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Osteoporosis International

, Volume 29, Issue 7, pp 1591–1599 | Cite as

Mediterranean diet and hip fracture incidence among older adults: the CHANCES project

  • V. Benetou
  • P. Orfanos
  • D. Feskanich
  • K. Michaëlsson
  • U. Pettersson-Kymmer
  • L. Byberg
  • S. Eriksson
  • F. Grodstein
  • A. Wolk
  • N. Jankovic
  • L. C. P. G. M de Groot
  • P. Boffetta
  • A. Trichopoulou
Original Article

Abstract

Summary

The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk.

Introduction

Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults.

Methods

A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis.

Results

A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92–0.99, pheterogeneity = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87–0.99) and high (HR 0.94; 95% CI 0.87–1.01) adherence to the score compared with those with low adherence.

Conclusions

In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

Keywords

Aging Bone health CHANCES Dietary patterns Hip fractures Mediterranean diet 

Notes

Funding

This work, derived from the CHANCES project, was supported by the FP7 framework program of DG-RESEARCH in the European Commission (grant number: HEALTH-F3-2010-242244). The national cohorts were supported by: EPIC-Elderly Greece: the Hellenic Health Foundation; EPIC-Elderly Umea, Sweden: the Swedish Cancer Society and the Swedish Research Council; COSM and SMC, Karolinska Institutet, Sweden: the Swedish Research Council Karolinska Institutet’s Strategic Foundation and Uppsala University, and the Swedish Cancer Society; NHS: the National Cancer Institute (grant UM1 CA186107).

Compliance with ethical standards

Conflicts of interest

Francine Grodstein declares unrestricted research gift from California Walnut Commission. Other authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

198_2018_4517_MOESM1_ESM.doc (102 kb)
ESM 1 (DOC 102 kb)

