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Noori M, Jayedi A, Khan TA, Moradi S, Shab-Bidar S. Mediterranean dietary pattern and bone mineral density: a systematic review and dose-response meta-analysis of observational studies. Eur J Clin Nutr 2022; 76:1657-1664. [PMID: 35173291 DOI: 10.1038/s41430-022-01093-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to systematically review the literature and test the dose-response relationship between adherence to the Mediterranean diet (MedDiet) and values of bone mineral density (BMD) in adults. METHODS Relevant observational studies were selected through searching PubMed, Scopus, and Web of Science databases up to March 4, 2021. A random-effects dose-response meta-analysis was performed to estimate the change in total and regional-specific BMD for a 2-point increment in the score of adherence to the MedDiet, and to clarify the shape of these associations. RESULTS Seven cross-sectional and one cohort studies with a total number of 13,209 participants were included in the final analyses. Each 2-point increment in the score of adherence to the MedDiet was associated with 0.009 (95% CI: 0.002, 0.016; I2 = 34%, n = 7), 0.006 (95% CI: 0.001, 0.012; I2 = 34%, n = 7), 0.005 (95% CI: 0.003, 0.007; I2 = 1%, n = 4), 0.005 (95% CI: 0.002, 0.008; I2 = 0%, n = 3), and 0.007 (95% CI: 0.005, 0.009; I2 = 0%, n = 4) gr/cm2 higher BMD of lumbar spine, femoral neck, hip, trochanter, and whole body, respectively. There was a positive linear relationship between the MedDiet adherence score and BMD of hip and trochanter. A nonlinear relationship was seen for lumbar spine, femoral neck, and whole body, with sharper increase in the BMD at lower MedDiet scores. The associations remained significant after controlling for important confounders including body weight, physical activity, smoking status, and energy intake. CONCLUSION Greater adherence to the MedDiet was associated with a small but important increase in BMD at the lumbar spine, femoral neck, hip, trochanter, and whole body. Adopting a Mediterranean-style eating pattern may have modest beneficial effects on bone health.
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Affiliation(s)
- Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Tauseef Ahmad Khan
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sajjad Moradi
- Halal Research Center of IRI, FDA, Tehran, Iran
- Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Zhong W, Zhao A, Lan H, Mao S, Li P, Jiang H, Wang P, Szeto IMY, Zhang Y. Dietary Diversity, Micronutrient Adequacy and Bone Status during Pregnancy: A Study in Urban China from 2019 to 2020. Nutrients 2022; 14:4690. [PMID: 36364952 PMCID: PMC9656709 DOI: 10.3390/nu14214690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Diet quality during reproduction is crucial to maternal and infant health. However, the association between dietary diversity and bone health of pregnant women remains unclear. We aimed to evaluate the dietary quality of Chinese urban gravidas using the dietary diversity score (DDS), and to explore the relationship of the DDS with micronutrient adequacy and bone health. In this cross-sectional study, we analyzed data from 775 pregnant women aged 18 years or older in urban China. Dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD-W) indicator. A 24-h dietary recall was used to collect diet data and to calculate the MDD-W and the nutrient intake. Bone health was measured using quantitative ultrasound and assessed by the speed of sound (SOS). Pearson's correlation coefficients between the DDS and the nutrient adequacy ratio (NAR) were calculated. A multivariable linear regression model was used to estimate the effect size of the DDS on the SOS. The mean DDS was 6.61 ± 1.53 points and 91.0% of participants reported the consumption of five or more food groups. Women in the diverse diet subgroup (DDS ≥ 7 points) were more likely to consume all kinds of food except starchy staples and had higher NARs. Pearson's correlation coefficients between the DDS and the NAR ranged from 0.161 to 0.484. For participants in the second trimester, those with a diverse diet had a higher SOS. A multivariable linear regression analysis showed that the DDS was positively and significantly associated with the SOS (β = 17.18, 95% CI = 5.97-28.39, p = 0.003), but this was not the case for women in the first and third trimesters. Urban Chinese women had good dietary diversity during pregnancy. A higher dietary diversity was associated with a higher NAR. From the point of view of bone, a diverse diet was positively correlated with better bone status, suggesting the importance of improving diet diversity for pregnant women, especially from mid-pregnancy.
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Affiliation(s)
- Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Hua Jiang
- School of Nursing, Peking University Health Science Center, Beijing 100191, China
| | - Peiyu Wang
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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Menghi L, Endrizzi I, Cliceri D, Zampini M, Giacalone D, Gasperi F. Validating the Italian version of the Adult Picky Eating Questionnaire. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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4
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Yen CC, Lin WC, Wang TH, Chen GF, Chou DY, Lin DM, Lin SY, Chan MH, Wu JM, Tseng CD, Huang YJ, Lee TF. Pre-screening for osteoporosis with calcaneus quantitative ultrasound and dual-energy X-ray absorptiometry bone density. Sci Rep 2021; 11:15709. [PMID: 34344965 PMCID: PMC8333105 DOI: 10.1038/s41598-021-95261-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/20/2021] [Indexed: 11/09/2022] Open
Abstract
Calcaneal quantitative ultrasonography (QUS) is a useful prescreening tool for osteoporosis, while the dual-energy X-ray absorptiometry (DXA) is the mainstream in clinical practice. We evaluated the correlation between QUS and DXA in a Taiwanese population. A total of 772 patients were enrolled and demographic data were recorded with the QUS and DXA T-score over the hip and spine. The correlation coefficient of QUS with the DXA-hip was 0.171. For DXA-spine, it was 0.135 overall, 0.237 in females, and 0.255 in males. The logistic regression model using DXA-spine as a dependent variable was established, and the classification table showed 66.2% accuracy. A receiver operating characteristic (ROC) analyses with Youden's Index revealed the optimal cut-off point of QUS for predicting osteoporosis to be 2.72. This study showed a meaningful correlation between QUS and DXA in a Taiwanese population. Thus, it is important to pre-screen for osteoporosis with calcaneus QUS.
