Positive Association between Dietary Inflammatory Index and the Risk of Osteoporosis: Results from the KoGES_Health Examinee (HEXA) Cohort Study

Associations of dietary inflammatory index scores and serum inflammatory factors with the risk of osteoporosis: a cross-sectional study from Xinjiang, China

BACKGROUND

Previous studies have shown that the inflammatory potential of the diet is associated with a variety of chronic noncommunicable diseases characterized by a chronic low-grade inflammatory response. However, the relationships between dietary inflammatory potential and organismal inflammatory status and osteoporosis have been less studied. This study aimed to investigate the relationships among inflammatory diet, inflammatory state and osteoporosis in the Xinjiang multiethnic population.

METHODS

The participants consisted of 4452 adults aged 35 to 74 years from Xinjiang, China. The dietary inflammatory index (DII) was calculated using dietary data collected with a semiquantitative food frequency questionnaire, and information about osteoporosis was derived from quantitative ultrasound measurements. The relationships of the DII score and inflammatory factors with the risk of osteoporosis were analysed using multivariate logistic regression, and the nonlinear associations between DII and osteoporosis were further analysed using restricted cubic splines.

RESULTS

The results showed that proinflammatory diets were associated with a greater risk of osteoporosis (T3 vs. T1: OR = 1.87; 95% CI = 1.44, 2.45) and that there was no nonlinear relationship between the DII and the risk of osteoporosis. Increased concentrations of the inflammatory factors IL-6, IL-10, IL-12p70, IL-17, and IL-23 were associated with a greater risk of osteoporosis.

CONCLUSIONS

The risk of osteoporosis can be reduced by increasing the consumption of an appropriate anti-inflammatory diet.

Nutrition-Based Support for Osteoporosis in Postmenopausal Women: A Review of Recent Evidence

Postmenopausal osteoporosis stands as the predominant bone disorder in the developed world, posing a significant public health challenge. Nutritional factors play a crucial role in bone health and may contribute to its prevention or treatment. Calcium and vitamin D, extensively studied with robust scientific evidence, are integral components of the non-pharmacological treatment for this disorder. Nevertheless, other less-explored nutritional elements appear to influence bone metabolism. This review provides a comprehensive summary of the latest evidence concerning the relationship between various nutrients, such as phosphorus, magnesium, vitamins, phytate, and phytoestrogens; specific foods like dairy or soy, and dietary patterns such as the Mediterranean diet with bone health and osteoporosis.

Positive relation between dietary inflammatory index and osteoporosis in postmenopausal women

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

Association of Physical Activity with Phenotypic Age among Populations with Different Breakfast Habits

BACKGROUND

The global aging situation has reached a serious stage, and healthy lifestyles, like regular physical activity and eating breakfast, could slow the process. Phenotypic age (PhenoAge) is regarded as a novel measure of aging. Therefore, our study aimed to quantify the impact of physical activity and eating breakfast on aging via PhenoAge and phenotypic age acceleration (PhenoAgeAccel).

METHODS

A total of 3719 adults who participated in the National Health and Nutrition Examination Survey were involved in this study. Physical activity was divided into an active group and an inactive group. According to the number of reported breakfast recalls, eating breakfast was divided into the no recalls group, one recall group, and both recalls group. Sensitivity analysis was performed by stratified analysis.

RESULTS

Active physical activity was a protective factor for PhenoAge and PhenoAgeAccel. Compared to the inactive group, the β values of the active group were -8.36 (-10.09, -6.62) for PhenoAge and -1.67 (-2.21, -1.14) for PhenoAgeAccel. The stratified analysis results showed that in the groups reporting breakfast in both recalls, one recall, and no recalls, the β values of the active group were -8.84 (-10.70, -6.98), -8.17 (-12.34, -4.00), and -3.46 (-7.74, 0.82), respectively, compared to the inactive group.

