the mentioned information were completed to get relevant determinants. A paired t-test, the McNemar test and univariate and multiple conditional logistic regression models were used to explore the association between these factors and low BMD. Results In total, 88 (28 boys, 60 girls) incident cases (4.15 ± 0.78 years) of low BMD and 88 sex- and age-matched (±2 months) controls (4.16 ± 0.80 years) of normal BMD were enrolled. The results of multiple conditional logistic regression analysis indicated that if children had larger chest circumference (odds ratio [OR] = 0.763), longer duration of breastfeeding (OR = 0.899) and lower frequency of eating snacks (OR = 0.439), the risk of low BMD would decrease. Conclusions Our findings suggest that pre-school children with an association of larger chest circumference, longer duration of breastfeeding and lower frequency of eating snacks could have lower risk for low BMD. Intended measures to strengthen those protective factors could be effective in reducing the cases of low BMD.

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

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

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

Background

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

Objective

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

Design

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

Results

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

Conclusions

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

Dietary Patterns, Bone Mineral Density, and Risk of Fractures: A Systematic Review and Meta-Analysis

The aim of this systematic review was to assess the evidence on the relation between dietary patterns, bone mineral density (BMD), and risk of fracture in different age groups. Medline and Embase were searched for articles that identified dietary patterns and related these to BMD or risk of fracture through May 2018. Multivariable adjusted odds ratios (ORs) and 95% confidence intervals (95%CI) comparing the lowest and highest categories of dietary pattern were combined by using a random effects meta-analysis. In total, 31 studies were selected for review, including 18 cohorts, 1 case-control, and 12 cross-sectional studies, in the meta-analysis of Prudent/healthy and Western/unhealthy dietary pattern, BMD, and risk of fracture. There was evidence of a lower risk of fracture when intakes in the highest categories were compared with the lowest categories of Prudent/healthy dietary pattern (OR = 0.81; 95%CI: 0.69, 0.95; p = 0.01). In contrast, when intakes in the highest categories were compared with the lowest categories of Western/unhealthy dietary pattern, a greater risk of fracture (OR = 1.10; 95%CI: 1.02, 1.19; p = 0.01) was observed among men. The present systematic review and meta-analysis provides evidence of an inverse association between a Prudent/healthy dietary pattern and risk of low BMD and a positive relation between Western/unhealthy dietary pattern and risk of low BMD.

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Vegetarian-style dietary pattern during adolescence has long-term positive impact on bone from adolescence to young adulthood: a longitudinal study

BACKGROUND

The amount of bone accrued during adolescence is an important determinant of later osteoporosis risk. Little is known about the influence of dietary patterns (DPs) on the bone during adolescence and their potential long-term implications into adulthood. We examined the role of adolescent DPs on adolescent and young adult bone and change in DPs from adolescence to young adulthood.

METHODS

We recruited participants from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2011). Data from 125 participants (53 females) for adolescent analysis (age 12.7 ± 2 years) and 115 participants (51 females) for adult analysis (age 28.2 ± 3 years) were included. Bone mineral content (BMC) and areal bone mineral density (aBMD) of total body (TB), femoral neck (FN) and lumbar spine (LS) were measured using dual-energy X-ray absorptiometry. Adolescent dietary intake data from multiple 24-h recalls were summarized into 25 food group intakes and were used in the principal component analysis to derive DPs during adolescence. Associations between adolescent DPs and adolescent or adult BMC/BMD were analyzed using multiple linear regression and multivariate analysis of covariance while adjusting for sex, age, the age of peak height velocity, height, weight, physical activity and total energy intake. Generalized estimating equations were used for tracking DPs.