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Affiliation(s)
- Chia-Chi Yen
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
- Department of Nutrition, Institute of Biomedical Nutrition, Hung-Kuang University, Taichung, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Wei-Chun Lin
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan.
| | - Tzu-Hao Wang
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Guan-Fan Chen
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Da-Ying Chou
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Dian-Min Lin
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Shu-Yuan Lin
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Min-Ho Chan
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Jia-Ming Wu
- Department of Biomedicine Engineering, Chengde Medical University, Chengde, 067000, Hebei, China
| | - Chin-Dar Tseng
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.
- Ph.D. Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC.
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5
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Li J, Zhou R, Huang W, Wang J. Bone loss, low height, and low weight in different populations and district: a meta-analysis between vegans and non-vegans. Food Nutr Res 2020; 64:3315. [PMID: 33061885 PMCID: PMC7534950 DOI: 10.29219/fnr.v64.3315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/13/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Jianfeng Li
- Department of Spine and Osteology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
| | - Ruiyun Zhou
- Zhuhai Medical Emergency Center, Pre-Hospital Emergency Training Base of Mid-southern China, Zhuhai, Guangdong Province, China
| | - Wei Huang
- Department of Spine and Osteology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
| | - Jianjun Wang
- Department of Spine and Osteology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
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Noel SE, Mangano KM, Mattei J, Griffith JL, Dawson-Hughes B, Bigornia S, Tucker KL. Dietary Approaches to Stop Hypertension, Mediterranean, and Alternative Healthy Eating indices are associated with bone health among Puerto Rican adults from the Boston Puerto Rican Osteoporosis Study. Am J Clin Nutr 2020; 111:1267-1277. [PMID: 32386194 PMCID: PMC7266690 DOI: 10.1093/ajcn/nqaa090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/07/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Conflicting results on associations between dietary quality and bone have been noted across populations, and this has been understudied in Puerto Ricans, a population at higher risk of osteoporosis than previously appreciated. OBJECTIVE To compare cross-sectional associations between 3 dietary quality indices [Dietary Approaches to Stop Hypertension (DASH), Alternative Health Eating Index (AHEI-2010), and Mediterranean Diet Score (MeDS)] with bone outcomes. METHOD Participants (n = 865-896) from the Boston Puerto Rican Osteoporosis Study (BPROS) with complete bone and dietary data were included. Indices were calculated from validated food frequency data. Bone mineral density (BMD) was measured using DXA. Associations between dietary indices (z-scores) and their individual components with BMD and osteoporosis were tested with ANCOVA and logistic regression, respectively, at the lumbar spine and femoral neck, stratified by male, premenopausal women, and postmenopausal women. RESULTS Participants were 59.9 y ± 7.6 y and mostly female (71%). Among postmenopausal women not taking estrogen, DASH (score: 11-38) was associated with higher trochanter (0.026 ± 0.006 g/cm2, P <0.001), femoral neck (0.022 ± 0.006 g/cm2, P <0.001), total hip (0.029 ± 0.006 g/cm2, P <0.001), and lumbar spine BMD (0.025 ± 0.007 g/cm2, P = 0.001). AHEI (score: 25-86) was also associated with spine and all hip sites (P <0.02), whereas MeDS (0-9) was associated only with total hip (P = 0.01) and trochanter BMD (P = 0.007) in postmenopausal women. All indices were associated with a lower likelihood of osteoporosis (OR from 0.54 to 0.75). None of the results were significant for men or premenopausal women. CONCLUSIONS Although all appeared protective, DASH was more positively associated with BMD than AHEI or MeDS in postmenopausal women not taking estrogen. Methodological differences across scores suggest that a bone-specific index that builds on existing indices and that can be used to address dietary differences across cultural and ethnic minority populations should be considered.
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Affiliation(s)
- Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA,Address correspondence to SEN (e-mail: )
| | - Kelsey M Mangano
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - John L Griffith
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Bess Dawson-Hughes
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Sherman Bigornia
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire Durham, Durham, MA, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
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7
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Grigoriou E, Trovas G, Papaioannou N, Dontas I, Makris K, Apostolou-Karampelis K, Dedoussis G. Dietary Patterns of Greek Adults and Their Associations with Serum Vitamin D Levels and Heel Quantitative Ultrasound Parameters for Bone Health. Nutrients 2020; 12:nu12010123. [PMID: 31906346 PMCID: PMC7019275 DOI: 10.3390/nu12010123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of this study is to investigate the dietary patterns which indicate the nutritional habits of Greek adults and their effects on serum 25(OH)D levels and quantitative ultrasound (QUS) parameters for bone health. This study is part of OSTEOS, an observational cross-sectional study. In total, 741 adults from rural and urban areas throughout Greece were recruited. A validated food frequency questionnaire (FFQ) was used for assessment of the population’s dietary habits. Serum 25(OH)D was measured by enzyme immunoassay; QUS parameters were assessed with an Achilles device. Principal component analysis (PCA) was carried out for dietary pattern determination, and univariate analysis of variance was used for the assessment of 25(OH)D, broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) determinants. Six dietary patterns explain 52.2% of the variability of Greek adults’ nutritional habits. The ‘vegetables–fruit’ dietary pattern explains the biggest rate of variability. Determinants of serum 25(OH)D are body mass index (BMI), elderly status, summer sun exposure, organized physical activity, a ‘healthy’ pattern in winter months, and adherence to a ‘sweet’ pattern. Determinants of QUS parameters are age, BMI, sedentary time, organized physical activity participation, and adherence to a ‘healthy’ pattern.
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Affiliation(s)
- Effimia Grigoriou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671 Athens, Greece; (E.G.); (K.A.-K.)
| | - George Trovas
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National & Kapodistrian University of Athens, 10 Athinas Street, KAT General Hospital, 14561 Athens, Greece; (G.T.); (N.P.); (I.D.)
| | - Nikolaos Papaioannou
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National & Kapodistrian University of Athens, 10 Athinas Street, KAT General Hospital, 14561 Athens, Greece; (G.T.); (N.P.); (I.D.)
| | - Ismene Dontas
- Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National & Kapodistrian University of Athens, 10 Athinas Street, KAT General Hospital, 14561 Athens, Greece; (G.T.); (N.P.); (I.D.)
| | | | - Konstantinos Apostolou-Karampelis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671 Athens, Greece; (E.G.); (K.A.-K.)
| | - George Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671 Athens, Greece; (E.G.); (K.A.-K.)
