Skip to main content

Advertisement

SpringerLink
Log in

Adherence to the 2006 American Heart Association’s Diet and Lifestyle Recommendations for cardiovascular disease risk reduction is associated with bone mineral density in older Chinese

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

This cross-sectional study investigated the association between the modified 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) and bone mineral density in Chinese adults. We found that better adherence to the AHA-DLR associated with higher bone mineral density (BMD) at multiple sites.

Introduction

Accumulating evidence shows that cardiovascular disease (CVD) and osteoporosis are associated with each other, yet little research has focused on whether strategies to reduce CVD risk could also benefit bone health. We aimed to assess the association between adherence to the modified 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) and BMD in Chinese adults.

Methods

We included 2092 women and 1051 men aged 40–75 years in this community-based cross-sectional study. Dietary information was assessed using a 79-item food frequency survey through face-to-face interviews at baseline (2008–2010) and 3 years later (2011–2013). Adherence to the AHA-DLR was assessed using modified diet and lifestyle scores (American Heart Association Diet and Lifestyle Score (AHA-DLS)) adjusted for bone health. BMD for the whole body, lumbar spine, total hip, femur neck, and trochanter sites was measured using dual-energy X-ray absorptiometry in 2011–2013.

Results

After adjusting for potential covariates, greater adherence to the modified AHA-DLS was positively and dose-dependently associated with BMD. The mean BMD was 1.93–3.11% higher in quartile 4 (vs. 1) (all p values <0.01) at multiple sites. Five-unit increases in the modified AHA-DLS score were associated with 4.20–6.07, 4.44–8.51, and 3.36–4.67 mg/cm2 increases in BMD at multiple sites for the total subjects, males, and females, respectively (all p values <0.01).

Conclusions

Better adherence to the AHA-DLR shows protective associations with BMD at multiple sites in the middle-aged and elderly Chinese population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lello S, Capozzi A, Scambia G (2015) Osteoporosis and cardiovascular disease: an update. Gynecol Endocrinol 31:590–594

    Article  CAS  PubMed  Google Scholar 

  2. Lampropoulos CE, Papaioannou I, D’Cruz DP (2012) Osteoporosis—a risk factor for cardiovascular disease. Nat Rev Rheumatol 8:587–598

    Article  CAS  PubMed  Google Scholar 

  3. Makovey J, Macara M, Chen JS, Hayward CS, March L, Sambrook PN (2013) High osteoporotic fracture risk and CVD risk co-exist in postmenopausal women. Bone 52:120–125

    Article  PubMed  Google Scholar 

  4. Crepaldi G, Maggi S (2009) Epidemiologic link between osteoporosis and cardiovascular disease. J Endocrinol Investig 32:2–5

    CAS  Google Scholar 

  5. Tanko LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920

    Article  PubMed  Google Scholar 

  6. Farhat GN, Newman AB, Sutton-Tyrrell K, Matthews KA, Boudreau R, Schwartz AV, Harris T, Tylavsky F, Visser M, Cauley JA (2007) The association of bone mineral density measures with incident cardiovascular disease in older adults. Osteoporos Int 18:999–1008

    Article  CAS  PubMed  Google Scholar 

  7. Lai SW, Liao KF, Lai HC, Tsai PY, Lin CL, Chen PC, Sung FC (2013) Risk of major osteoporotic fracture after cardiovascular disease: a population-based cohort study in Taiwan. J Epidemiol 23:109–114

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shen C, Deng J, Zhou R, Chen J, Fan S, Li Z, Hu Y, Zhong Q (2012) Relation between bone mineral density, bone loss and the risk of cardiovascular disease in a Chinese cohort. Am J Cardiol 110:1138–1142

    Article  PubMed  Google Scholar 

  9. Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673

    Article  CAS  PubMed  Google Scholar 

  10. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB (2009) Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119:1093–1100

    Article  PubMed  PubMed Central  Google Scholar 

  11. Benetou V, Orfanos P, Pettersson-Kymmer U et al (2013) Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24:1587–1598

    Article  CAS  PubMed  Google Scholar 

  12. Bamia C, Lagiou P, Buckland G et al (2013) Mediterranean diet and colorectal cancer risk: results from a European cohort. Eur J Epidemiol 28:317–328

    Article  CAS  PubMed  Google Scholar 

  13. Lichtenstein AH, Appel LJ, Brands M et al (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association nutrition committee. Circulation 114:82–96