RESULTS

We derived five DPs including "Vegetarian-style", "Western-like", "High-fat, high-protein", "Mixed" and "Snack" DPs. The "Vegetarian-style" DP was a positive independent predictor of adolescent TBBMC, and adult TBBMC, TBaBMD (P < 0.05). Mean adolescent TBaBMD and young adult TBBMC, TBaBMD, FNBMC and FNaBMD were 5%, 8.5%, 6%, 10.6% and 9% higher, respectively, in third quartile of "Vegetarian-style" DP compared to first quartile (P < 0.05). We found a moderate tracking (0.47-0.63, P < 0.001) in DP scores at individual levels from adolescence to adulthood. There were an upward trend in adherence to "Vegetarian-style" DP and an downward trend in adherence to "High-fat, high-protein" DP from adolescence to young adulthood (P < 0.01).

CONCLUSION

A "Vegetarian-style" DP rich in dark green vegetables, eggs, non-refined grains, 100% fruit juice, legumes/nuts/seeds, added fats, fruits and low-fat milk during adolescence is positively associated with bone health.

Association of dietary patterns with overweight risk and all-cause mortality in children with cancer

BACKGROUND/OBJECTIVES

This study aimed to investigate the association of dietary patterns with overweight risk and all-cause mortality in pediatric cancer patients.

SUBJECTS/METHODS

Prospective cohort study was undertaken; 83 cancer patients admitted to the pediatric cancer ward at a university hospital in Seoul were included and followed for obesity and death over 24 months. Food consumption data were collected from patients using validated meal order sheets for breakfast, lunch, and dinner at the pediatric cancer ward over 3 days. Using principal component analysis, three dietary patterns were derived from 29 food groups.

RESULTS

Eighteen deaths occurred among the patient cohort during the follow-up period. The “spicy & fried meat and fish” dietary pattern was positively associated with overweight risk at both baseline [odds ratio (OR) = 4.396, 95% confidence interval (CI) = 1.111-17.385, P for trend = 0.023] and after 6 months (OR = 4.088, 95% CI = 1.122-14.896, P for trend = 0.025) as well as all-cause mortality (hazard ratios = 5.124, 95% CI = 1.080-24.320, P for trend = 0.042), when comparing the highest and lowest tertiles after adjusting for covariates. The “fish, egg, meat, and fruits & vegetables” dietary pattern was associated with lower overweight risk after 24 months (OR = 0.157, 95% CI = 0.046-0.982, P for trend = 0.084).

CONCLUSION

The results imply that dietary patterns might be associated with weight gain and premature death among pediatric cancer patients.

The association between dietary inflammatory properties and bone mineral density and risk of fracture in US adults

BACKGROUND/OBJECTIVES

To examine the associations of dietary inflammatory index (DII) with bone mineral density (BMD) and fracture risk in adult Americans.Subjects/Method:The United States National Health and Nutrition Examination Survey participants during 2005-2010 were included if they had measured data on dietary intake and BMD. DII scores were calculated from estimated micro- and macronutrients from a single 24-h dietary recall. BMD was measured using dual-energy X-ray absorptiometry densitometers. Risk of fractures was obtained from participant self-report (ever) based on doctor information. Analyze of covariance and χ²-tests were employed, while accounting for the complex survey design.

RESULTS

A total of 18 318 participants were included, with 51.3% (9397) being men. Age, sex, race, physical activity, smoking, C-reactive protein and body mass index-adjusted mean BMD (g/cm²) in different bodily sites significantly decreased across increasing quarters of the DII (all P<0.001). After further adjustment for calcium intake, the trend in BMD across DII quarters remained significant for total femur, femoral neck, trochanter and intertrochanter BMD (all P<0.001). Across increasing quarters of the DII, the proportion of fractures ranged from 1.1 to 1.5% for hip fracture (P=0.02), from 7.9 to 10.5% for wrist fracture (P<0.001) and from 2.2 to 2.7% for spine fracture (P=0.002. Prevalent wrist fractures significantly differed across DII quarters (P<0.0001), driven by high prevalence in the top quarter, while hip and spine fractures' prevalence did not vary significantly.