- Correspondence: ; Tel.: +30-2109549304
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Schraders K, Zatta G, Kruger M, Coad J, Weber J, Brough L, Thomson J. Quantitative Ultrasound and Dual X-Ray Absorptiometry as Indicators of Bone Mineral Density in Young Women and Nutritional Factors Affecting It. Nutrients 2019; 11:nu11102336. [PMID: 31581575 PMCID: PMC6836084 DOI: 10.3390/nu11102336] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 12/31/2022] Open
Abstract
Young adulthood is an important stage in the accrual of bone mass. Young women are often unaware of the need, and how to optimize modifiable risk factors, particularly intake of nutrients associated with good bone health. In this study, an accessible way to estimate osteoporosis risk, quantitative ultrasound (QUS), is compared to the gold-standard technique dual X-ray absorptiometry (DXA) in a group of 54 healthy young women (18–26 years) from Manawatu, New Zealand, and the relationship with nutrient intake is investigated. Broadband ultrasound attenuation and speed of sound (BUA, SOS) were assessed by QUS calcaneal scans and bone mineral concentration/density (BMC/BMD) were determined by DXA scans of the lumbar spine and hip (total and femoral neck). Dietary intake of energy, protein, and calcium was estimated using three-day food diaries and questionnaires. DXA mean Z-scores (>−2.0) for the hip (0.19) and spine (0.2) and QUS mean Z-scores (>−1.0) (0.41) were within the expected ranges. DXA (BMD) and QUS (BUA, SOS) measurements were strongly correlated. Median intakes of protein and calcium were 83.7 g/day and 784 mg/day, respectively. Protein intake was adequate and, whilst median calcium intake was higher than national average, it was below the Estimated Average Requirement (EAR). No significant relationship was found between dietary intake of calcium or protein and BMD or BMC. To conclude, QUS may provide a reasonable indicator of osteoporosis risk in young women but may not be an appropriate diagnostic tool. Increased calcium intake is recommended for this group, regardless of BMD.
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Affiliation(s)
- Katie Schraders
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Giancarla Zatta
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Marlena Kruger
- School of Health Sciences, College of Health, Massey University, Palmerston North 4442, New Zealand.
| | - Jane Coad
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Janet Weber
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Louise Brough
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
| | - Jasmine Thomson
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North 4442, New Zealand.
- Fonterra Research and Development Centre, Fonterra Co-operative Group Limited, Palmerston North 4442, New Zealand.
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9
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Jang BY, Bu SY. A Vegetable and Fish Dietary Pattern Is Positively Associated with Skeletal Muscle Mass in Korean Men. Clin Nutr Res 2019; 8:1-16. [PMID: 30746343 PMCID: PMC6355951 DOI: 10.7762/cnr.2019.8.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Isolating the effects of a single nutrient or food in relation to health outcomes including increased skeletal muscle mass is a challenging task because dietary constituents are highly correlated and synergistic. Hence, diet pattern analysis may be used to investigate the role of certain diets in health outcomes. The present study investigated the dietary patterns and their relationship to skeletal muscle mass in Korean adults. Data were extracted from the 2008–2011 Korea National Health and Nutrition Examination Surveys. To explore the dietary patterns of the study subjects, factor analysis was performed using data obtained from a 24-hour recall. The skeletal muscle index according to dietary pattern scores was then investigated to estimate the changes in skeletal muscle mass. Three patterns were initially identified from the factor analysis. Of these vegetables and fish (VF) pattern was the primary factor with high reliability and was a common factor in sex-separated analyses. The VF pattern scores were positively associated with increased skeletal muscle mass in both men and women. Further analysis according to quartile levels of VF pattern scores showed a positive association between skeletal muscle mass and VF pattern in men but not in women. These results suggest that dietary patterns focused on vegetables and seafoods may contribute to increased skeletal muscle mass in Korean men but that sex difference should be considered in nutrition care for skeletal muscle health.
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Affiliation(s)
- Bo Young Jang
- Department of Food and Nutrition, College of Engineering, Daegu University, Gyeongsan 38453, Korea
| | - So Young Bu
- Department of Food and Nutrition, College of Engineering, Daegu University, Gyeongsan 38453, Korea
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10
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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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Dietary Patterns, Bone Mineral Density, and Risk of Fractures: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10121922. [PMID: 30563066 PMCID: PMC6316557 DOI: 10.3390/nu10121922] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 01/22/2023] Open
Abstract
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.
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12
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de Haas SCM, de Jonge EAL, Voortman T, Graaff JSD, Franco OH, Ikram MA, Rivadeneira F, Kiefte-de Jong JC, Schoufour JD. Dietary patterns and changes in frailty status: the Rotterdam study. Eur J Nutr 2018; 57:2365-2375. [PMID: 28744573 PMCID: PMC6182690 DOI: 10.1007/s00394-017-1509-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/11/2017] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the associations between a priori and a posteriori derived dietary patterns and a general state of health, measured as the accumulation of deficits in a frailty index. METHODS Cross-sectional and longitudinal analysis embedded in the population-based Rotterdam Study (n = 2632) aged 45 years. Diet was assessed at baseline (year 2006) using food frequency questionnaires. Dietary patterns were defined a priori using an existing index reflecting adherence to national dietary guidelines and a posteriori using principal component analysis. A frailty index was composed of 38 health deficits and measured at baseline and follow-up (4 years later). Linear regression analyses were performed using adherence to each of the dietary patterns as exposure and the frailty index as outcome (all in Z-scores). RESULTS Adherence to the national dietary guidelines was associated with lower frailty at baseline (β -0.05, 95% CI -0.08, -0.02). Additionally, high adherence was associated with lower frailty scores over time (β -0.08, 95% CI -0.12, -0.04). The PCA revealed three dietary patterns that we named a "Traditional" pattern, high in legumes, eggs and savory snacks; a "Carnivore" pattern, high in meat and poultry; and a "Health Conscious" pattern, high in whole grain products, vegetables and fruit. In the cross-sectional analyses adherence to these patterns was not associated with frailty. However, adherence to the "Traditional" pattern was associated with less frailty over time (β -0.09, 95% CI -0.14, -0.05). CONCLUSION No associations were found for adherence to a "healthy" pattern or "Carnivore" pattern. However, Even in a population that is relatively young and healthy, adherence to dietary guidelines or adherence to the Traditional pattern could help to prevent, delay or reverse frailty levels.