CONCLUSIONS

Active physical activity was strongly correlated with lower values of PhenoAge and PhenoAgeAccel, but the association was no longer statistically significant when combined with not regularly eating breakfast.

The relationship between dietary inflammatory index and osteoporosis among chronic kidney disease population

Dietary inflammation index (DII) is an epidemiological survey tool to evaluate dietary inflammation potential. Osteoporosis, whose development is deeply affected by inflammation, may be also affected by dietary inflammatory patterns. However, the relationship between DII and osteoporosis is unclear for chronic kidney disease (CKD) population. Our study involved 526 CKD patients from the US National Health and Nutrition Examination Survey (NHANES). DII levels were stratified into four quantile groups. Multivariable regression models were used to examine the association between DII and osteoporosis. Restricted cubic splines and subgroup analysis were additionally adopted. Results showed that the overall prevalence of osteoporosis among CKD patients was 25.3%. After fully adjusted, OR (95% confidence interval) for Q4 group compared with Q3 (reference group) in total and female population were 2.09 (1.05, 4.23) and 2.80 (1.14, 7.08), respectively. Subgroup analysis indicated that these results had no interaction with age, gender, body mass index (BMI), renal function, urinary protein, calcium, phosphorus and total 25-hydroxyvitamin D. DII was negatively correlated with lumbar spine bone mineral density (BMD) in CKD population (P < 0.05). Therefore, in CKD patients, higher DII was associated with higher osteoporosis risk and lower BMD of lumber spine, especially in female. Anti-inflammatory diet patterns may be a protective intervention for some CKD-related osteoporosis.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association between dietary inflammatory potential and the probable sarcopenia among community-dwelling older adults: a cross-sectional study

BACKGROUND

Unlike the numerous studies concerning the role of dietary inflammatory potential in chronic diseases, limited studies focused on the association of dietary inflammatory potential with handgrip strength (HGS) and probable sarcopenia (PS). This study tends to explore the association between dietary inflammatory potential and PS among older adults in Tehran.

METHODS

The cross-sectional study was conducted between May and October 2019 on 201 randomly selected older adults in Tehran, Iran. A validated food frequency questionnaire was utilized for recording dietary intake. Dietary habits were evaluated through Dietary Inflammatory Index (DII) and Empirical Dietary Inflammatory Index (EDII). PS assessment was done by HGS estimation. Statistical evaluation included descriptive analyses, logistic, and linear regression.

RESULTS

Those probably suffering from sarcopenia were older than healthy ones (p < 0.0001) and had significantly higher DII scores (p = 0.05) but not EDII (p = 0.85). Besides, PS subjects had a lower intake of anti-inflammatory nutrients. The odds of PS were doubled in people on the top tertile of DII (OR = 2.49, 95% (CI) = 1.11-5.58) and second tertile of EDII (OR = 2.29, 95% (CI) = 1.03-5.07) relative to bottom tertiles after adjusting for confounders. The relationships between index scores and HGS were simply significant in the adjusted model of EDII and HGS (B = -0.49, p = 0.04).

CONCLUSION

Conclusively, participants adhering to a pro-inflammatory diet had more likelihood of PS. Findings are in line with current recommendations to reduce unhealthy foods with more inflammatory potential. These findings warrant confirmation in high-quality interventional studies.

Dietary inflammatory index and bone mineral density in Mexican population

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

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

A meta-analysis of dietary inflammatory index and bone health status

Background

The inflammatory potential of diets is associated with several diseases and can affect bone health. We aimed to systematically review and pool the current evidence on the association of DII with bone health in observational studies.

Methods

We searched PubMed and NLM Gateway (for Medline), Web of Science, Scopus and EMBASE up to December 16, 2020 for studies that examined the relationship between DII score and bone mineral density (BMD) or fracture. All observational studies were included in this meta-analysis. Heterogeneity between studies was evaluated using Cochran Q-statistic and I2 statistics. Random effect meta-analysis method was used to pool the effect size. Stratified meta-analysis according to the type of study (cohort/ non-cohort) was performed to assess the relationship of DII with BMD and fracture.