CONCLUSIONS

The current study provides evidence suggesting a potential adverse effect of pro-inflammatory diet on bone health; which may have implications for dietary approaches for those with history of abnormal bone health complications.

Abdominal Obesity and Risk of Hip Fracture: A Systematic Review and Meta-Analysis of Prospective Studies

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.

Milk-cereal and whole-grain dietary patterns protect against low bone mineral density among male adolescents and young adults

BACKGROUND/OBJECTIVES

Evidence supporting the possible effect of dietary factors on adult bone health has emerged in recent decades. The purpose of this study was to ascertain the influence of different dietary patterns on bone mineral density (BMD) among Korean male youth.

SUBJECTS/METHODS

Data were extracted from the Korean National Health and Nutrition Examination Survey (KNHANES) during 2008-2011. The subjects included 1351 male aged 10-25 years. We defined 'low BMD group' as subjects with a BMD Z-score of -2.0 or less. Dietary patterns were derived from 20 food groups via factor analysis.

RESULTS

Three dietary patterns-meat and vegetable, white rice and kimchi, milk-cereal and whole grain-were derived. The 'milk-cereal and whole-grain' dietary pattern score showed positive association with energy, protein, fat, calcium, phosphorus, potassium, riboflavin and vitamin C intakes. Participants in the top tertile of the milk-cereal and whole-grain pattern were less likely to have low BMD, compared with subjects in the bottom tertile (odds ratio=0.36, 95% confidence interval=0.16-0.81, P=0.018).

CONCLUSIONS

Our findings suggest that the milk-cereal and whole-grain dietary pattern may have a benign influence on bone health in the Korean male youth.

Dietary patterns explaining differences in bone mineral density and hip structure in the elderly: the Rotterdam Study

BACKGROUND

Evidence on the association between dietary patterns, measures of hip bone geometry, and subsequent fracture risk are scarce.

OBJECTIVE

The objective of this study was to evaluate whether dietary patterns that explain most variation in bone mineral density (BMD) and hip bone geometry are associated with fracture risk.

DESIGN

We included 4028 subjects aged ≥55 y from the Rotterdam study. Intake of 28 food groups was assessed with the use of food-frequency questionnaires. BMD, bone width, section modulus (SM; reflecting bending strength) and cortical buckling ratio (BR; reflecting bone instability) were measured with the use of dual-energy X-ray absorptiometry. BMD and geometry-specific dietary patterns were identified with the use of reduced rank regression. Fracture data were reported by general practitioners (median follow-up 14.8 y).

RESULTS

We identified 4 dietary patterns. Of the 4, we named 2 patterns "fruit, vegetables, and dairy" and "sweets, animal fat, and low meat," respectively. These 2 patterns were used for further analysis. Independently of confounders, adherence to the fruit, vegetables, and dairy pattern was associated with high BMD, high SM, low BR, and low risk of fractures [HR (95% CI) for osteoporotic fractures: 0.90 (0.83, 0.96); for hip fractures: 0.85 (0.81, 0.89) per z score of dietary pattern adherence]. Adherence to the sweets, animal fat, and low meat pattern was associated with high bone width, high SM, high BR, and high risk of fractures [HR (95% CI) for osteoporotic fractures: 1.08 (1.00, 1.06); for hip fractures: 1.06 (1.02, 1.12) per z score].

CONCLUSION

The fruit, vegetables, and dairy pattern might be associated with lower fracture risk because of high BMD, high bending strength, and more stable bones. The sweets, animal fat, and low meat pattern might be associated with higher fracture risk because of widened, unstable bones, independently of BMD. Dietary recommendations associated with bone geometry in addition to BMD might influence risk of fractures.

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

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.