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Affiliation(s)
- Sandra C M de Haas
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- VU University Amsterdam, Amsterdam, The Netherlands
| | - Ester A L de Jonge
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jolien Steenweg-de Graaff
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Global Public Health, Leiden University College The Hague, P.O. Box 13228, 2501 EE, The Hague, The Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Internal Medicine, University Medical Centre, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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13
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Consistency and Generalizability of Dietary Patterns in a Multiethnic Working Population. J Acad Nutr Diet 2018; 118:1249-1262.e3. [DOI: 10.1016/j.jand.2018.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/16/2018] [Indexed: 12/19/2022]
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14
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Movassagh EZ, Baxter-Jones ADG, Kontulainen S, Whiting S, Szafron M, Vatanparast H. Vegetarian-style dietary pattern during adolescence has long-term positive impact on bone from adolescence to young adulthood: a longitudinal study. Nutr J 2018; 17:36. [PMID: 29490662 PMCID: PMC6389064 DOI: 10.1186/s12937-018-0324-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/15/2018] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Elham Z. Movassagh
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic place, Saskatoon, SK S7N 2Z4 Canada
| | - Adam D. G. Baxter-Jones
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK S7N5B2 Canada
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK S7N5B2 Canada
| | - Susan Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic place, Saskatoon, SK S7N 2Z4 Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, 104 Clinic place, Saskatoon, SK S7N 5E5 Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic place, Saskatoon, SK S7N 2Z4 Canada
- School of Public Health, University of Saskatchewan, 104 Clinic place, Saskatoon, SK S7N 5E5 Canada
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15
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Craig JV, Bunn DK, Hayhoe RP, Appleyard WO, Lenaghan EA, Welch AA. Relationship between the Mediterranean dietary pattern and musculoskeletal health in children, adolescents, and adults: systematic review and evidence map. Nutr Rev 2018; 75:830-857. [PMID: 29028268 PMCID: PMC5939869 DOI: 10.1093/nutrit/nux042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Context: An understanding of the modifiable effects of diet on bone and skeletal muscle mass and strength over the life course will help inform strategies to reduce age-related fracture risk. The Mediterranean diet is rich in nutrients that may be important for optimal musculoskeletal health. Objective: The aim of this systematic review was to investigate the relationship between a Mediterranean diet and musculoskeletal outcomes (fracture, bone density, osteoporosis, sarcopenia) in any age group. Data Sources: Ten electronic databases were searched. Study Selection: Randomized controlled trials and prospective cohort studies that investigated a traditional Mediterranean diet, published in any language, were eligible. Studies using other designs or other definitions of the Mediterranean diet were collated separately in an evidence map. Data Extraction: Details on study design, methods, population, dietary intervention or exposure, length of follow-up, and effect on or association with musculoskeletal outcomes were extracted. Results: The search yielded 1738 references. Data from eligible randomized controlled trials (n = 0) and prospective cohort studies (n = 3) were synthesized narratively by outcome for the systematic review. Two of these studies reported on hip fracture incidence, but results were contradictory. A third study found no association between the Mediterranean diet and sarcopenia incidence. Conclusions: Overall, the systematic review and evidence map demonstrate a lack of research to understand the relationship between the Mediterranean diet and musculoskeletal health in all ages. Systematic Review Registration: PROSPERO registration number IDCRD42016037038.
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Affiliation(s)
- Jean V Craig
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Richard P Hayhoe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Will O Appleyard
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Elizabeth A Lenaghan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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16
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Associations of dietary patterns with bone mass, muscle strength and balance in a cohort of Australian middle-aged women. Br J Nutr 2017; 118:598-606. [PMID: 28990541 DOI: 10.1017/s0007114517002483] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Influences of dietary patterns on musculoskeletal health are poorly understood in middle-aged women. This cross-sectional analysis from a cohort of 347 women (aged 36-57 years) aimed to examine associations between dietary patterns and musculoskeletal health outcomes in middle-aged women. Diet was measured by the Cancer Council of Victoria FFQ. Total body bone mineral content (TB BMC), femoral neck and lumbar spine bone density (dual-energy X-ray absorptiometry), lower limbs muscle strength (LMS) and balance tests (timed up and go test, step test, functional reach test (FRT) and lateral reach test) were also measured. Exploratory factor analysis was used to identify dietary patterns and scores for each pattern generated using factor loadings with absolute values ≥0·20. Associations between food pattern scores and musculoskeletal outcomes were assessed using multivariable linear regression. Three dietary patterns were identified: 'Healthy' (high consumption of a plant-based diet - vegetables, legumes, fruit, tomatoes, nuts, snacks, garlic, whole grains and low intake of high-fat dairy products), 'high protein, high fat' (red meats, poultry, processed meats, potatoes, cruciferous and dark-yellow vegetables, fish, chips, spirits and high-fat dairy products) and 'Processed foods' (high intakes of meat pies, hamburgers, beer, sweets, fruit juice, processed meats, snacks, spirits, pizza and low intake of cruciferous vegetables). After adjustment for confounders, Healthy pattern was positively associated with LMS, whereas Processed foods pattern was inversely associated with TB BMC and FRT. The associations were not significant after accounting for multiple comparisons. There were no associations with any other outcomes. These results suggest that maintaining a healthy diet could contribute to bone acquisition, muscle strength and balance in adult life. However, while they provide some support for further investigating dietary strategies for prevention of age-related loss of muscle and deterioration in balance, the exploratory nature of the analyses means that confirmation in longitudinal studies and/or trials with pre-specified hypotheses is needed.