Results

In total, 13 articles were included in the present systematic review, including five cohorts, five cross-sectional, and three case-control studies. The total sample size of these studies was 211,938 individuals aged 5 to 85 years. According to random-effect meta-analysis, DII was associated with increased odds of fracture in non-cohort studies (pooled OR=1.42, 95%CI: 1.17, 1.67), but this association was not statistically significant in cohort studies (pooled OR=1.03, 95%CI: 0.97, 1.09). Moreover, only in non-cohort studies, the mean of BMD in subjects in the highest DII category was significantly lower than those in the lowest DII category (SMD: -9.59, 95%CI: -10.84,-8.33).

Conclusions

Our findings showed that high score of DII can have devastating effects on bone health. Further longitudinal studies are necessary to confirm these findings among more diverse populations.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Associations of dietary and lifestyle oxidative balance scores with mortality risk among older women: the Iowa Women's Health Study

PURPOSE

Substantial basic science evidence suggests that oxidative stress may play a role in aging-related health outcomes, including cardiovascular diseases (CVD) and cancer, and oxidative stress markers were linked with all-cause and cause-specific mortality in epidemiologic studies. However, the associations of many individual dietary and lifestyle anti-/pro-oxidant exposures with mortality are inconsistent. Oxidative balance scores (OBS) that incorporated multiple dietary and lifestyle factors were previously developed and reported to reflect the collective oxidative effects of multiple exposures.

METHODS

We investigated associations of 11-component dietary and 4-component (physical activity, adiposity, alcohol, and smoking) lifestyle OBS (higher scores were considered more anti-oxidative) with all-cause and cause-specific mortality among women 55-69 years of age at baseline in the prospective Iowa Women's Health Study (1986-2012). We assessed OBS-mortality associations using multivariable Cox proportional hazards regression.

RESULTS

Of the 34,137 cancer-free women included in the analytic cohort, 18,058 died (4521 from cancer, and 6825 from CVD) during a mean/median 22.0/26.1 person-years of follow-up. Among participants in the highest relative to the lowest lifestyle OBS quintiles, the adjusted hazards ratios and their 95% confidence intervals for all-cause, all-cancer, and all-CVD mortality were 0.50 (0.48, 0.53), 0.47 (0.43, 0.52), and 0.54 (0.50, 0.58) (all P_trend < 0.001), respectively. The associations of the dietary OBS with mortality were close to null.

CONCLUSION

Our findings, combined with results from previous studies, suggest that a predominance of antioxidant over pro-oxidant lifestyle exposures may be associated with lower all-cause, all-CVD, and all-cancer mortality risk.

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

Our systematic review and meta-analysis indicated that pro-inflammatory diets, as measured by higher Dietary Inflammatory Index scores, are significantly associated with lower BMD of lumbar spine and total hip as well as elevated risk of osteoporosis and fractures. These findings may contribute to the development of public health strategies.

INTRODUCTION

Inflammatory Index (DII) is a method to assess the inflammatory potential of diets; it has been reported to be associated with several diseases. However, the relation between DII and bone health remains controversial for the inconsistent findings from previous studies. This systematic review and meta-analysis aimed to ascertain the underlying relationships between DII and bone mineral density (BMD), osteoporosis risk, and fracture risk.

METHODS

We systematically searched PubMed and Web of Science for all relevant epidemiological studies published up to May 1, 2020. Fixed-effects model or random-effects model was employed to pool the study-specific effect sizes (ESs) and 95% confidence intervals (CIs).

