Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review
Abstract
:1. Introduction
2. Methodology
2.1. Search Strategy
2.2. Screening
- Inclusion Criteria
- Study design
- Participants
- Exposure
- Outcomes
- Exclusion Criteria
- Conference abstracts, reviews or editorials;
- Studies evaluating the effect of interventions, e.g., Randomised Controlled Trials;
- Studies using ‘posterior’ methods to evaluate the diet pattern;
- Studies evaluating the effect of the traditional Mediterranean diet in Mediterranean populations (as this has been studied elsewhere). If a study reported results involving a mixture of populations, only those relevant to the non-Mediterranean populations were included;
- Studies assessing the effect of dietary patterns on osteoporotic fractures by DII (its application has been widely studied).
2.3. Data Extraction
2.4. Descriptive Synthesis
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
First Author, Year | Country (No.) | Gender (F/M) and Population | Mean Age (Age Range) (Years) | Study Design | Dietary Pattern | Diet Score | Outcome | Main Associations Studies | Statistical Measure of Effect |
---|---|---|---|---|---|---|---|---|---|
Erkkilä et al., 2017 [36] | Finland | F 554 | 67.9 (65–71) | Prospective cohort | BSD | BSD score | Bone Mineral Density (BMD) | Association between quartiles of BSD (Q1-Q2-Q3-Q4) score and BMD (Femoral, lumbar, or total body). | Lumbar BMD: p = 0.428 (NS) * |
Femoral neck BMD: p = 446 (NS) * | |||||||||
Total body BMD: p = 0.294 (NS) * | |||||||||
Shahriarpour et al., 2020 [37] | Iran | F 151 | 61.2 (50–85) | Cross sectional | DASH diet | DASH score | Bone Mineral Density (BMD) | 1. Association between tertiles of DASH score (T1-T2-T3) and BMD (Femoral neck or lumbar spine). | Lumbar spine BMD overall difference across tertiles: p = 0.068 ** (NS) |
Lumbar spine BMD; pairwise difference between T3-T1: p = 0.594 ** (NS) | |||||||||
Femoral neck BMD overall difference across tertiles: p = 0.323 ** (NS) | |||||||||
Femoral neck BMD pairwise difference between T3-T1: p = 0.921 ** (NS) | |||||||||
Lumbar spine osteoporosis: OR = 0.28 (95% CI 0.09–0.88) (p = 0.029) ** | |||||||||
2. Association between adherence to the DASH dietary pattern in different tertile divisions (T1-T2-T3) and risk of osteoporosis | Femoral neck osteoporosis: OR = 1.21 (95%CI 0.21–7.00) ** (NS) | ||||||||
Byberg et al., 2016 [40] | Sweden | Total 71,306 F (33,403) M (37,903) | 60 | Cross sectional | Mediterranean-like diet | mMED score | First incident hip fracture (main outcome) | Association between adherence to the mMED score in different tertile divisions (T1-T2-T3) and the incidence of osteoporotic fracture in both genders. | Comparing the highest quintile of adherence to the mMED (6 to 8 points) with the lowest (0 to 2 points): |
First incident fracture of any type and first incident non-hip fracture (secondary outcomes) - | Both genders: hip fracture risk: HR = 0.78 (95%CI 0.69–0.89) ***** | ||||||||
Haring et al., 2016 [38] | The United States | F 7916 | 63.6 (63.6 ± 7.4) | Prospective cohort | No prescribed eating patterns | aMED score, HEI-2010 score, AHEI-2010 score, DASH score | Incident hip and total fractures | Association between adherence to the aMED, HEI-2010, AHEI-2010, and DASH score in different quintile divisions (Q1-Q2-Q3-Q4-Q5) and the risk of osteoporotic fracture. | aMED: hip fracture: HR = 0.80 (95%CI 0.66–0.97) *** total fracture: HR = 1.01 (95%CI 0.95–1.07) *** (NS), |
HEI-2010: hip fracture: HR = 0.87 (95%CI 0.75–1.02) *** (NS) total fracture: HR = 0.98 (95%CI 0.93–1.02) *** (NS), | |||||||||
AHEI-2010: hip fracture: HR = 0.94 (95%CI 0.80–1.09) *** (NS) total fracture: HR = 1.01 (95% CI 0.96–1.05) *** (NS), | |||||||||
DASH: hip fracture: HR = 0.89 (95%CI 0.75–1.06) *** (NS) total fracture: HR = 0.98 (95%CI 0.94–1.03) *** (NS). | |||||||||