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17
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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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18
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Malmir H, Saneei P, Larijani B, Esmaillzadeh A. Adherence to Mediterranean diet in relation to bone mineral density and risk of fracture: a systematic review and meta-analysis of observational studies. Eur J Nutr 2017. [PMID: 28638994 DOI: 10.1007/s00394-017-1490-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to systematically review available data on the association between adherence to MD and BMD as well as risk of fractures and to summarize this information through a meta-analysis. METHODS Previous studies in the field of adherence to MD in relation to BMD and risk of fracture were selected through searching PubMed, Scopus, ISI Web of Science and Google Scholar databases prior to June, 2016 using Mesh and non-Mesh relevant keywords. RESULTS In the meta-analysis of four effect sizes, obtained from three studies, we found that adherence to MD was associated with a 21% reduced risk of hip fracture (overall RR 0.79; 95% CIs 0.72-0.87). Adherence to MD was positively associated with lumber spine's (mean difference of BMD comparing highest and lowest categories of MD score 0.12; 95% CI 0.06-0.19 g/cm2), femoral neck (0.10; 0.06-0.15 g/cm2) and total hip (0.11; 0.09-0.14 g/cm2) BMD. Meta-regression of included observational studies revealed a significant inverse linear association between Mediterranean diet score and risk of hip fracture, such that one unit increase in the score of Mediterranean diet was associated with a reduction in the risk of hip fracture (RR 0.95, 95% CI 0.92-0.98 p = 0.01). CONCLUSION Adherence to MD was associated with a reduced risk of fracture as well as with a higher mean BMD.
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Affiliation(s)
- Hanieh Malmir
- 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, PO Box 14155-6117, Tehran, Iran
| | - Parvane Saneei
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, PO Box 14114-13137, Tehran, Iran.
| | - Ahmad Esmaillzadeh
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box 14155-6117, Tehran, Iran. .,Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran.
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19
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Milk-cereal and whole-grain dietary patterns protect against low bone mineral density among male adolescents and young adults. Eur J Clin Nutr 2017; 71:1101-1107. [PMID: 28561037 DOI: 10.1038/ejcn.2017.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/06/2017] [Accepted: 04/20/2017] [Indexed: 11/08/2022]
Abstract
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.
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20
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Blekkenhorst LC, Hodgson JM, Lewis JR, Devine A, Woodman RJ, Lim WH, Wong G, Zhu K, Bondonno CP, Ward NC, Prince RL. Vegetable and Fruit Intake and Fracture-Related Hospitalisations: A Prospective Study of Older Women. Nutrients 2017; 9:nu9050511. [PMID: 28524097 PMCID: PMC5452241 DOI: 10.3390/nu9050511] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 12/03/2022] Open
Abstract
The importance of vegetable and fruit intakes for the prevention of fracture in older women is not well understood. Few studies have explored vegetable and fruit intakes separately, or the associations of specific types of vegetables and fruits with fracture hospitalisations. The objective of this study was to examine the associations of vegetable and fruit intakes, separately, and specific types of vegetables and fruits with fracture-related hospitalisations in a prospective cohort of women aged ≥70 years. Vegetable and fruit intakes were assessed at baseline (1998) in 1468 women using a food frequency questionnaire. The incidence of fracture-related hospitalisations over 14.5 years of follow-up was determined using the Hospital Morbidity Data Collection, linked via the Western Australian Data Linkage System. Fractures were identified in 415 (28.3%) women, of which 158 (10.8%) were hip fractures. Higher intakes of vegetables, but not fruits, were associated with lower fracture incidence. In multivariable-adjusted models for vegetable types, cruciferous and allium vegetables were inversely associated with all fractures, with a hazard ratio (HR) (95% confidence interval) of 0.72 (0.54, 0.95) and 0.66 (0.49, 0.88), respectively, for the highest vs. lowest quartiles. Increasing vegetable intake, with an emphasis on cruciferous and allium vegetables, may prevent fractures in older postmenopausal women.
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Affiliation(s)
- Lauren C Blekkenhorst
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6000, Australia.
| | - Jonathan M Hodgson
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6000, Australia.
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Joshua R Lewis
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Richard J Woodman
- Centre for Epidemiology and Biostatistics, School of Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia.
| | - Wai H Lim
- School of Medicine and Pharmacology, QEII Medical Centre Unit, University of Western Australia, Perth, WA 6009, Australia.
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
| | - Kun Zhu
- School of Medicine and Pharmacology, QEII Medical Centre Unit, University of Western Australia, Perth, WA 6009, Australia.
- Department of Endocrinology and Diabetes, and Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia.
| | - Catherine P Bondonno
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6000, Australia.
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Natalie C Ward
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6000, Australia.
- School of Biomedical Sciences & Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6102, Australia.
| | - Richard L Prince
- School of Medicine and Pharmacology, QEII Medical Centre Unit, University of Western Australia, Perth, WA 6009, Australia.
- Department of Endocrinology and Diabetes, and Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia.
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21
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de Jonge EA, Kiefte-de Jong JC, Hofman A, Uitterlinden AG, Kieboom BC, Voortman T, Franco OH, Rivadeneira F. Dietary patterns explaining differences in bone mineral density and hip structure in the elderly: the Rotterdam Study. Am J Clin Nutr 2017; 105:203-211. [PMID: 27903522 DOI: 10.3945/ajcn.116.139196] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/19/2016] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Ester Al de Jonge
- Department of Epidemiology and.,Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology and .,Department of Global Public Health, Leiden University College, The Hague, Netherlands
| | - Albert Hofman
- Department of Epidemiology and.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
| | - André G Uitterlinden
- Department of Epidemiology and.,Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands
| | - Brenda Ct Kieboom
- Department of Epidemiology and.,Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands.,Inspectorate for Health Care, Utrecht, Netherlands
| | | | | | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands
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22
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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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Denova-Gutiérrez E, Clark P, Tucker KL, Muñoz-Aguirre P, Salmerón J. Dietary patterns are associated with bone mineral density in an urban Mexican adult population. Osteoporos Int 2016; 27:3033-40. [PMID: 27198234 DOI: 10.1007/s00198-016-3633-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
| | - P Clark
- Hospital Infantil de Mexico Federico Gomez, Ciudad de México, Mexico.
