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The Association of Aromatic Amino Acids with Incident Hip Fracture, aBMD, and Body Composition from the Cardiovascular Health Study

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Abstract

In 5187 persons from the Cardiovascular Health Study, there was no significant association of dietary intakes of aromatic amino acids (AAA) with areal BMD of the hip or body composition. However, those who had the lowest dietary intakes of AAA were at increased risk for incident hip fractures. Prior studies of the association of protein intake with osteoporosis are conflicting and have not directly examined the relationship of aromatic amino acids (AAA) with fractures, areal bone mineral density (aBMD), and body composition. We sought to determine the relationship of dietary intakes of AAA with osteoporosis parameters in elderly men and women. 5187 men and women aged ≥ 65 years from the Cardiovascular Health Study (CHS) with dietary intakes of AAA (tryptophan, phenylalanine, tyrosine) estimated by food frequency questionnaire (FFQ) were included. We examined the relationship between a one-time estimate of daily dietary AAA intake with risk of incident hip fractures over a median of 13.2 years of fracture follow-up. A subset (n = 1336) who had dual energy X-ray absorptiometry (DXA) performed were included in a cross-sectional analysis of the association of dietary AAA intake with aBMD of the total hip and measurements of body composition. In multivariable models adjusted for demographic and clinical variables, medication use, and diet, higher dietary AAA intake was not significantly associated with incident hip fractures. All hazard ratios (HR) were less than one (tryptophan, HR 0.14, 95% CI 0.01 to 1.89; phenylalanine, HR 0.60, 95% CI 0.23 to 1.55; tyrosine, HR 0.59, 95% CI 0.27 to 1.32), but confidence intervals were wide and included no difference. However, in post hoc analyses, the lowest quartile of intake for each AAA was associated with an increased risk for hip fracture compared to higher quartiles (p ≤ 0.047 for all). Dietary AAA intakes were not significantly associated with total hip aBMD or any measurements of body composition. Overall, there was no significant association of dietary AAA intake with hip fractures, aBMD of the hip, or body composition. However, there may be a subset of elderly individuals with low dietary intakes of AAA who are at increased for hip fractures.

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Acknowledgements

Drs. Carbone, Bůžková, Fink, Isales, Le, Shikany, Coughlin, and Robbins participated in the analysis/interpretation of the data, drafting and/or critical analysis of the manuscript and approved the final version of the submitted manuscript. Mattie Raiford participated in drafting the manuscript, approved the final version, and assisted with interpretation of the data. Drs. Carbone, Bůžková, and Robbins accept responsibility for the integrity of the data analysis. The contents do not represent the views of the Department of Veterans Affairs or the United States Government. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and Grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org.

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Authors and Affiliations

  1. Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA

    Brian Le, Mattie Raiford, Steven S. Coughlin & Laura D. Carbone

  2. Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA

    Brian Le, Mattie Raiford & Carlos M. Isales

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Petra Bůžková

  4. Department of Medicine, University of California – Davis, Sacramento, CA, USA

    John A. Robbins

  5. Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA

    Howard A. Fink

  6. Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA

    Howard A. Fink

  7. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Howard A. Fink

  8. Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Howard A. Fink

  9. Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    James M. Shikany

  10. Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA

    Steven S. Coughlin

  11. Department of Medicine, J. Harold Harrison MD Distinguished University Chair in Rheumatology, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA

    Laura D. Carbone

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  1. Brian Le
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Correspondence to Laura D. Carbone.

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Brian Le, Petra Bůžková, John Robbins, Howard Fink, Mattie Raiford, Carlos Isales, James Shikany, Steven Coughlin, and Laura Carbone have no conflict of interest.

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The study was approved by the Institutional Review Board (IRB) at each site. All participants gave written informed consent.

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Le, B., Bůžková, P., Robbins, J.A. et al. The Association of Aromatic Amino Acids with Incident Hip Fracture, aBMD, and Body Composition from the Cardiovascular Health Study. Calcif Tissue Int 105, 161–172 (2019). https://doi.org/10.1007/s00223-019-00562-9

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