Fung et al., 2018 [39] | The United States | 111,048, F (74,446) M (36,602) | (50–75) | Prospective cohort | No prescribed eating patterns | aMED score, AHEI-2010 score, DASH score | Hip fracture (self-reported) | Association between adherence to the aMED, AHEI-2010, and DASH score in different quintile divisions (Q1-Q2-Q3-Q4-Q5) and the risk of osteoporotic fracture in different genders. | aMED Women: hip fracture: HR = 0.96 (95%CI 0.81–1.12) **** (NS) Men: hip fracture: HR = 0.92 (95%CI 0.69–1.22) **** (NS) |
AHEI-2010 Women: hip fracture: HR = 0.87 (95%CI = 0.75–1.00) **** (NS) Men: hip fracture: HR = 0.88 (95%CI 0.67–1.17) **** (NS) | |||||||||
DASH Women: hip fracture: HR = 0.95 (95%CI 0.815–1.11) **** (NS) Men: hip fracture: HR = 0.98 (95%CI 0.73–1.31) **** (NS). | |||||||||
Benetou et al., 2018 [41] | Europe and the USA | Total 131,241 F (110,459) M (20,782) | ≥60 | Prospective cohort | Mediterranean diet | mMED score | Hip fracture (diagnosed or reported at follow-up or recorded as cause of death) | Association between adherence to the mMED score in different tertile divisions (T1-T2-T3) and the risk of osteoporotic fracture in both genders. | Both genders: EPIC-Umea Sweden cohort: hip fracture: HR = 0.75 (95%CI 0.41–1.36) ****** (NS) |
NHS-USA cohort: hip fracture: HR = 1.02 (95%CI 0.91–1.15) ****** (NS) | |||||||||
COSM-Sweden cohort: hip fracture: HR = 0.97 (95%CI 0.83–1.13) ****** (NS) | |||||||||
SMC-Sweden cohort: hip fracture: HR = 0.91 (95% 0.82–1.03) ****** (NS). |
3.3. Summary of ‘a Priori’ Dietary Scores
3.4. The Effect of Diet Scores on BMD and Osteoporosis Diagnosis
3.5. The Influence of Diet Scores on Osteoporotic Fracture
4. Discussion
5. Conclusions
Supplementary Materials
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
BMD (g/cm2) | Quantiles of Diet Scores | ||||||||
---|---|---|---|---|---|---|---|---|---|
Quartiles of BSD Score (Mean 95%CI) (Erkkilä et al., 2017 [36]) | p Value | Tertiles of DASH Score (Mean 95%CI) (Shahriarpour et al., 2020 [37]) | p Value | ||||||
Q1 | Q2 | Q3 | Q4 | T1 | T2 | T3 | |||
Lumbar BMD | 1.136 (1.093–1.179) | 1.102 (1.057–1.146) | 1.112 (1.065–1.159) | 1.135 (1.087–1.184) | 0.446 | 0.83 (0.79–0.87) | 0.89 (0.86–0.93) | 0.87 (0.83–0.90) | 0.068 |
Femoral neck BMD | 0.874 (0.846–0.901) | 0.886 (0.837–0.896) | 0.892 (0.862–0.922) | 0.873 (0.842–0.904) | 0.428 | 0.66 (0.63–0.68) | 0.68 (0.66–0.71) | 0.68 (0.65–0.70) | 0.323 |
Total body BMD | 1.078 (1.056–1.101) | 1.073 (1.050–1.095) | 1.094 (1.071–1.118) | 1.088 (1.064–1.112) | 0.294 | - | - | - | - |
Osteoporosis | |||||||||
Lumbar spine | - | - | - | - | - | 1.0 | 0.21 (0.07–0.64) | 0.28 (0.09–0.88) | 0.020 |
Femoral neck | - | - | - | - | - | 1.0 | 0.51 (0.10–2.71) | 1.21 (0.21–7.00) | 0.860 |
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Scoring System | BSD | DASH | aMED | HEI-2010 | AHEI-2010 | mMED (Byberg et al. [40]) | mMED (Benetou et al. [41]) | ||
---|---|---|---|---|---|---|---|---|---|
Scoring component | 1 | Fruits and berries | Fruits | Fruits | Total vegetables | Whole fruit | Fruits and vegetables | Fruits | |
2 | Vegetables | Vegetables | Vegetables | Total fruit | Vegetables | Legumes and nuts | Vegetables | ||
3 | Cereals | Whole grains | Whole grains | Whole fruit | Nuts and legumes | No refined or high fibre grains | Legumes | ||
4 | Low-fat milk | Low-fat dairy | Fish | Seafood proteins | Whole grains | Fermented dairy products | Cereals | ||
5 | Fish | Nuts and legumes | Nuts | Plant proteins | PUFAs | Fish | Fish | ||
6 | Meat products | Red and processed meats | Legumes | Total protein foods | Long-chain ω−3 polyunsaturated fatty acids | Use of olive or rapeseed oil (%) | Meat | ||
7 | Total fat | Sodium | Fat ratio | Whole grains | Red and processed meats | Red and processed meats | Dietary products | ||