Dietary sugar intake and dietary behaviors in Korea: a pooled study of 2,599 children and adolescents aged 9-14 years

BACKGROUND/OBJECTIVES

Dietary sugar intake, particularly added sugar and sugar-sweetened beverages, has received worldwide attention recently. Investigation of dietary behaviors may facilitate understanding of dietary sugar intakes of children and adolescents. However, the relationship between dietary sugar intake and dietary behaviors in the Korean population has not been investigated. Thus, this study aimed to estimate dietary sugar intake and food sources according to sex as well as examine the relationship of dietary sugar intake with frequent snacking and dietary patterns among Korean children and adolescents.

SUBJECTS/METHODS

We pooled data from five studies involving Korean children and adolescents conducted from 2002 to 2011. A total of 2,599 subjects aged 9-14 years were included in this study. Each subject completed more than 3 days of dietary records.

RESULTS

Mean daily total sugar intake was 46.6 g for boys and 54.3 g for girls. Compared with boys, girls showed higher sugar intakes from fruits (7.5 g for boys and 8.8 g for girls; P = 0.0081) and processed foods (27.9 g for boys and 34.9 g for girls; P < 0.0001). On average, 95.4% of boys and 98.8% of girls consumed snacks during the study period, and total sugar intake showed a significantly increasing trend with increasing energy intake from snacks (P < 0.0001 for both sexes). Two dietary patterns were identified by cluster analysis: Traditional and Westernized patterns. Total sugar intake was higher in the Westernized pattern (56.2 g for boys and 57.2 g for girls) than in the Traditional pattern (46.5 g for boys and 46.3 g for girls).

CONCLUSIONS

These results suggest that multilateral and practical development of a nutrition education and intervention program that considers dietary behaviors as well as absolute sugar intake is required to prevent excessive sugar intake in Korean children and adolescents.

Dietary patterns are associated with bone mineral density in an urban Mexican adult population

Several types of nutrients and foods affect bone mineral density (BMD). However, these nutrients occur together in food groups and dietary patterns, and the overall effects of dietary patterns are not yet well known.

INTRODUCTION

We evaluated the associations between dietary patterns and BMD among adults participating in the Health Workers Cohort Study.

METHODS

In a cross-sectional analysis, we examined 6915 Mexican adults aged 20-80 years. All participants completed a validated self-administered food frequency questionnaire (FFQ) and had total, hip, and spine BMD measurements assessed by dual-energy X-ray absorptiometry (DXA). The FFQ included 116 foods, which were grouped into 22 categories and entered into a factor analysis to derive dietary patterns.

RESULTS

Three dietary patterns emerged-a Prudent, a Refined foods, and a Dairy and fish pattern. After adjustment for potential confounders, those in the highest quintile of the Prudent pattern had lower odds (OR) of low spine BMD (OR = 0.80; 95 % CI 0.68, 0.94; P for trend = 0.031) compared to those in the lowest quintile. In contrast, participants in the highest quintile of the Refined foods pattern had greater odds of low total BMD (OR = 1.74; 95 % CI 1.10, 2.76; P for trend = 0.016) than those in the lowest quintile. Finally, participants in the highest quintile of the Dairy and fish dietary pattern had significantly lower likelihood of having low BMD.

CONCLUSION

This study identified specific dietary patterns associated with BMD among a Mexican adult population and highlights the importance of promoting food-based prevention strategies for maintaining bone health.

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia

Objective: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. Methods: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. Results: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with a Western-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. Conclusion: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth.

Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis

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.

Association of Dietary Sugars and Sugar-Sweetened Beverage Intake with Obesity in Korean Children and Adolescents