References

  1. 1.
    Kanis JA, Odén A, EV MC, Johansson H, Wahl DA, Cooper C, IOF Working Group on Epidemiology and Quality of Life (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Odén A, McCloskey EV, Kanis JA, Harvey NC, Johansson H (2015) Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int 26(9):2243–2248CrossRefPubMedGoogle Scholar
  3. 3.
    Ward KA, Prentice A, Kuh DL, Adams JE, Ambrosini GL (2016) Life course dietary patterns and bone health in later life in a British birth cohort study. J Bone Miner Res 31(6):1167–1176CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Hardcastle AC, Aucott L, Fraser WD, Reid DM, Macdonald HM (2011) Dietary patterns, bone resorption and bone mineral density in early post-menopausal Scottish women. Eur J Clin Nutr 65(3):378–385CrossRefPubMedGoogle Scholar
  5. 5.
    McNaughton SA, Wattanapenpaiboon N, Wark JD, Nowson CA (2011) An energy-dense, nutrient-poor dietary pattern is inversely associated with bone health in women. J Nutr 141(8):1516–1523CrossRefPubMedGoogle Scholar
  6. 6.
    McTiernan A, Wactawski-Wende J, Wu L, Rodabough RJ, Watts NB, Tylavsky F, Women's Health Initiative Investigators et al (2009) Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: the Women's Health Initiative Dietary Modification Trial. Am J Clin Nutr 89(6):1864–1876CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Langsetmo L, Hanley DA, Prior JC, Barr SI, Anastassiades T, Towheed T, Goltzman D, Morin S, Poliquin S, Kreiger N, CaMos Research Group (2011) Dietary patterns and incident low-trauma fractures in postmenopausal women and men aged ≥ 50 y: a population-based cohort study. Am J Clin Nutr 93(1):192–199CrossRefPubMedGoogle Scholar
  8. 8.
    Benetou V, Orfanos P, Pettersson-Kymmer U, Bergström U, Svensson O, Johansson I, Berrino F, Tumino R, Borch KB, Lund E, Peeters PHM, Grote V, Li K, Altzibar JM, Key T, Boeing H, von Ruesten A, Norat T, Wark PA, Riboli E, Trichopoulou A (2013) Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24(5):1587–1598CrossRefPubMedGoogle Scholar
  9. 9.
    Fung TT, Feskanich D (2015) Dietary patterns and risk of hip fractures in postmenopausal women and men over 50 years. Osteoporos Int 26(6):1825–1830CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Feart C, Lorrain S, Ginder Coupez V, Samieri C, Letenneur L, Paineau D et al (2013) Adherence to a Mediterranean diet and risk of fractures in French older persons. Osteoporos Int 2013;24(12):3031–3041Google Scholar
  11. 11.
    Haring B, Crandall CJ, Wu C, LeBlanc ES, Shikany JM, Carbone L et al (2016) Dietary patterns and fractures in postmenopausal women: results from the Women’s Health Initiative. JAMA Intern Med 176(5):645–652CrossRefPubMedGoogle Scholar
  12. 12.
    Byberg L, Bellavia A, Larsson SC, Orsini N, Wolk A, Michaëlsson K (2016) Mediterranean diet and hip fracture in Swedish men and women. J Bone Miner Res 31(12):2098–2105CrossRefPubMedGoogle Scholar
  13. 13.
    Hu FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13:3–9CrossRefPubMedGoogle Scholar
  14. 14.
    Millen BE, Abrams S, Adams-Campbell L, Anderson CA, Brenna JT, Campbell WW et al (2016) The 2015 dietary guidelines advisory committee scientific report: development and major conclusions. Adv Nutr 7(3):438–444CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Tapsell LC, Neale EP, Satija A, Hu FB (2016) Foods, nutrients, and dietary patterns: interconnections and implications for dietary guidelines. Adv Nutr 7(3):445–454CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Trichopoulou A, Lagiou P (1997) Healthy traditional Mediterranean diet: an expression of culture, history and lifestyle. Nutr Rev 55:383–389CrossRefPubMedGoogle Scholar
  17. 17.
    Sofi F, Macchi C, Abbate R, Gensini GF, Casini A (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 17(12):2769–2782CrossRefPubMedGoogle Scholar
  18. 18.
    Schwingshackl L, Missbach B, König J, Hoffmann G (2015) Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr 18(7):1292–1299CrossRefPubMedGoogle Scholar
  19. 19.
    van de Rest O, Berendsen AA, Haveman-Nies A, de Groot LC (2015) Dietary patterns, cognitive decline, and dementia: a systematic review. Adv Nutr 6(2):154–168CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martínez-González MÁ, Martínez-Lapiscina EH, Fitó M, Pérez-Heras A, Salas-Salvadó J, Estruch R, Ros E (2015) Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med 175(7):1094–1103CrossRefPubMedGoogle Scholar
  21. 21.
    Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocké MC, Peeters PH et al (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Harmon BE, Boushey CJ, Shvetsov YB, Ettienne R, Reedy J, Wilkens LR, le Marchand L, Henderson BE, Kolonel LN (2015) Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr 101(3):587–597CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Boffetta P, Bobak M, Borsch-Supan A, Brenner H, Eriksson S, Grodstein F, Jansen E, Jenab M, Juerges H, Kampman E, Kee F, Kuulasmaa K, Park Y, Tjonneland A, van Duijn C, Wilsgaard T, Wolk A, Trichopoulos D, Bamia C, Trichopoulou A (2014) The Consortium on Health and Ageing: network of cohorts in Europe and the United States (CHANCES) project—design, population and data harmonization of a large-scale, international study. Eur J Epidemiol 29(12):929–936CrossRefPubMedGoogle Scholar
  24. 24.
    Kuulasmaa K, Palosaari T (2014) Editors. Contributors from partners of the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). CHANCES cohort descriptions, assessment of the availability and quality data and definitions of variables. MORGAM Project e-publications [internet]; URT: http://www.thl.fi/publications/morgam/chances_d9/index.html
  25. 25.
