A posteriori dietary patterns are related to risk of fracture and low bone mineral density: findings from a systematic review and meta-analysis
Background: Observational studies suggest that dietary pattern intake plays an important role in the development of fracture and low bone mineral density (BMD). However, the association remains unclear. This systematic review was performed to evaluate the relationship between dietary patterns and fracture and BMD by pooling available data from existing studies.
Methods: MEDLINE and EMBASE databases were searched up to January 2015 for eligible observational studies regarding the relationships between common dietary patterns and risk of fracture/ low BMD. Random-effects models were applied to pool the summary estimates for the highest versus the lowest category of dietary pattern. Sensitivity analyses were conducted and publication bias was assessed using Begg or Egger's tests.
Results: A total of thirteen cross-sectional studies were included in the meta-analysis. There was evidence of inverse associations between the Healthy/Prudent dietary pattern and the risk of low BMD (OR: 0.75; 95% CI: 0.21 to 1.30; p =0.007) and a positive association between Unhealthy/Western dietary pattern and low BMD risk (OR: 1.21; 95% CI: 0.58 to 1.90; p<0.001) for the highest versus the lowest category. Moreover, the association between highest compared with lowest categories of intake of the Healthy/Prudent dietary pattern and the risk of fracture showed a significant inverse association (OR = 0.63; 95% CI: 0.53, 0.73; p< 0.001) which was positive for Unhealthy/Western dietary patterns and fracture risk (OR = 1.08; 95% CI: 0.90, 1.26; p<0.001).
Conclusion:There appears to be a beneficial effect of healthy dietary pattern on fracture and low BMD risk and adding a new direction toward prevention of fracture and low BMD level on population level.
2. Melton Lr, Thamer M, Ray N, Chan J, ChesnutCr, Einhorn T, et al. Fractures attributable toosteoporosis: report from the NationalOsteoporosis Foundation. J Bone Miner Res.1997;12(1):16-23.
3. Reginster J-Y, Gillet P, Sedrine WB, Brands G,Ethgen O, de Froidmont C, et al. Direct costs ofhip fractures in patients over 60 years of age inBelgium. Pharmacoeconomics. 1999;15(5):507-14.
4. Cooper C, Campion G, Melton III L. Hip fracturesin the elderly: a world-wide projection.Osteoporosis Int. 1992;2(6):285-9.
5. Freudenheim J, Johnson N, Smith E.Relationships between usual nutrient intake andone-mineral content of women 35-65 years ofage: longitudinal and cross-sectional analysis. AmJ Clin Nutr. 1986;44(6):863-76.
6. Devine A, Criddle RA, Dick IM, Kerr DA, PrinceRL. A longitudinal study of the effect of sodiumand calcium intakes on regional bone density inostmenopausal women. Am J Clin Nutr.1995;62(4):740-5.
7. Greendale GA, FitzGerald G, Huang M-H,Sternfeld B, Gold E, Seeman T, et al. Dietary soyisoflavones and bone mineral density: results fromthe study of women's health across the nation. AmJ Epidemiol. 2002;155(8):746-54.
8. Hu FB. Dietary pattern analysis: a new directionin nutritional epidemiology. Curr Opin Lipidol.2002;13(1):3-9.
9. Reedy J, Wirfält E, Flood A, Mitrou PN, Krebs-Smith SM, Kipnis V, et al. Comparing 3 dietarypattern methods—Cluster analysis, factoranalysis, and index analysis—With colorectalcancer risk the NIH–AARP diet and health study.Am J Epidemiol. 2010;171(4):479-87.
10. Higgins JP, Thompson SG, Deeks JJ, Altman DG.Measuring inconsistency in meta-analyses. BMJ.2003 Sep 6;327(7414):557-60.
11. Peters JL, Sutton AJ, Jones DR, Abrams KR,Rushton L. Contour-enhanced meta-analysisfunnel plots help distinguish publication bias fromother causes of asymmetry. J Clin Epidemiol..2008;61(10):991-6.
12. Wosje KS, Khoury PR, Claytor RP, CopelandKA, Hornung RW, Daniels SR, et al. Dietarypatterns associated with fat and bone mass inyoung children. Am J Clin Nutr. 2010;92(2):294-303.
13. Samieri C, Ginder Coupez V, Lorrain S,Letenneur L, Allès B, Féart C, et al. Nutrientpatterns and risk of fracture in older subjects:Results from the Three-City Study. OsteoporosisIn. 2013;24(4):1295-305.
14. Noh HY, Song YJ, Lee JE, Joung H, Park MK, LiSJ, et al. Dietary patterns are associated withphysical growth among school girls aged 9-11years. Nutr Res Pract. 2011;5(6):569-77.
15. Karamati M, Yousefian-Sanni M, Shariati-BafghiSE, Rashidkhani B. Major nutrient patterns andbone mineral density among postmenopausalIranian women. Calcif Tissue Int. 2014;94(6):648-58.