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - K L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - P Muñoz-Aguirre
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México
| | - J Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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de Jonge EAL, Rivadeneira F, Erler NS, Hofman A, Uitterlinden AG, Franco OH, Kiefte-de Jong JC. Dietary patterns in an elderly population and their relation with bone mineral density: the Rotterdam Study. Eur J Nutr 2016; 57:61-73. [PMID: 27557817 PMCID: PMC5847075 DOI: 10.1007/s00394-016-1297-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/11/2016] [Indexed: 01/25/2023]
Abstract
Purpose Our aim was to identify dietary patterns that are associated with bone mineral density (BMD) against a background of relatively high dairy intake in elderly Dutch subjects. Methods Participants were 55 years of age and older (n = 5144) who were enrolled in The Rotterdam Study, a population-based prospective cohort study. Baseline intake of 28 pre-defined food groups was determined using a validated food frequency questionnaire. Dietary patterns were identified using principal component analysis. BMD was measured using dual-energy X-ray absorptiometry at baseline and at three subsequent visits (between 1993 and 2004). Linear mixed modelling was used to longitudinally analyse associations of adherence to each pattern with repeatedly measured BMD (both in Z scores). Results After adjustment for confounders, two dietary patterns were associated with high BMD: a “Traditional” pattern, characterized by high intake of potatoes, meat and fat (β = 0.06; 95 % CI 0.03, 0.09) and a “Health conscious” pattern, characterized by high intake of fruits, vegetables, poultry and fish (β = 0.06; 95 % CI 0.04, 0.08). The “Processed” pattern, characterized by high intake of processed meat and alcohol, was associated with low BMD (β = −0.03; 95 % CI −0.06, −0.01). Associations of adherence to the “Health conscious” and “Processed” pattern with BMD were independent of body weight and height, whereas the association between adherence to the “Traditional” pattern with BMD was not. Conclusions Against a background of high dairy intake and independent of anthropometrics, a “Health conscious” dietary pattern may have benefits for BMD, whereas a “Processed” dietary pattern may pose a risk for low BMD. Electronic supplementary material The online version of this article (doi:10.1007/s00394-016-1297-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ester A L de Jonge
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, PO box 2040, 3000, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, PO box 2040, 3000, Rotterdam, The Netherlands
| | - Nicole S Erler
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, PO box 2040, 3000, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, PO box 2040, 3000, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, PO box 2040, 3000, Rotterdam, The Netherlands. .,Department of Global Public Health, Leiden University College, PO box 13228, 2501, The Hague, The Netherlands.
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van den Hooven EH, Ambrosini GL, Huang RC, Mountain J, Straker L, Walsh JP, Zhu K, Oddy WH. Identification of a dietary pattern prospectively associated with bone mass in Australian young adults. Am J Clin Nutr 2015; 102:1035-43. [PMID: 26377163 DOI: 10.3945/ajcn.115.110502] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/07/2015] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
| | - Gina L Ambrosini
- School of Population Health and Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rae-Chi Huang
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - Leon Straker
- School of Physiotherapy, Curtin University, Perth, Australia
| | - John P Walsh
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Kun Zhu
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Wendy H Oddy
- Telethon Kids Institute, University of Western Australia, Perth, Australia;
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Development of a Food Group-Based Diet Score and Its Association with Bone Mineral Density in the Elderly: The Rotterdam Study. Nutrients 2015; 7:6974-90. [PMID: 26295256 PMCID: PMC4555156 DOI: 10.3390/nu7085317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/31/2015] [Accepted: 08/11/2015] [Indexed: 11/28/2022] Open
Abstract
No diet score exists that summarizes the features of a diet that is optimal for bone mineral density (BMD) in the elderly. Our aims were (a) to develop a BMD-Diet Score reflecting a diet that may be beneficial for BMD based on the existing literature, and (b) to examine the association of the BMD-Diet Score and the Healthy Diet Indicator, a score based on guidelines of the World Health Organization, with BMD in Dutch elderly participating in a prospective cohort study, the Rotterdam Study (n = 5144). Baseline dietary intake, assessed using a food frequency questionnaire, was categorized into food groups. Food groups that were consistently associated with BMD in the literature were included in the BMD-Diet Score. BMD was measured repeatedly and was assessed using dual energy X-ray absorptiometry. The BMD-Diet Score considered intake of vegetables, fruits, fish, whole grains, legumes/beans and dairy products as “high-BMD” components and meat and confectionary as “low-BMD” components. After adjustment, the BMD-Diet Score was positively associated with BMD (β (95% confidence interval) = 0.009 (0.005, 0.012) g/cm2 per standard deviation). This effect size was approximately three times as large as has been observed for the Healthy Diet Indicator. The food groups included in our BMD-Diet Score could be considered in the development of future dietary guidelines for healthy ageing.