    Article  PubMed  Google Scholar 

  14. Bhupathiraju SN, Lichtenstein AH, Dawson-Hughes B, Tucker KL (2011) Adherence index based on the AHA 2006 diet and lifestyle recommendations is associated with select cardiovascular disease risk factors in older Puerto Ricans. J Nutr 141:460–469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bhupathiraju SN, Lichtenstein AH, Dawson-Hughes B, Hannan MT, Tucker KL (2013) Adherence to the 2006 American Heart Association diet and lifestyle recommendations for cardiovascular disease risk reduction is associated with bone health in older Puerto Ricans. Am J Clin Nutr 98:1309–1316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121:e46–e215

    Article  PubMed  Google Scholar 

  17. Tucker KL, Falcon LM, Bianchi LA, Cacho E, Bermudez OI (2000) Self-reported prevalence and health correlates of functional limitation among Massachusetts elderly Puerto Ricans, Dominicans, and non-Hispanic white neighborhood comparison group. J Gerontol A Biol Sci Med Sci 55:M90–M97

    Article  CAS  PubMed  Google Scholar 

  18. Chen GD, Zhu YY, Cao Y, Liu J, Shi WQ, Liu ZM, Chen YM (2015) Association of dietary consumption and serum levels of vitamin a and beta-carotene with bone mineral density in Chinese adults. Bone 79:110–115

    Article  CAS  PubMed  Google Scholar 

  19. Zhang ZQ, Deng J, He LP, Ling WH, Su YX, Chen YM (2013) Comparison of various anthropometric and body fat indices in identifying cardiometabolic disturbances in Chinese men and women. PLoS One 8:e70893

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhang CX, Ho SC (2009) Validity and reproducibility of a food frequency questionnaire among Chinese women in Guangdong province. Asia Pac J Clin Nutr 18:240–250

    CAS  PubMed  Google Scholar 

  21. Yang YX, Wang G, Pan X (2002) China food composition table. Peking University Medical Press, Beijing

    Google Scholar 

  22. Liu DM (2008) Analysis of isomers of trans fatty acids in food and investigation of the consumption of trans fatty acids in Chinese. Dissertation, Nanchang University

  23. Brown CC, Kipnis V, Freedman LS, Hartman AM, Schatzkin A, Wacholder S (1994) Energy adjustment methods for nutritional epidemiology: the effect of categorization. Am J Epidemiol 139:323–338

    Article  CAS  PubMed  Google Scholar 

  24. Leslie WD, Lix LM, Tsang JF, Caetano PA (2007) Single-site vs multisite bone density measurement for fracture prediction. Arch Intern Med 167:1641–1647

    Article  PubMed  Google Scholar 

  25. Rivas A, Romero A, Mariscal-Arcas M, Monteagudo C, Feriche B, Lorenzo ML, Olea F (2013) Mediterranean diet and bone mineral density in two age groups of women. Int J Food Sci Nutr 64:155–161

    Article  PubMed  Google Scholar 

  26. Lin PH, Ginty F, Appel LJ, Aickin M, Bohannon A, Garnero P, Barclay D, Svetkey LP (2003) The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 133:3130–3136

    CAS  PubMed  Google Scholar 

  27. Doyle L, Cashman KD (2003) The effect of nutrient profiles of the dietary approaches to stop hypertension (DASH) diets on blood pressure and bone metabolism and composition in normotensive and hypertensive rats. Br J Nutr 89:713–724

    Article  CAS  PubMed  Google Scholar 

  28. Johansson J, Nordstrom A, Nordstrom P (2015) Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women. Bone 81:72–79

    Article  PubMed  Google Scholar 

  29. Qu X, Zhang X, Zhai Z, Li H, Liu X, Liu G, Zhu Z, Hao Y, Dai K (2014) Association between physical activity and risk of fracture. J Bone Miner Res 29:202–211

    Article  PubMed  Google Scholar 

  30. Park SM, Joung JY, Cho YY, Sohn SY, Hur KY, Kim JH, Kim SW, Chung JH, Lee MK, Min YK (2015) Effect of high dietary sodium on bone turnover markers and urinary calcium excretion in Korean postmenopausal women with low bone mass. Eur J Clin Nutr 69:361–366