16. Yoshimoto Y, Muto S, Fujikura J, Sakuma M,Kaneko Y, Otto CT, et al. Obesity, bone statusand dietary intake of Palauan elderly congregatingin a Senior Citizen's Center. Pac Health Dialog. 2005 Mar;12(1):22-32.
17. Ward WE, Kim S, Robert Bruce W. A westernstylediet reduces bone mass and biomechanicalbone strength to a greater extent in male comparedwith female rats during development. Br J Nutr.2003;90(3):589-95.
18. Wang S, Mu M, Zhao Y, Wang X, Shu L, Li Q, etl. [Dietary patterns in college freshmen and itsrelation to bone mineral density]. Wei Sheng YanJiu. 2012;41(4):579-84.
19. Shin S, Hong K, Kang SW, Joung H. A milk andcereal dietary pattern is associated with a reducedlikelihood of having a low bone mineral density ofthe lumbar spine in Korean adolescents. Nutr Res.2013;33(1):59-66.
20. Mu M, Wang SF, Sheng J, Zhao Y, Wang GX,Liu KY, et al. Dietary patterns are associated withbody mass index and bone mineral density inChinese freshmen. J Am Coll Nutr.2014;33(2):120-8.
21. Klevay LM, Wildman RE. Meat diets and fragilebones: inferences about osteoporosis. J TraceElem Med Biol. 2002;16(3):149-54.
22. Fernandez-Real JM, Bullo M, Moreno-NavarreteJM, Ricart W, Ros E, Estruch R, et al. AMediterranean diet enriched with olive oil isassociated with higher serum total osteocalcinlevels in elderly men at high cardiovascular risk. JClin Endocrinol Metab. 2012;97(10):3792-8.
23. Romero Perez A, Rivas Velasco A. Adherence toMediterranean diet and bone health. Nutr Hosp.2014;29(5):989-96.
24. Maurer M, Riesen W, Muser J, Hulter HN, KrapfR. Neutralization of Western diet inhibits boneresorption independently of K intake and reducescortisol secretion in humans. Am J Physiol RenalPhysiol. 2003;284(1):F32-40.
25. Macdonald HM, New SA, Fraser WD, CampbellMK, Reid DM. Low dietary potassium intakesand high dietary estimates of net endogenous acidproduction are associated with low bone mineraldensity in premenopausal women and increasedmarkers of bone resorption in postmenopausalwomen. Am J Clin Nutr. 2005;81(4):923-33.
26. Liberato SC, Bressan J, Hills AP. The role ofphysical activity and diet on bone mineral indicesin young men: a cross-sectional study. J Int SocSports Nutr. 2013;10(1):43.
27. Lac G, Cavalie H, Ebal E, Michaux O. Effects ofa high fat diet on bone of growing rats.Correlations between visceral fat, adiponectin andbone mass density. Lipids Health Dis. 2008;7:16.
28. Keramat A, Patwardhan B, Larijani B, Chopra A,Mithal A, Chakravarty D, et al. The assessment ofosteoporosis risk factors in Iranian womencompared with Indian women. BMCMusculoskelet Disord. 2008;9:28.
29. Kato I, Toniolo P, Zeleniuch-Jacquotte A, ShoreRE, Koenig KL, Akhmedkhanov A, et al. Diet,smoking and anthropometric indices andpostmenopausal bone fractures: a prospectivestudy. Int J Epidemiol. 2000;29(1):85-92.
30. Hostmark AT, Sogaard AJ, Alvaer K, Meyer HE.The oslo health study: a dietary index estimatingfrequent intake of soft drinks and rare intake offruit and vegetables is negatively associated withbone mineral density. J Osteoporos.2011;2011:102686.
31. Hamidi M, Tarasuk V, Corey P, Cheung AM.Association between the Healthy Eating Index andbone turnover markers in US postmenopausalwomen aged >/=45 y. Am J Clin Nutr.2011;94(1):199-208.
32. Francis RM. What do we currently know aboutnutrition and bone health in relation to UnitedKingdom public health policy with particularreference to calcium and vitamin D? Br J Nutr.2008;99(1):155-9.
33. Devlin MJ, Grasemann C, Cloutier AM, Louis L,Alm C, Palmert MR, et al. Maternal perinatal dietinduces developmental programming of bonearchitecture. J Endocrinol. 2013 Apr;217(1):69-81.
34. Choi MJ, Park EJ, Jo HJ. Relationship of nutrientintakes and bone mineral density of elderlywomen in Daegu, Korea. Nutr Res Pract.2007;1(4):328-34.
35. Alquaiz AM, Kazi A, Tayel S, Shaikh SA, Al-Sharif A, Othman S, et al. Prevalence and factorsassociated with low bone mineral density in Saudiwomen: A community based survey. MCMusculoskeletal Disorders. 2014;15(1).
36. Agrawal T, Verma AK. Cross sectional study ofosteoporosis among women. Med J Armed Forces India2013;69(2):168-71.
37. Tucker KL, Chen H, Hannan MT, Cupples LA,Wilson PW, Felson D, et al. Bone mineral densityand dietary patterns in older adults: theFramingham Osteoporosis Study. Am J Clin Nutr.2002;76(1):245-52.
