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Dietary Pattern Analysis in Nutritional Science Research: A Review of Current Evidence Relating Dietary Patterns to Indices of Bone Health and Fracture Risk

  • Adrian D. Wood
  • Helen M. MacdonaldEmail author
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

The dietary pattern approach to nutritional science research may help to overcome some of the limitations associated with single nutrient studies such as colinearity of nutrients and inaccuracies of food composition databases. We provide a step by step outline of how to generate dietary patterns with commonly available statistical software and then examine their association with bone mineral density (measured by dual energy X-ray absorptiometry) using data collected from a well-characterised group of postmenopausal women as an example. We then review and summarise the current evidence relating dietary patterns to indices of bone health and fracture risk.

Published research data shows that nutrient dense dietary patterns, characterised generally by high intakes of plant based foods, as well as lean protein or oily fish, have been consistently positively associated with surrogate markers of bone health (such as bone mineral density (BMD)) irrespective of population demographics. A small number of studies (predominantly prospective in nature) have progressed beyond surrogate markers to assess dietary pattern associations with incident fracture. Overall it is difficult to make recommendations either in support of or against specific dietary patterns or food groups to help maintain bone mass or prevent fracture given the marked heterogeneity of published studies.

There is a requirement for consistency in future dietary pattern research with thorough consideration of potential confounding factors and recognition of the limitations of the general approach.

Keywords

Dietary patterns Bone health Bone mineral density Falls Fracture Postmenopausal women 