    Harris H, Håkansson N, Olofsson C, Julin B, Åkesson A, Wolk A (2013) The Swedish mammography cohort and the cohort of Swedish men: study design and characteristics of two population-based longitudinal cohorts. OA Epidemiol 1(2):16CrossRefGoogle Scholar
  26. 26.
    Colditz GA, Hankinson SE (2005) The nurses’ health study: lifestyle and health among women. Nat Rev Cancer 5(5):388–396CrossRefPubMedGoogle Scholar
  27. 27.
    Gedeborg R, Engquist H, Berglund L, Michaelsson K (2008) Identification of incident injuries in hospital discharge registers. Epidemiology 19(6):860–867CrossRefPubMedGoogle Scholar
  28. 28.
    Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C et al (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 9(11):450CrossRefGoogle Scholar
  29. 29.
    Colditz GA, Martin P, Stampfer MJ, Willett WC, Sampson L, Rosner B et al (1986) Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol 123(5):894–900CrossRefPubMedGoogle Scholar
  30. 30.
    Margetts BM, Pietinen P (1997) European prospective investigation into cancer and nutrition: validity studies on dietary assessment methods. Int J Epidemiol 26(Suppl 1):S1–S5CrossRefPubMedGoogle Scholar
  31. 31.
    Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al (2007) The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61(9):1037–1056CrossRefPubMedGoogle Scholar
  32. 32.
    Khani BR, Ye W, Terry P, Wolk A (2004) Reproducibility and validity of major dietary patterns among Swedish women assessed with a food-frequency questionnaire. J Nutr 134(6):1541–1545CrossRefPubMedGoogle Scholar
  33. 33.
    Messerer M, Johansson S-E, Wolk A (2004) The validity of questionnaire-based micronutrient intake estimates is increased by including dietary supplement use in Swedish men. J Nutr 134(7):1800–1805CrossRefPubMedGoogle Scholar
  34. 34.
    Rautiainen S, Serafini M, Morgenstern R, Prior RL, Wolk A (2008) The validity and reproducibility of food-frequency questionnaire-based total antioxidant capacity estimates in Swedish women. Am J ClinNutr 87(5):1247–1253Google Scholar
  35. 35.
    Feskanich D, Rimm EB, Giovannucci EL, Colditz GA, Stampfer MJ, LitinLB, Willett WC (1993) Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc 93(7):790–796CrossRefPubMedGoogle Scholar
  36. 36.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608CrossRefPubMedGoogle Scholar
  37. 37.
    Der Simonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRefGoogle Scholar
  38. 38.
    Schulman RC, Weiss AJ, Mechanick JI (2011) Nutrition, bone, and aging: an integrative physiology approach. Curr Osteoporos Rep 9(4):184–195CrossRefPubMedGoogle Scholar
  39. 39.
    Nieves JW (2013) Skeletal effects of nutrients and nutraceuticals, beyond calcium and vitamin D. Osteoporos Int 24(3):771–786CrossRefPubMedGoogle Scholar
  40. 40.
    Nutrition and bone health. Michael F Holick, Jeri W. Nieves Editors. Second Edition, 2015. Humana PressGoogle Scholar
  41. 41.
    Sahni S, Mangano KM, McLean RR, Hannan MT, Kiel DP (2015) Dietary approaches for bone health: lessons from the Framingham Osteoporosis Study. Curr Osteoporos Rep 13(4):245–255CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    García-Martínez O, Rivas A, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C (2014) The effect of olive oil on osteoporosis prevention. Int J Food Sci Nutr 65(7):834–840CrossRefPubMedGoogle Scholar
  43. 43.
    Jacobs DR Jr, Steffen LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78(3Suppl):508S–513SGoogle Scholar
  44. 44.
    Riley RD, Lambert PC, Abo-Zaid G (2010) Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ 340:c221CrossRefPubMedGoogle Scholar
  45. 45.
    Schousboe JT, Paudel ML, Taylor BC, Virnig BA, Cauley JA, Curtis JR, Ensrud KE (2013) Magnitude and consequences of misclassification of incident hip fractures in large cohort studies: the study of osteoporotic fractures and Medicare claims data. Osteoporos Int 24(3):801–810CrossRefPubMedGoogle Scholar
  46. 46.
    Willett WC (2016) Mediterranean diet and fracture risk. JAMA Intern Med 176(5):652–653CrossRefPubMedGoogle Scholar
  47. 47.
    Feskanich D, Flint AJ, Willett WC (2014) Physical activity and inactivity and risk of hip fractures in men. Am J Public Health 104(4):e75–e81CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Benetou V, Orfanos P, Benetos IS, Pala V, Evangelista A, Frasca G, Giurdanella MC, Peeters PHM, van der Schouw YT, Rohrmann S, Linseisen J, Boeing H, Weikert C, Pettersson U, van Guelpen B, Bueno-de-Mesquita HB, Altzibar J, Boffetta P, Trichopoulou A (2011) Anthropometry, physical activity and hip fractures in the elderly. Injury 42(2):188–193CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • V. Benetou
    • 1
  • P. Orfanos
    • 1
    • 2
  • D. Feskanich
    • 3
  • K. Michaëlsson
    • 4
  • U. Pettersson-Kymmer
    • 5
  • L. Byberg
    • 4
  • S. Eriksson
    • 6
  • F. Grodstein
    • 3
  • A. Wolk
    • 4
    • 7
  • N. Jankovic
    • 8
    • 9
  • L. C. P. G. M de Groot
    • 9
  • P. Boffetta
    • 10
  • A. Trichopoulou
    • 2
  1. 1.WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  2. 2.Hellenic Health FoundationAthensGreece
  3. 3.Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical SchoolBostonUSA
  4. 4.Department of Surgical Sciences, Section of OrthopedicsUppsala UniversityUppsalaSweden
  5. 5.Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
  6. 6.Department of Community MedicineUmeå UniversityUmeåSweden
  7. 7.Institute of Environmental Medicine, Division of Nutritional EpidemiologyKarolinska InstitutetStockholmSweden
  8. 8.Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry, and Epidemiology, Faculty of MedicineUniversity Duisburg-EssenEssenGermany
  9. 9.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  10. 10.Institute for Translational Epidemiology and Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA

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