Few studies have examined the association between dietary sugar intake and obesity in Asian children and adolescents. We evaluated the association of dietary sugar intake and its food source with obesity in Korean children and adolescents. In this cross-sectional analysis, data were obtained from five studies conducted between 2002 and 2011. The study included 2599 children and adolescents who had completed more than three days of dietary records and had anthropometric data. Total sugar intake was higher in girls than in boys (54.3 g for girls and 46.6 g for boys, p < 0.0001). Sugar intake from milk and fruits was inversely associated with overweight or obesity in girls only (OR for overweight, 0.52; 95% CI, 0.32–0.84; p for trend = 0.0246 and OR for obesity, 0.42; 95% CI, 0.23–0.79; p for trend = 0.0113). Sugar-sweetened beverage (SSB) consumption was not associated with obesity in girls, while boys had lower odds ratios for obesity (OR for obesity, 0.52; 95% CI, 0.26–1.05; p for trend = 0.0310). These results suggest that total sugars and SSB intake in Asian children and adolescents remains relatively low and sugar intake from milk and fruits is associated with a decreased risk of overweight or obesity, especially in girls.

Identification of a dietary pattern prospectively associated with bone mass in Australian young adults

BACKGROUND

Relatively little is known about the relations between dietary patterns and bone health in adolescence, which is a period of substantial bone mass accrual.

OBJECTIVES

We derived dietary patterns that were hypothesized to be related to bone health on the basis of their protein, calcium, and potassium contents and investigated their prospective associations with bone mineral density (BMD), bone area, and bone mineral content (BMC) in a cohort of young adults.

DESIGN

The study included 1024 young adults born to mothers who were participating in the Western Australian Pregnancy Cohort (Raine) Study. Dietary information was obtained from food-frequency questionnaires at 14 and 17 y of age. Dietary patterns were characterized according to protein, calcium, and potassium intakes with the use of reduced-rank regression. BMD, bone area, and BMC were estimated with the use of a total body dual-energy X-ray absorptiometry scan at 20 y of age.

RESULTS

We identified 2 major dietary patterns. The first pattern was positively correlated with intakes of protein, calcium, and potassium and had high factor loadings for low-fat dairy products, whole grains, and vegetables. The second pattern was positively correlated with protein intake but negatively correlated with intakes of calcium and potassium and had high factor loadings for meat, poultry, fish, and eggs. After adjustment for anthropometric, sociodemographic, and lifestyle factors, a higher z score for the first pattern at 14 y of age was positively associated with BMD and BMC at 20 y of age [differences: 8.6 mg/cm(2) (95% CI: 3.0, 14.1 mg/cm(2)) and 21.9 g (95% CI: 6.5, 37.3 g), respectively, per SD increase in z score]. The z score for this same pattern at 17 y of age was not associated with bone outcomes at 20 y of age. The second pattern at 14 or 17 y of age was not associated with BMD, BMC, or bone area.

CONCLUSIONS

A dietary pattern characterized by high intakes of protein, calcium, and potassium in midadolescence was associated with higher BMD and BMC at 20 y of age. Our results indicate that high consumption of low-fat dairy products, whole grains, and vegetables in adolescence are associated with beneficial effects on bone development.

Infant dietary patterns and bone mass in childhood: the Generation R Study

Early life nutrition affects peak bone mass attainment. In this prospective cohort study, children with high adherence to a "dairy and whole grains" pattern in infancy had higher bone mineral density at the age of 6 years. Although the observed effects are small, our study provides insight into mechanisms linking early nutrition to bone acquisition in childhood.

INTRODUCTION

Nutrition in early life may affect peak bone mass attainment. Previous studies on childhood nutrition and skeletal health mainly focused on individual nutrients, which does not consider the cumulative effects of nutrients. We investigated the associations between dietary patterns in infancy and childhood bone health.

METHODS

This study included 2850 children participating in a population-based prospective cohort study. Dietary information was obtained from a food frequency questionnaire at the age of 13 months. Using principal component analysis, three major dietary patterns were extracted, explaining in total 30% of the variation in dietary intake. At the age of 6 years, a total body dual-energy X-ray absorptiometry (DXA) scan was performed, and bone mineral density (BMD), bone mineral content (BMC), area-adjusted BMC (aBMC), and bone area (BA) were analyzed.

