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Prospective Associations of Dietary and Nutrient Patterns with Fracture Risk: A 20-Year Follow-Up Study

Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar 196, Ethiopia
The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, SA 5011, Australia
Freemason’s Centre for Men’s Health, Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia
Author to whom correspondence should be addressed.
Nutrients 2017, 9(11), 1198;
Received: 7 September 2017 / Revised: 10 October 2017 / Accepted: 26 October 2017 / Published: 31 October 2017
(This article belongs to the Special Issue Dietary Patterns, Diet Quality and Human Health)
PDF [805 KB, uploaded 31 October 2017]


Studies on long-term exposure to foods/nutrients and its associations with fracture risk are scarce. Using data from the China Health and Nutrition Survey (CHNS), we determined the prospective association of dietary and nutrient patterns with fractures. Data from 15,572 adults aged ≥18 years were analyzed. Fracture occurrence was self-reported and dietary intake data were collected using a 24-h recall method for three consecutive days, for each individual across nine waves (1989–2011). We used cumulative and overall mean, recent and baseline dietary and nutrient exposures. Hazard ratios (HR) were used to determine the associations. Two dietary (traditional and modern) and two nutrient (plant- and animal-sourced) patterns were identified. After adjusting for potential confounders, study participants in the third tertiles (highest intake) of the modern dietary and animal-sourced nutrient patterns’ cumulative scores had a 34% (HR = 1.34; 95% CI: 1.06–1.71) and 37% (HR = 1.37; 95% CI: 1.08–1.72) increase in fracture risks compared to those in the first tertiles, respectively. While the overall mean factor scores of dietary and nutrient patterns had a similar (or stronger) pattern of association as the cumulative scores, no association between recent and baseline scores and fracture was found. Greater adherence to a modern dietary and/or an animal-sourced nutrient pattern is associated with a higher risk of total fractures. This suggests that a modern animal based diet is related to bone fragility. A repeated three-day 24-h recall dietary assessment provides a stronger association with fracture compared to a recent or baseline exposure. View Full-Text
Keywords: dietary pattern; nutrient pattern; fracture; China Health and Nutrition Survey dietary pattern; nutrient pattern; fracture; China Health and Nutrition Survey

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Melaku, Y.A.; Gill, T.K.; Appleton, S.L.; Taylor, A.W.; Adams, R.; Shi, Z. Prospective Associations of Dietary and Nutrient Patterns with Fracture Risk: A 20-Year Follow-Up Study. Nutrients 2017, 9, 1198.

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