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Byberg L, Bellavia A, Orsini N, Wolk A, Michaëlsson K. Fruit and vegetable intake and risk of hip fracture: a cohort study of Swedish men and women. J Bone Miner Res 2015; 30:976-84. [PMID: 25294687 DOI: 10.1002/jbmr.2384] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/03/2014] [Indexed: 01/11/2023]
Abstract
Dietary guidelines recommend a daily intake of 5 servings of fruits and vegetables. Whether such intakes are associated with a lower risk of hip fracture is at present unclear. The aim of the present study was to investigate the dose-response association between habitual fruit and vegetable intake and hip fracture in a cohort study based on 40,644 men from the Cohort of Swedish Men (COSM) and 34,947 women from the Swedish Mammography Cohort (SMC) (total n = 75,591), free from cardiovascular disease and cancer, who answered lifestyle questionnaires in 1997 (age 45 to 83 years). Intake of fruits and vegetables (servings/day) was assessed by food frequency questionnaire and incident hip fractures were retrieved from the Swedish Patient Register (1998 to 2010). The mean follow-up time was 14.2 years. One-third of the participants reported an intake of fruits and vegetables of >5 servings/day, one-third reported >3 to ≤5 servings/day, 28% reported >1 to ≤3 servings/day, and 6% reported ≤1 serving/day. During 1,037,645 person-years we observed 3644 hip fractures (2266 or 62% in women). The dose-response association was found to be strongly nonlinear (p < 0.001). Men and women with zero consumption had 88% higher rate of hip fracture compared with those consuming 5 servings/day; adjusted hazard ratio (HR) was 1.88 (95% CI, 1.53 to 2.32). The rate was gradually lower with higher intakes; adjusted HR for 1 versus 5 servings/day was 1.35 (95% CI, 1.21 to 1.58). However, more than 5 servings/day did not confer additionally lower HRs (adjusted HR for 8 versus 5 servings/day was 0.96; 95% CI, 0.90 to 1.03). Similar results were observed when men and women were analyzed separately. We conclude that there is a dose-response association between fruit and vegetable intake and hip fracture such that an intake below the recommended five servings/day confers higher rates of hip fracture. Intakes above this recommendation do not seem to further lower the risk.
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Affiliation(s)
- Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Andrea Bellavia
- Institute of Environmental Medicine, Unit of Nutritional Epidemiology, Karolinska Institutet, Solna, Sweden
| | - Nicola Orsini
- Institute of Environmental Medicine, Unit of Nutritional Epidemiology, Karolinska Institutet, Solna, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Unit of Nutritional Epidemiology, Karolinska Institutet, Solna, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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Dietary patterns and bone mineral density in Brazilian postmenopausal women with osteoporosis: a cross-sectional study. Eur J Clin Nutr 2015; 70:85-90. [PMID: 25804275 DOI: 10.1038/ejcn.2015.27] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/15/2014] [Accepted: 01/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to investigate the association between dietary patterns and bone mineral density (BMD) in postmenopausal women with osteoporosis. SUBJECTS/METHODS This cross-sectional study included 156 postmenopausal and osteoporotic Brazilian women aged over 45 years. BMD of lumbar spine, total femur (TF), femoral neck and of total body (TB), as well as body composition (fat and lean mass), was assessed by dual-energy X-ray absorptiometry. Body mass index and lifestyle information were also obtained. Dietary intake was assessed by using a 3-day food diary. Dietary patterns were obtained by principal component factor analysis. Adjusted multiple linear regression analysis was applied in order to evaluate the predictive effect of dietary patterns on BMD. Significance was set at P<0.05. RESULTS Five patterns were retained: 'healthy', 'red meat and refined cereals', 'low-fat dairy', 'sweet foods, coffee and tea' and 'Western'. The 'sweet foods, coffee and tea' pattern was inversely associated with TF BMD (β=-0.178; 95% CI: -0.039 to -0.000) and with TB BMD (β=-0.320; 95% CI: -0.059 to -0.017) even after adjusting for energy and calcium intake, lean mass, age and postmenopausal time. CONCLUSIONS A concomitant excessive consumption of sweet foods and caffeinated beverages appears to exert a negative effect on BMD even when the skeleton already presents some demineralization. Food and beverage intake is a modifiable factor that should not be neglected in the treatment of individuals with osteoporosis.
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Shin S, Sung J, Joung H. A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults. Eur J Clin Nutr 2014; 69:442-8. [PMID: 25351648 DOI: 10.1038/ejcn.2014.231] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 08/10/2014] [Accepted: 09/29/2014] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- S Shin
- 1] Graduate School of Public Health, Seoul National University, Seoul, Korea [2] Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - J Sung
- 1] Graduate School of Public Health, Seoul National University, Seoul, Korea [2] Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - H Joung
- 1] Graduate School of Public Health, Seoul National University, Seoul, Korea [2] Institute of Health and Environment, Seoul National University, Seoul, Korea
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Monjardino T, Lucas R, Ramos E, Lopes C, Gaio R, Barros H. Associations between a posteriori defined dietary patterns and bone mineral density in adolescents. Eur J Nutr 2014; 54:273-82. [PMID: 24806081 DOI: 10.1007/s00394-014-0708-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/24/2014] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Teresa Monjardino
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal,
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Monjardino T, Lucas R, Ramos E, Barros H. Associations between a priori-defined dietary patterns and longitudinal changes in bone mineral density in adolescents. Public Health Nutr 2014; 17:195-205. [PMID: 23149164 PMCID: PMC10282249 DOI: 10.1017/s1368980012004879] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 09/18/2012] [Accepted: 09/21/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To quantify short- and long-term associations between dietary patterns defined a priori and bone mineral density (BMD) during adolescence. DESIGN Dietary patterns were defined at 13 years old using a Mediterranean diet (MD) quality index, the Dietary Approaches to Stop Hypertension (DASH) diet index and the Oslo Health Study (OHS) dietary index. Linear regression coefficients were used to estimate associations between dietary patterns and forearm BMD at 13 and 17 years, measured by dual-energy X-ray absorptiometry. SETTING Public and private schools of Porto, Portugal. SUBJECTS The EPITeen cohort comprising 1180 adolescents born in 1990, recruited at schools during the 2003/2004 school year and re-evaluated in 2007/2008. RESULTS In girls, at 13 years, mean BMD (g/cm2) in the first and third tertiles was 0·369 and 0·368 for the MD pattern, 0·368 and 0·369 for the DASH diet, and 0·370 and 0·363 for the OHS index. In boys, mean BMD (g/cm2) in the first and third tertiles was 0·338 and 0·347 for the MD pattern, 0·342 and 0·346 for the DASH diet, and 0·344 and 0·342 for the OHS index. None of these differences were significant. Mean BMD at 17 years and prospective variation were also not significantly different between tertiles of adherence to each score. However, a trend of increased BMD at 13 years with greater adherence to the MD pattern was observed in boys (adjusted coefficient = 0·248; 95% CI 0·052, 0·444). CONCLUSIONS The selected dietary patterns may not capture truly important dietary differences in determining BMD or diet may not be, beyond nutrient adequacy, a limiting determinant of BMD.