References

  1. 1.
    Scientific Advisory Committee on Nutrition. Update on Vitamin D. London: TSO; 2007.Google Scholar
  2. 2.
    Wood AD, Macdonald HM. Interactions of dietary patterns, systemic inflammation, and bone health. In: Burckhardt P, Dawsonhughes B, Weaver C, editors. Nutritional influences on bone health. London, UK: Springer; 2013.Google Scholar
  3. 3.
    Fung TT, Willett WC, Stamper MJ, Manson JE, Hu FB. Dietary patterns and the risk of coronary heart disease in women. JAMA Intern Med. 2001;161:1857–62.CrossRefGoogle Scholar
  4. 4.
    Fung TT, Schulze M, Manson JE, Willet WC, Hu FB. Dietary patterns, meat intake and the risk of type 2 diabetes in women. JAMA Intern Med. 2004;164:2235–40.CrossRefGoogle Scholar
  5. 5.
    Fung TT, Hu FB, Fuchs C, Giovannucci E, Hunter DJ, Stampfer MJ, et al. Major dietary patterns and the risk of colorectal cancer in women. JAMA Intern Med. 2003;163:309–14.CrossRefGoogle Scholar
  6. 6.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. NEJM. 2003;348(26):2599–608.PubMedCrossRefGoogle Scholar
  7. 7.
    Macdonald HM, Hardcastle AC. Dietary patterns and bone health. In: Burckhardt P, Dawsonhughes B, Weaver C, editors. Nutritional influences on bone health. London, UK: Springer; 2010.Google Scholar
  8. 8.
    Macdonald HM, New SA, Reid DM. Longitudinal changes in dietary intake in Scottish women around the menopause: changes in dietary pattern result in minor changes in nutrient intake. Public Health Nutr. 2005;8:409–16.PubMedCrossRefGoogle Scholar
  9. 9.
    New SA. An epidemiological investigation into rhe influence of nutritional factors on bone mineral density and bone metabolism:. Aberdeen, UK: University of Aberdeen; 1995.Google Scholar
  10. 10.
    Holland B, Welch AA, Unwin ID, Buss DH, Paul AA, Southgate DAT, editors. McCance and Widdowson’s The Composition of Foods. 5th edition ed. Cambridge, UK: Royal Society of Chemistry; 1992.Google Scholar
  11. 11.
    Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65:1220S–8. Discussion 1229S–1231S.PubMedGoogle Scholar
  12. 12.
    Hardcastle AC, Aucott LS, Fraser WD, Reid DM, Macdonald HM. Dietary patterns, bone resorption, and bone mineral density in early post-menopausal Scottish women. Eur J Clin Nutr. 2010;65:378–85.PubMedCrossRefGoogle Scholar
  13. 13.
    Karamati M, Jessri M, Shariati-Bafghi SE, Rashidkhani B. Dietary patterns in relation to bone mineral density among postmenopausal Iranian women. Calcif Tissue Int. 2012;91:40–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Whittle CR, Woodside JV, Cardwell CR, McCourt HJ, Young IS, Murray LJ, et al. Dietary patterns and bone mineral status in young adults: the Northern Ireland young hearts project. Br J Nutr. 2012;108:1494–504.PubMedCrossRefGoogle Scholar
  15. 15.
    Fairweather-Tait SJ, Skinner J, Guile GR, Cassidy A, Spector TD, Macgregor AJ. Diet and bone mineral density study in postmenopausal women from the Twins UK registry shows a negative association with a traditional English dietary pattern and a positive association with wine. Am J Clin Nutr. 2011;94:1371–5.PubMedCrossRefGoogle Scholar
  16. 16.
    McNaughton SA, Wattanapenaiboon N, Wark JD, Nowson CA. An energy dense nutrient poor dietary pattern is inversely associated with bone health in women. J Nutr. 2011;141:1516–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Sugiura M, Nakamura M, Ogawa K, Ikoma Y, Ando F, Shimokata H, et al. Dietary patterns of antioxidant vitamins and carotenoid intake associated with bone mineral density: findings from postmenopausal Japanese female subjects. Osteoporos Int. 2011;22:143–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Langsetmo L, Poliquin S, Hanley DA, Prior JC, Barr S, Anastassiades T, et al. Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density. BMC Musculoskelet Disord. 2010;11:20.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Kontogianni MD, Melistas L, Yannakoulia M, Malagaris I, Panagiotakos DB, Yiannakouris N. Association between dietary patterns and indices of bone mass in a sample of Mediterranean women. Nutrition. 2009;25:165–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Okubo H, Sasaki S, Horiguchi H, Oguma E, Miyamoto K, Hosoi Y, et al. Dietary patterns associated with bone mineral density in premenopausal farmwomen. Am J Clin Nutr. 2006;83:1185–92.PubMedGoogle Scholar
  21. 21.
    Tucker KL, Chen H, Hannan MT, Cupples LA, Wilson PWF, Felson D, et al. Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. Am J Clin Nutr. 2002;76:245–52.PubMedGoogle Scholar
  22. 22.
    Zeng F, Wu B, Fan F, Xie H, Xue W, Zhu H, et al. Dietary patterns and the risk of hip fractures in elderly Chinese: a matched case-control study. J Clin Endocrinol Metab. 2013. doi: 10.1210/jc.2013-1190.PubMedGoogle Scholar
  23. 23.
    Samieri C, Ginder Coupez V, Lorrain S, Letenneur L, Alles B, Feart C, et al. Nutrient patterns and risk of fracture in older subjects: results from the three-city study. Osteoporos Int. 2013;24:1295–305.PubMedCrossRefGoogle Scholar
  24. 24.
    Benetou V, Orfanos P, Pettersson-Kymmer U, Bergstrom U, Svensson O, Johansson I, et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int. 2013;24(5):1587–98.PubMedCrossRefGoogle Scholar
  25. 25.
    Langsetmo L, Hanley DA, Prior JC, Barr SI, Anastassiades T, Towheed T, et al. Dietary patterns and incidence of low trauma fractures in postmenopausal women and men aged ≥50 y: a population based cohort study. Am J Clin Nutr. 2011;93:192–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Monma Y, Niu K, Iwasaki K, Tomita N, Nakaya N, Hozawa A, et al. Dietary patterns associated with fall-related fracture in elderly Japanese: a population based prospective study. BMC Geriatr. 2010;10:31.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    McTiernan A, Wactawski-Wende J, Wu L, Rodabough RJ, Watts NB, Tylavsky F, et al. 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. 2009;89:1864–76.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Xu L, Dibley M, D’Este C, Phillips M, Porteous J, Attia J. Food groups and risk of forearm fractures in postmenopausal women in Chengdu, China. Climacteric. 2009;12(3):222–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Wachman A, Bernstein DS. Diet and osteoporosis. Lancet. 1968;1:958–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Darling AL, Millward DJ, Torgerson DJ, Hewitt CE, Lanham-New SA. Dietary protein and bone health: a systematic review and meta-analysis. Am J Clin Nutr. 2009;90:1674–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Schulze MB, Hoffman K. Methodological approaches to study dietary patterns in relation to risk of coronary heart disease and stroke. Br J Nutr. 2006;95(5):860–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Wosje KS, Khoury PR, Claytor RP, Copeland KA, Hornung RW, Daniels SR, et al. Dietary patterns associated with fat and bone mass in young children. Am J Clin Nutr. 2010;92:294–303.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Bone and Musculoskeletal Research ProgrammeUniversity of AberdeenAberdeenUK

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