8 | Fat ratio | Sweetened beverages | Red and processed meats | Low-fat dairy | Sugar-sweetened beverages and fruit juice | Alcohol | Fat ratio | ||
9 | Alcohol | Alcohol | Fatty acids ratio | Trans fat | Alcohol | ||||
10 | Refined grains | Sodium | |||||||
11 | Sodium | Alcohol | |||||||
12 | Empty calories | ||||||||
Total | 9 | 8 | 9 | 12 | 11 | 8 | 9 | ||
Scoring criteria | |||||||||
Quantile segmentation | Quartiles | Tertile a | Quintile b | Quintile | Quintile | Quintile | Tertile | Tertile | |
Detailed scores | Components (1–8) were scored according to sex-specific population consumption quartile points: the consumption of 1,2,3,4,5 and 8 was positively awarded for 0–3 points (0,1,2,3), while the scores of 6 and 7 were pointed vice versa. For 9, Men consume ≤ 20 g/d or women consume ≤ 10 g/d received 1 point; otherwise, received 0 points. | Components (1–8) were scored according to sex-specific population consumption quintile points: the consumption of 1–5 was awarded for 1–5 points (1,2,3,4,5), while the scores of 6–8 were pointed vice versa. | Components (1–8) were scored according to sex-specific population consumption median points: the consumption of 1–7 above the sex-specific median was awarded for 1 point, otherwise received 0, while the scores of 8 were pointed vice versa. For 9, Men consume 10–25 g/d or women consume 5–15 g/d received 1 point; otherwise, received 0 points. | Components (1–12) were scored according to sex-specific population consumption quintile points: the consumption of 1–6 was awarded for 0–5 points; the consumption of 7–11 was rewarded for 0–10 points; the consumption of 12 was rewarded for 0–20 points. | Components (1–11) were scored according to sex-specific population consumption quintile points: the component 1–11 was rewarded for 0–10 points. | Components (1–7) were scored according to sex-specific population consumption median points: the consumption of 1–6 above the sex-specific median was awarded for 1 point, while the scores of 7 were pointed vice versa. For 8, both genders consume 5–15 g/d 1 point; otherwise, received 0 points. | Components (1–7) were scored according to sex-specific population consumption median points: the consumption of 1,2,3,4,5 and 8 above the sex-specific median was awarded for 1 point, while the scores of 6–7 were pointed vice versa. For 9, Men consume 10–50 g/d or women consume 5–25 g/d received 1 point; otherwise, received 0 points. | ||
Total scores | 25 | 40 | 40 | 9 | 100 | 110 | 8 | 9 | |
Score interval for different quantiles | Q1 ≤ 9 | T1 10–22 | Q1< 20 | Q1 < 2 | Q1 < 53 | Q1 < 47 | T1 0–2 | T1 0–6 | |
Q2 10–13 | T2 22–26 | Q2 20–23 | Q2 2–4 | Q2 53–60 | Q2 47–53 | T2 3–5 | T2 4–5 | ||
Q3 14–15 | T3 27–35 | Q3 23–25 | Q3 4–5 | Q3 60–66 | Q3 53–59 | T3 6–8 | T3 6–9 | ||
Q4 ≥ 16 | Q4 25–28 | Q4 5–6 | Q4 66–72 | Q4 59–65 | |||||
Q5 >28 | Q5 > 6 | Q5 > 72 | Q5 > 65 | ||||||
Notes | -8 = PUFA/(SFA + trans-fatty acids) | -7 = MUFA/SFA | -2 includes 100% fruit juice -3 includes all forms except juice -4 includes legumes (beans and peas) -9 = (PUFAs + MUFAs)/SFAs -13 includes energy from solid fats, added sugars, and any alcohol more than 13 g per 1000 kcal | -1 does not include fruit juice and potatoes |
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Chen, H.; Avgerinou, C. Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review. Nutrients 2023, 15, 4255. https://doi.org/10.3390/nu15194255
Chen H, Avgerinou C. Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review. Nutrients. 2023; 15(19):4255. https://doi.org/10.3390/nu15194255
Chicago/Turabian StyleChen, Huiyu, and Christina Avgerinou. 2023. "Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review" Nutrients 15, no. 19: 4255. https://doi.org/10.3390/nu15194255
APA StyleChen, H., & Avgerinou, C. (2023). Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review. Nutrients, 15(19), 4255. https://doi.org/10.3390/nu15194255