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Affiliation(s)
- Teresa Monjardino
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Al Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute of Public Health of the University of Porto, Porto, Portugal
| | - Raquel Lucas
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Al Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute of Public Health of the University of Porto, Porto, Portugal
| | - Elisabete Ramos
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Al Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute of Public Health of the University of Porto, Porto, Portugal
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Al Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute of Public Health of the University of Porto, Porto, Portugal
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Abstract
PURPOSE OF REVIEW Both dietary and nondietary factors contribute to iron deficiency, the most common nutritional deficiency worldwide. Identifying dietary factors associated with iron deficiency is challenging due to the number of components in food affecting iron absorption. This review describes recent advances in dietary approaches to assessing iron-related nutrition. RECENT FINDINGS Most research investigating the relationship between dietary intake and iron deficiency has focussed on individual foods and nutrients, despite several components in foods influencing iron absorption. More recently, studies have considered the overall diet and combinations of foods eaten, through the analysis of dietary patterns and practices. This includes the development and validation of dietary assessment tools to assess iron-related dietary patterns. SUMMARY Dietary pattern analysis which considers the whole diet and combinations of foods eaten may enhance our understanding of how diet impacts on iron deficiency. The analysis of dietary patterns offers an alternative and complementary approach to the traditional focus on individual foods and nutrients when investigating dietary factors associated with iron deficiency.
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Affiliation(s)
- Kathryn L Beck
- aInstitute of Food Nutrition and Human Health, Massey University, North Shore City bDepartment of Human Nutrition, University of Otago, Dunedin, New Zealand
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Zeng FF, Wu BH, Fan F, Xie HL, Xue WQ, Zhu HL, Chen YM. Dietary patterns and the risk of hip fractures in elderly Chinese: a matched case-control study. J Clin Endocrinol Metab 2013; 98:2347-55. [PMID: 23585662 DOI: 10.1210/jc.2013-1190] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Many studies have investigated the effects of individual foods or nutrients on bone health, but limited research has focused on dietary patterns. PURPOSE We examined the association of dietary patterns with the risk of hip fractures in elderly Chinese. DESIGN This 1:1 age- (±3 years) and gender-matched case-control study were performed between June 2009 and June 2012. SETTING The study was conducted in Guangdong Province, China. PARTICIPANTS A total of 581 pairs of hip fracture incident cases and controls (71 ± 7 years) were studied. Face-to-face interviews were conducted to assess dietary intake using a 79-item food frequency questionnaire, whereas general information was collected using structured questionnaires. Dietary patterns were identified by a principal components factor analysis. Univariate and multivariate conditional logistic regression were used to analyze the association. MAIN RESULT We identified 4 dietary patterns: healthy, prudent, traditional, and high-fat. Dose-dependent lower risks of hip fracture were observed in relation to higher scores in the healthy dietary pattern related to high fruit and vegetable intake and in the prudent pattern typified by a higher intake of nuts, mushrooms, algae, and seafood but lower in grains, whereas the same were associated with lower scores in the high-fat dietary pattern (all P trend < .05). The adjusted odds ratios (95% confidence intervals) for hip fractures, comparing the extreme tertiles of the 3 patterns, were 0.42 (0.24-0.73) for healthy, 0.51 (0.28-0.90) for prudent, and 2.25 (1.38-3.69) for high-fat. No significant association was found between the traditional dietary pattern (with a high intake of Chinese herbal tea, double stewed soup, processed meat and fish, and organ meat) and hip fracture risk. CONCLUSIONS Our findings suggest that the consumption of a healthy or prudent dietary pattern can protect against hip fractures, whereas a high-fat pattern promotes the incidence of such fractures.
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Affiliation(s)
- Fang-fang Zeng
- Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
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A dairy and fruit dietary pattern is associated with a reduced likelihood of osteoporosis in Korean postmenopausal women. Br J Nutr 2013; 110:1926-33. [PMID: 23578480 DOI: 10.1017/s0007114513001219] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to identify the association of dietary patterns with osteoporosis in Korean postmenopausal women from the Korean Health and Nutrition Examination Survey 2008–10. The present cross-sectional analysis included 3735 postmenopausal women who completed a health interview, nutrition survey and a health examination including bone mineral density (BMD) measurements. The general characteristics and dietary intakes of the participants were obtained using a standardised questionnaire and a 24 h recall method, respectively. The BMD of the femoral neck and lumbar spine was measured using dual-energy X-ray absorptiometry; osteoporosis was defined based on the WHO T-score criteria. Overall, we identified four dietary patterns using factor analysis as follows: 'meat, alcohol and sugar', 'vegetables and soya sauce', 'white rice, kimchi and seaweed' and 'dairy and fruit', which accounted for 30·9% of the total variance in food intake (11·3, 7·7, 6·0 and 5·9%, respectively). The subjects in the highest quintile of the 'dairy and fruit' pattern showed a decreased risk of osteoporosis of the lumbar spine (53 %) compared with those in the lowest quintile, after adjusting for covariates (OR 0·47, 95% CI 0·35, 0·65, P for trend<0·0001). In contrast, the 'white rice, kimchi and seaweed' dietary pattern was negatively associated with bone health (OR 1·40, 95% CI 1·03, 1·90, P for trend=0·0479). The present results suggest that an increased intake of dairy foods and fruits in the traditional Korean diet, based on white rice and vegetables, may decrease the risk of osteoporosis in Korean postmenopausal women.
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