RESULTS

Eleven studies with a total of 127,769 participants were included. We found that continuous DII was negatively associated with BMD of lumbar spine (odds ratios [OR]: 0.990; 95% CI: 0.984, 0.995) and total hip (OR: 0.995; 95% CI: 0.990, 0.999), but not femoral neck (OR: 0.998; 95% CI: 0.994, 1.002). Moreover, the highest category of DII displayed significantly associations to increased risk of osteoporosis (ES: 1.31; 95% CI: 1.16, 1.48) and fractures (ES: 1.28; 95% CI: 1.03, 1.59) compared with the lowest category of DII, respectively.

CONCLUSION

Our analysis indicated that diets with high pro-inflammatory components might increase the risk of osteoporosis and fractures and lower BMD of lumbar spine and total hip. More prospective studies involving populations of diverse ages and genders are expected to further verify the universality of the results.

Energy Metabolism and Ketogenic Diets: What about the Skeletal Health? A Narrative Review and a Prospective Vision for Planning Clinical Trials on this Issue

The existence of a common mesenchymal cell progenitor shared by bone, skeletal muscle, and adipocytes cell progenitors, makes the role of the skeleton in energy metabolism no longer surprising. Thus, bone fragility could also be seen as a consequence of a “poor” quality in nutrition. Ketogenic diet was originally proven to be effective in epilepsy, and long-term follow-up studies on epileptic children undergoing a ketogenic diet reported an increased incidence of bone fractures and decreased bone mineral density. However, the causes of such negative impacts on bone health have to be better defined. In these subjects, the concomitant use of antiepileptic drugs and the reduced mobilization may partly explain the negative effects on bone health, but little is known about the effects of diet itself, and/or generic alterations in vitamin D and/or impaired growth factor production. Despite these remarks, clinical studies were adequately designed to investigate bone health are scarce and bone health related aspects are not included among the various metabolic pathologies positively influenced by ketogenic diets. Here, we provide not only a narrative review on this issue, but also practical advice to design and implement clinical studies on ketogenic nutritional regimens and bone health outcomes. Perspectives on ketogenic regimens, microbiota, microRNAs, and bone health are also included.

Interaction effects of co-consumption of fast food and sugar-sweetened beverages on psychological symptoms: Evidence from a nationwide survey among Chinese adolescents

BACKGROUND

Although fast food and sugar-sweetened beverages (SSBs) consumption have been closely linked to childhood and adolescent obesity, the data regarding their co-consumption and relationship to mental health remains controversial.

METHODS

A multi-centered population-based survey was conducted among Chinese adolescents from grades 7 to 12. Data about participants' consumption of fast foods and SSBs were obtained from self-reported questionnaires. Psychological symptoms were assessed using the Multi-dimensional Sub-health Questionnaire of Adolescents (MSQA). The association between co-consumption of fast food and SSBs and psychological symptoms was assessed using quantile regression analysis, adjusting for covariates.

RESULTS

Approximately one-fifth of the 14,500 participants reported psychological symptoms. The regression coefficient (β) value increased as the quantile of fast food, SSBs, and co-consumption increased in the quantile regression model, and the model had an excellent goodness-of-fit (F = 192.51, p < 0.001). In the interaction model, fast food and SSBs in combination were associated with greater odds of psychological symptoms (aOR = 1.90, 95% CI: 1.69, 2.12). The synergy index, relative excess risk of interaction, and attributable proportions were 1.86 (95% CI: 1.17, 2.96), 0.4 (95% CI: 0.20, 0.63), and 0.22 (95% CI: 0.11, 0.33), respectively.

LIMITATIONS

Information bias is inevitable in self-reported data among participants. The ability to assess causal relationships is reduced by a cross-sectional study design.

CONCLUSIONS

Our findings suggest that co-consumption of fast food and SSBs was cross-sectionally associated with mental health problems among adolescents.

