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Mediterranean diet and incidence of hip fractures in a European cohort

Osteoporosis International volume 24, pages 1587–1598 (2013)Cite this article

Abstract

Summary

Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men.

Introduction

Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries.

Methods

A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders.

Results

Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89–0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79–0.94) and high fruit (HR = 0.89; 95 % CI = 0.82–0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06–1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32–2.31) was also a risk factor.

Conclusions

In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.

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Acknowledgments

The EPIC study was funded by “Europe Against Cancer” Programme of the European Commission (SANCO), German Cancer Aid, German Cancer Research Center (DKFZ), German Federal Ministry of Education and Research, Greek Ministry of Health, Hellenic Health Foundation, Stavros Niarchos Foundation, Italian Association for Research on Cancer, Italian National Research Council, Dutch Prevention Funds, LK Research Funds, Dutch ZON (Zorg Onderzoek Nederland), The CIBER en Epidemiología y Salud Pública (CIBERESP), Research Institute Biodonostia, Basque Regional Government, World Cancer Research Fund (WCRF), Cancer Research UK, the Swedish Research Council, Medical Faculty of Umeå University, and the county council of Västerbotten. We also thank Göran Hallmans, Åsa Ågren, Hubert Sjödin, and Magnus Hellström for skillful data processing and for help creating the Swedish fracture database, and participants and staff from the NSHDS cohort study.

Conflicts of interest

None

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Authors and Affiliations

  1. WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 Mikras Asias street, 115 27, Athens, Greece

    V. Benetou, P. Orfanos & A. Trichopoulou

  2. Department of Pharmacology and Clinical Neurosciences, Umeå University, 901 87, Umeå, Sweden

    U. Pettersson-Kymmer

  3. Department of Surgical and Perioperative Sciences, Umeå University, 901 87, Umeå, Sweden

    U. Bergström & O. Svensson

  4. Department of Odontology, Umeå University, 901 87, Umeå, Sweden

    I. Johansson

  5. Department of Preventive and Predictive Medicine, Epidemiology Unit, Fondazione IRCCS Instituto Nazionale Tumori, Via Venezian, 1, 20133, Milan, Italy

    F. Berrino

  6. Cancer Registry and Histopathology Unit, “Civile M.P.Arezzo” Hospital, Asp 7, Via Dante, Ragusa, Italy

    R. Tumino

  7. Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway

    K. B. Borch & E. Lund

  8. Julius Center, University Medical Center Utrecht, Stratenum 6.131, 3508 GA, Utrecht, The Netherlands

    P. H. M. Peeters

  9. Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, St. Mary’s Campus, Norfolk Place, Paddington, London, W2 1PG, UK

    P. H. M. Peeters, T. Norat & P. A. Wark

  10. Division of Cancer Epidemiology c020, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany

    V. Grote & K. Li

  11. Public Health Division of Gipuzkoa, Health Department of Basque Country, BIODonostia Research Institute, CIBER Epidemiología y Salud Pública CIBERESP, San Sebastian, Spain

    J. M. Altzibar

  12. Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK

    T. Key

  13. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany

    H. Boeing & A. von Ruesten

  14. School of Public Health, Imperial College, St. Mary’s Campus, Norfolk Place, Paddington, London, W2 1PG, UK

    E. Riboli

  15. Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos, 115 27, Athens, Greece

    A. Trichopoulou

  16. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 Mikras Asias street, Athens, 115 27, Greece

    V. Benetou

Authors
  1. V. Benetou
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  2. P. Orfanos
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  3. U. Pettersson-Kymmer
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  4. U. Bergström
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  5. O. Svensson
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  6. I. Johansson
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  7. F. Berrino
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  8. R. Tumino
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  9. K. B. Borch
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  10. E. Lund
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  11. P. H. M. Peeters
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  12. V. Grote
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  13. K. Li
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  14. J. M. Altzibar
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  15. T. Key
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  16. H. Boeing
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  17. A. von Ruesten
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  18. T. Norat
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  19. P. A. Wark
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  20. E. Riboli
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  21. A. Trichopoulou
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Corresponding author

Correspondence to V. Benetou.

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Benetou, V., Orfanos, P., Pettersson-Kymmer, U. et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24, 1587–1598 (2013). https://doi.org/10.1007/s00198-012-2187-3

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  • DOI: https://doi.org/10.1007/s00198-012-2187-3

Keywords

  • A priori methods
  • Bone health
  • Diet
  • Dietary patterns
  • Hip fractures
  • Mediterranean diet