38. Sugiura M, Nakamura M, Ogawa K, Ikoma Y,Ando F, Shimokata H, et al. Dietary patterns ofantioxidant vitamin and carotenoid intakeassociated with bone mineral density: findingsfrom post-menopausal Japanese female subjects.Osteoporos Int. 2011;22(1):143-52.
39. Langsetmo L, Poliquin S, Hanley DA, Prior JC,Barr S, Anastassiades T, et al. Dietary patterns inCanadian men and women ages 25 and older:relationship to demographics, body mass index,and bone mineral density. BMC MusculoskeletDisord. 2010;11:20.
40. Go G, Tserendejid Z, Lim Y, Jung S, Min Y, ParkH. The association of dietary quality and foodgroup intake patterns with bone health statusamong Korean postmenopausal women: a studyusing the 2010 Korean National Health andNutrition Examination Survey Data. Nutr ResPract. 2014;8(6):662-9.
41. Benetou V, Orfanos P, Pettersson-Kymmer U,Bergstrom U, Svensson O, Johansson I, et al.Mediterranean diet and incidence of hip fracturesin a European cohort. Osteoporos Int.2013;24(5):1587-98.
42. Pedone C, Napoli N, Pozzilli P, Rossi FF,Lauretani F, Bandinelli S, et al. Dietary patternand bone density changes in elderly women: alongitudinal study. J Am Coll Nutr.2011;30(2):149-54.
43. Whittle CR, Woodside JV, Cardwell CR,McCourt HJ, Young IS, Murray LJ, et al. Dietarypatterns and bone mineral status in young adults:the Northern Ireland Young Hearts Project. Br JNutr. 2012 28;108(8):1494-504.
44. Shin S, Sung J, Joung H. A fruit, milk and wholegrain dietary pattern is positively associated withbone mineral density in Korean healthy adults.Eur J Clin Nutr. 2015;69(4):442-8.
45. Shin S, Joung H. A dairy and fruit dietary patternis associated with a reduced likelihood ofosteoporosis in Korean postmenopausal women.Br J Nutr. 2013;110(10):1926-33.
46. Park SJ, Joo SE, Min H, Park JK, Kim Y, KimSS, et al. Dietary patterns and osteoporosis risk inpostmenopausal Korean women. Osong PublicHealth Res Perspect. 2012;3(4):199-205.
47. Okubo H, Sasaki S, Horiguchi H, Oguma E,Miyamoto K, Hosoi Y, et al. Dietary patternsassociated with bone mineral density inpremenopausal Japanese farmwomen. Am J ClinNutr. 2006;83(5):1185-92.
48. Monma Y, Niu K, Iwasaki K, Tomita N, NakayaN, Hozawa A, et al. Dietary patterns associatedwith fall-related fracture in elderly Japanese: apopulation based prospective study. BMC Geriatr.2010;10:31.
49. McNaughton SA, Wattanapenpaiboon N, WarkJD, Nowson CA. An energy-dense, nutrient-poordietary pattern is inversely associated with bonehealth in women. J Nutr. 2011;141(8):1516-23.
50. Langsetmo L, Hanley DA, Prior JC, Barr SI, Anastassiades T, Towheed T, et al. Dietarypatterns and incident low-trauma fractures inpostmenopausal women and men aged ≥50 y: Apopulation-based cohort study. Am J Clin Nutr.2011;93(1):192-9.
51. Karamati M, Jessri M, Shariati-Bafghi SE,Rashidkhani B. Dietary patterns in relation tobone mineral density among menopausal Iranianwomen. Calcif Tissue Int. 2012;91(1):40-9.
52. Hardcastle AC, Aucott L, Fraser WD, Reid DM,Macdonald HM. Dietary patterns, bone resorptionand bone mineral density in early postmenopausalScottish women. Eur J Clin Nutr2011;65(3):378-85.
53. Dai Z, Butler LM, van Dam RM, Ang LW, YuanJM, Koh WP. Adherence to a vegetable-fruit-soydietary pattern or the Alternative Healthy EatingIndex is associated with lower hip fracture riskamong Singapore Chinese. J Nutr.2014;144(4):511-8.
54. Zeng FF, Wu BH, Fan F, Xie HL, Xue WQ, ZhuHL, et al. Dietary patterns and the risk of hipfractures in elderly Chinese: a matched casecontrolstudy. J Clin Endocrinol Metab. 2013Jun;98(6):2347-55.
55. Kontogianni MD, Melistas L, Yannakoulia M,Malagaris I, Panagiotakos DB, Yiannakouris N.Association between dietary patterns and indicesof bone mass in a sample of MediterraneanWomen. Nutrition. 2009;25(2):165-71.
56. Jacques PF, Tucker KL. Are dietary patternsuseful for understanding the role of diet in chronicdisease? Am J Clin Nutr. 2001;73(1):1-2
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