    Article  CAS  PubMed  Google Scholar 

  31. Shin S, Sung J, Joung H (2015) A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults. Eur J Clin Nutr 69(4):442–448

    Article  CAS  PubMed  Google Scholar 

  32. Chen YM, Ho SC, Woo JL (2006) Greater fruit and vegetable intake is associated with increased bone mass among postmenopausal Chinese women. Br J Nutr 96:745–751

    Article  CAS  PubMed  Google Scholar 

  33. Farina EK, Kiel DP, Roubenoff R, Schaefer EJ, Cupples LA, Tucker KL (2011) Protective effects of fish intake and interactive effects of long-chain polyunsaturated fatty acid intakes on hip bone mineral density in older adults: the Framingham osteoporosis study. Am J Clin Nutr 93:1142–1151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Corwin RL, Hartman TJ, Maczuga SA, Graubard BI (2006) Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III. J Nutr 136:159–165

    CAS  PubMed  Google Scholar 

  35. Jeong TD, Lee W, Choi SE, Kim JS, Kim HK, Bae SJ, Chun S, Min WK (2014) Relationship between serum total cholesterol level and serum biochemical bone turnover markers in healthy pre- and postmenopausal women. Biomed Res Int 2014:398397

    PubMed  PubMed Central  Google Scholar 

  36. Mangge H, Becker K, Fuchs D, Gostner JM (2014) Antioxidants, inflammation and cardiovascular disease. World J Cardiol 6:462–477

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mundy GR (2007) Osteoporosis and inflammation. Nutr Rev 65:S147–S151

    Article  PubMed  Google Scholar 

  38. Wilson C (2014) Bone: oxidative stress and osteoporosis. Nat Rev Endocrinol 10:3

    Google Scholar 

  39. Tarakida A, Iino K, Abe K, Taniguchi R, Higuchi T, Mizunuma H, Nakaji S (2011) Hypercholesterolemia accelerates bone loss in postmenopausal women. Climacteric 14:105–111

    Article  CAS  PubMed  Google Scholar 

  40. Yamaguchi T, Sugimoto T, Yano S, Yamauchi M, Sowa H, Chen Q, Chihara K (2002) Plasma lipids and osteoporosis in postmenopausal women. Endocr J 49:211–217

    Article  CAS  PubMed  Google Scholar 

  41. Richardson MR, Boyer WR, Johnson TM, Churilla JR (2015) Vigorous intensity physical activity and C-reactive protein in U.S. adults. Metab Syndr Relat Disord 13:453–457

    Article  CAS  PubMed  Google Scholar 

  42. Kavouras SA, Panagiotakos DB, Pitsavos C, Chrysohoou C, Arnaoutis G, Skoumas Y, Stefanadis C (2010) Physical activity and adherence to Mediterranean diet increase Total antioxidant capacity: the ATTICA study. Cardiol Res Pract 2011:248626

    PubMed  PubMed Central  Google Scholar 

  43. Schwingshackl L, Hoffmann G (2014) Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr Metab Cardiovasc Dis 24:929–939

    Article  CAS  PubMed  Google Scholar 

  44. Razavi Zade M, Telkabadi MH, Bahmani F, Salehi B, Farshbaf S, Asemi Z (2016) The effects of DASH diet on weight loss and metabolic status in adults with non-alcoholic fatty liver disease: a randomized clinical trial. Liver Int 36(4):563–571

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was jointly supported by the National Natural Science Foundation of China (81472965, 81130052), the 5010 Program for Clinical Researches (No. 2007032) of the Sun Yat-sen University (Guangzhou, China), and Danone Institute China Diet Nutrition Research & Communication Grant in 2012.

Author information

Authors and Affiliations

  1. Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    G. D. Chen, D. Ding, H. Y. Tian, Y. Y. Zhu, W. T. Cao, C. Wang & Y. M. Chen

Authors
  1. G. D. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Y. Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Y. Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. T. Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. M. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. M. Chen.

Ethics declarations

None.

Additional information

Geng-dong Chen and Ding Ding contributed equally to this article

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, G.D., Ding, D., Tian, H.Y. et al. Adherence to the 2006 American Heart Association’s Diet and Lifestyle Recommendations for cardiovascular disease risk reduction is associated with bone mineral density in older Chinese. Osteoporos Int 28, 1295–1303 (2017). https://doi.org/10.1007/s00198-016-3857-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-016-3857-3

Keywords

Search

Navigation