The inflammatory potential of Argentinian diet and oral squamous cell carcinoma

Introduction

Introduction: the goal of this study was to evaluate whether an association exists between dietary components related to inflammation and oral squamous cell carcinoma (OSCC) in Argentina. Methods: a case-control study was carried out with 3 controls for each case and participants of both genders who were between 24 and 85 years of age, who were recruited at the outpatient clinic, Odontology School, Universidad Nacional de Córdoba, between 2012 and 2015. Dietary information was collected using a semi-quantitative food frequency questionnaire from which energy-adjusted Dietary Inflammatory Index (E-DIITM) scores were computed. Logistic regression models were fit to assess the association between E-DII and OSCC. Results: significantly higher intakes of macronutrients such as fat, protein and cholesterol, and of micronutrients such as iron, riboflavin, monounsaturated, polyunsaturated, omega-6 and omega-3 fatty acids, and vitamin B6 were observed in cases as compared to controls (all p < 0.05). We also observed a significant 69% increase in OSCC for each point on the E-DII scale (OR 1.69, 95% CI [1.18-2.43]) after adjusting for alcohol and tobacco consumption. Conclusion: we found an association between diet-associated inflammation, as represented by the E-DII, and risk of OSCC. Future research should be directed at deepening our understanding of this association in other populations, and should include studies utilizing prospective designs.

The Preoperative Dietary Inflammatory Index Predicts Changes in Cardiometabolic Risk Factors After 12 Months of Roux-en-Y Gastric Bypass

BACKGROUND

The objective of this study was to evaluate Dietary Inflammatory Index (DII®) in the preoperative period as well as 3 and 12 months post-surgery and its association with cardiometabolic risk factors after RYGB.

MATERIALS AND METHODS

This is a prospective cohort study of 50 patients (both sexes) who underwent RYGB. All data were collected in 3 phases: before surgery, 3, and 12 months post-surgery. To calculate DII scores, we utilized mean nutrients from three 24-h recalls at each time point.

RESULTS

The patients had median age of 39.1 ± 7.9 years (70% women). Mean preoperative DII® score of 0.39 ± 1.49 was slightly pro-inflammatory. Mean DII score reduced to - 1.52 ± 1.27 after 3 months post-surgery and was classified anti-inflammatory. This value rebounded to - 0.88 ± 1.49 at 12 months but was still anti-inflammatory. From the adjusted linear regression analysis, we observed that preoperative DII score was statistically associated with variations in neck circumference (β = - 0.50; p = 0.03), waist-hip ratio (β = 0.01; p = 0.02), total cholesterol (β = 6.47; p = 0.002), and LDL cholesterol (β = 6.42; p = 0.001) after 12 months post-surgery. Changes in DII® at 3 and 12 months were not associated with changes in cardiometabolic risk factors.

CONCLUSION

We observe significant changes in the inflammation potential of diet after 3 and 12 months of RYGB. Patients with higher preoperative E-DII scores have a greater metabolic improvement after 12 months of surgery.

Proinflammatory Dietary Intake is Associated with Increased Risk of Metabolic Syndrome and Its Components: Results from the Population-Based Prospective Study

Metabolic syndrome (MetS) is a major public health challenge throughout the world, although studies on its association with the inflammatory potential of diet are inconsistent. The aim of this prospective study was to assess the association between the Dietary Inflammatory Index (DII^®) and the risk of MetS and its components in a Korean population. Data from 157,812 Korean adults (mean age 52.8 years; 53,304 men and 104,508 women with mean follow-up of 7.4 years) collected by members of the Korean Genome and Epidemiology Study form the basis for this report. DII scores were calculated based on Semi-Quantitative Food-Frequency Questionnaire data. Multivariable-adjusted Cox proportional hazard models were used to estimate the association between DII scores and MetS. In women, higher DII scores (pro-inflammatory diet) increased the risk of MetS (hazard ratio [HR]_{quintile5 v. 1} 1.43; 95% confidence interval (CI) 1.21–1.69; p for trend ≤ 0.0001) and its five components. A positive association was observed for postmenopausal women, with a 50% higher risk of developing MetS (HR_{quintile5 v. 1} 1.50; 95% CI 1.23–1.83; p for trend = 0.0008) after fully adjusting for potential confounders. Irrespective of the menopausal status of women, higher DII (=Q5) scores were positively associated with all 5 components of MetS (p < 0.05). In men, higher DII scores significantly increased the risk of low HDL cholesterol [HR]_{quintile5 v. 1} 1.59 (1.27–1.99); p for trend = 0.0001], elevated waist circumferences [HR]_{quintile5 v. 1} 1.28 (1.08–1.52); p for trend = 0.01], and high blood pressure [HR]_{quintile5 v. 1} 1.17 (1.03–1.32); p for trend = 0.05]. These results indicate that diet with pro-inflammatory potential, as represented by higher DII scores, is prospectively associated with increased risk of MetS, and the relationship is stronger in women than in men.

Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII^®) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]_{Quintile 5 vs. 1} 1.43; 95% CI 1.04–1.96) and in women (HR_{Quintile 5 vs. 1} 1.19; 95% CI 0.85–1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HR_{Quintile 5 vs. 1} 1.80; 95% CI 1.03–3.12), obese men (HR_{Quintile 5 vs. 1} 1.77; 95% CI 1.13–2.76) and men who smoked (HR_{Quintile 5 vs. 1} 1.60; 95% CI 1.10–2.33), respectively. The risk of developing stroke was significantly higher for men (HR_{Quintile 5 vs. 1} 2.06; 95% CI 1.07–3.98; p = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.

Bone Marrow Adipose Tissue Quantification by Imaging

PURPOSE OF REVIEW

The significance and roles of marrow adipose tissue (MAT) are increasingly known, and it is no more considered a passive fat storage but a tissue with significant paracrine and endocrine activities that can cause lipotoxicity and inflammation.

RECENT FINDINGS

Changes in the MAT volume and fatty acid composition appear to drive bone and hematopoietic marrow deterioration, and studying it may open new horizons to predict bone fragility and anemia development. MAT has the potential to negatively impact bone volume and strength through several mechanisms that are partially described by inflammaging and lipotoxicity terminology. Evidence indicates paramount importance of MAT in age-associated decline of bone and red marrow structure and function. Currently, MAT measurement is being tested and validated by several techniques. However, purpose-specific adaptation of existing imaging technologies and, more importantly, development of new modalities to quantitatively measure MAT are yet to be done.

Higher Pro-Inflammatory Dietary Score is Associated with Higher Hyperuricemia Risk: Results from the Case-Controlled Korean Genome and Epidemiology Study_Cardiovascular Disease Association Study

In previous studies, the elevated dietary inflammatory index (DII®) scores have been consistently associated with several chronic diseases. However, the relationship with hyperuricemia remains unknown. The aim of this study was to determine if the DII is associated with hyperuricemia risk. The study included 13,701 participants (men 5102; women 8599) in a large-scale cross-sectional study in South Korea. A validated semi-quantitative food frequency questionnaire (SQFFQ) was used to measure dietary intake, and blood samples were obtained to determine hyperuricemia. As the DII score increased, the hyperuricemia risk increased among women (OR 1.35, 95% CI 1.03-1.77, p trend = 0.02). However, no significant results were found for men. Women with lower BMI scores had higher risks of hyperuricemia with higher DII scores (OR 1.62, 95% CI 1.05-2.52, p trend = 0.03). As the DII increased, however, only women who consumed alcohol ("past or current drinkers") had higher risks of hyperuricemia (OR 1.92, 1.22-3.02, p trend = 0.004). Among the DII components, intake of flavonoids showed a significant association with the hyperuricemia risk in women (OR 0.75, 0.59-0.96, p trend = 0.03). Our results suggest that higher intake of pro-inflammatory diet is significantly associated with higher risk of hyperuricemia among women. These results reinforce the importance of less pro-inflammatory habitual dietary patterns in lowering the risk of hyperuricemia and secondary afflictions such as cardiovascular diseases.

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

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