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

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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.

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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).

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Authors and Affiliations

  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 Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 115 27, Athens, Greece

    V. Benetou & P. Orfanos

  2. Hellenic Health Foundation, Athens, Greece

    P. Orfanos & A. Trichopoulou

  3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA

    D. Feskanich & F. Grodstein

  4. Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden

    K. Michaëlsson, L. Byberg & A. Wolk

  5. Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

    U. Pettersson-Kymmer

  6. Department of Community Medicine, Umeå University, Umeå, Sweden

    S. Eriksson

  7. Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden

    A. Wolk

  8. Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany

    N. Jankovic

  9. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    N. Jankovic & L. C. P. G. M de Groot

  10. Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    P. Boffetta

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  1. V. Benetou
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  2. P. Orfanos
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  3. D. Feskanich
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  4. K. Michaëlsson
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  5. U. Pettersson-Kymmer
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  6. L. Byberg
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  7. S. Eriksson
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  8. F. Grodstein
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  9. A. Wolk
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  10. N. Jankovic
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  11. L. C. P. G. M de Groot
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  12. P. Boffetta
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  13. A. Trichopoulou
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Corresponding author

Correspondence to V. Benetou.

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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.

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Benetou, V., Orfanos, P., Feskanich, D. et al. Mediterranean diet and hip fracture incidence among older adults: the CHANCES project. Osteoporos Int 29, 1591–1599 (2018). https://doi.org/10.1007/s00198-018-4517-6

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  • DOI: https://doi.org/10.1007/s00198-018-4517-6

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