RESULTS

Higher adherence score to a "dairy and whole grains" pattern was positively associated with BMD and aBMC, but not with BMC and BA. Accordingly, children in the highest quartile of the "dairy and whole grains" pattern had higher BMD (difference 3.98 mg/cm(2), 95% confidence interval (CI) 0.36 to 7.61) and aBMC (difference 4.96 g, 95% CI 1.27 to 8.64) than children in the lowest quartile. Stratification for vitamin D supplementation showed that the positive associations between the "dairy and whole grains" pattern and bone outcomes were only observed in children who did not receive vitamin D supplementation. A "potatoes, rice, and vegetables" and a "refined grains and confectionery" pattern were not consistently associated with bone outcomes.

CONCLUSIONS

An infant dietary pattern characterized by high intakes of dairy and cheese, whole grains, and eggs is positively associated with bone development in childhood. Further research is needed to investigate the consequences for bone health in later life.

Increased inflammatory potential of diet is associated with bone mineral density among postmenopausal women in Iran

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.

A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults

BACKGROUND/OBJECTIVES

Osteoporosis is a major health problem that will grow in burden with ageing of the global population. Modifiable risk factors for osteoporosis, including diet, have significant implications for disease prevention. We examined associations between dietary patterns and bone mineral density (BMD) in a Korean adult population.

SUBJECTS/METHODS

In total, 1828 individuals from the Healthy Twin Cohort were included as subjects. Information on general characteristics, lifestyles and health status was obtained through a health examination, and BMD was assessed using DEXA. Dietary intake was assessed using a 3-day food record, and dietary patterns were examined by factor analysis. Associations between dietary patterns and BMD were examined using mixed linear regression, adjusting for family and twin structure as well as other potential risk factors for bone health.

RESULTS

Four dietary patterns were identified (Rice and kimchi; eggs, meat and flour; Fruit, milk and whole grains; and Fast food and soda). The 'Fruit, milk and whole grains' pattern was associated with a reduced risk of having low BMD in men (odds ratio (OR)=0.38; 95% confidence interval (CI)=0.22-0.67) and women (OR=0.45; 95% CI=0.28-0.72) and was positively associated with BMD at multiple sites. The 'rice and kimchi' pattern had a positive association with only whole-arm BMD in men and women.

CONCLUSIONS

Our results suggest that a dietary pattern with high intake of dairy products, fruits and whole grains may contribute positively to bone health in a Korean adult population, and dietary pattern-based strategies could have potential in promoting bone health.

Associations between a posteriori defined dietary patterns and bone mineral density in adolescents

PURPOSE

Dietary pattern analysis may uncover the joint effects of multiple dietary components on bone health, but such research is scarce and targets mostly adults.

METHODS

We quantified prospective associations between dietary patterns and bone mineral density (BMD) in 1,007 adolescents of a cohort born in 1990 and recruited at schools in Porto during the 2003/2004 school year. Forearm BMD was measured using dual-energy X-ray absorptiometry. Participants' dietary patterns were classified "Healthier", "Dairy products", "Fast food and sweets" and "Lower intake" according to previously identified patterns obtained in a larger sample of 1,489 participants using the K-means method. Using dietary patterns at 13 years old as the main exposure, associations were estimated cross-sectionally (with BMD at the age of 13) and prospectively (with annual BMD variation between 13 and 17 years), using linear regression coefficients adjusted for height, weight, energy intake and, in girls, for menarche age.

RESULTS

No significant associations between the a posteriori dietary patterns identified and mean BMD at 13 were found. However, among girls, adherence to a pattern characterized by low intake of energy and all food groups was negatively associated with annual BMD variation between 13 and 17 years [adjusted coefficient (95 % CI) -0.451 (-0.827; -0.074) mg·cm⁻²·year⁻¹].

CONCLUSIONS

Although results showed that, in girls, adherence to a "Lower intake" dietary pattern is associated with lower annual BMD variation throughout adolescence, overall, there were no consistent associations between dietary patterns and forearm BMD in adolescents.