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Pro-inflammatory dietary pattern is associated with fractures in women: an eight-year longitudinal cohort study

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Abstract

Summary

In this study, during 8 years of follow-up, we reported that higher dietary inflammatory index values were associated with a higher risk of incident fractures in women, but not in men, after adjusting for potential confounders.

Introduction

Inflammation is a key risk factor for many adverse outcomes in older people. While diet is a potential source of inflammation, little is known about the impact of inflammatory diet on fractures. Thus, we investigated whether higher Dietary Inflammatory Index (DII)™ ® scores are associated with fractures in a cohort of North American people.

Methods

This longitudinal study with a follow-up of 8 years included 3648 participants (1577 males and 2071 females; mean age = 60.6 years) with/at risk of knee osteoarthritis participating with in the Osteoarthritis Initiative. DII scores were calculated using the validated Block Brief 2000 Food Frequency Questionnaire, categorized into sex-specific quintiles. Information on fractures was obtained through self-reported history of fractures at hip, spine, and forearm. The relationship between baseline DII score and incident fracture was assessed through a Cox’s regression analysis, adjusted for potential baseline confounders, and reported as hazard ratios (HRs).

Results

During 8 years of follow-up, 560 individuals developed fractures (15.4%). Adjusting for 10 potential confounders, women in the highest DII score quintile (i.e., most pro-inflammatory diet) had a significantly higher risk for fractures (HR = 1.46; 95% CI = 1.02–2.11) compared to women in the lowest quintile. An increase in one standard deviation of DII scores significantly predicted fracture onset in women (adjusted HR = 1.14; 95% CI = 1.02–1.27). The association between DII score and fractures was not significant among men or in the sample as whole.

Conclusion

Pro-inflammatory diet is associated with a higher incidence of fractures in women but not men.

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Funding

The OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners. NS and JRH were supported by the US National Institute for Diabetes, Digestive and Kidney Diseases (grant no. R44DK103377). The sponsors had no role in the design, methods, subject recruitment, data collection, analysis or preparation of this paper.

Author information

Authors and Affiliations

  1. National Research Council,, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padova, Italy

    N. Veronese & S. Maggi

  2. Ambulatory of Nutrition, IRCCS “S. de Bellis”, National Institute of Gastroenterology-Research Hospital, Castellana Grotte, Bari, Italy

    N. Veronese & M. G. Caruso

  3. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK

    B. Stubbs

  4. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Box SE5 8AF, London, UK

    B. Stubbs

  5. Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK

    B. Stubbs

  6. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain

    A. Koyanagi

  7. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain

    A. Koyanagi

  8. Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA

    J. R. Hébert & N. Shivappa

  9. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA

    J. R. Hébert & N. Shivappa

  10. Connecting Health Innovations LLC, Columbia, SC, USA

    J. R. Hébert & N. Shivappa

  11. Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK

    C. Cooper

  12. MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK

    C. Cooper

  13. National Institute for Health Research Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK

    C. Cooper

  14. Department of Radiology, University of Foggia, Foggia, Italy

    G. Guglielmi

  15. Department of Radiology, Scientific Institute “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Foggia, Italy

    G. Guglielmi

  16. Department of Public Health, Epidemiology and Health Economics, University of Liege, CHU Sart Tilman B23, 4000, Liège, Belgium

    J. Y. Reginster

  17. Division of Bone Diseases, Department of Internal Medicine Specialties, and Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland

    R. Rizzoli

Authors
  1. N. Veronese
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  2. B. Stubbs
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  3. A. Koyanagi
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  4. J. R. Hébert
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  5. C. Cooper
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  6. M. G. Caruso
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  7. G. Guglielmi
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  8. J. Y. Reginster
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  9. R. Rizzoli
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  10. S. Maggi
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  11. N. Shivappa
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Corresponding author

Correspondence to N. Veronese.

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Conflicts of interest

Dr. JRH owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. NS is an employee of CHI. Prof. Reginster received consulting fees or paid advisory boards from IBSA-GENEVRIER, MYLAN, Radius Health, PIERRE FABRE; lecture fees when speaking at the invitation of sponsor: IBSA-GENEVRIER, MYLAN, CNIEL, Dairy Research Council (DRC), and grant supports from IBSA-GENEVRIER, MYLAN, CNIEL, Radius Health.

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Veronese, N., Stubbs, B., Koyanagi, A. et al. Pro-inflammatory dietary pattern is associated with fractures in women: an eight-year longitudinal cohort study. Osteoporos Int 29, 143–151 (2018). https://doi.org/10.1007/s00198-017-4251-5

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  • DOI: https://doi.org/10.1007/s00198-017-4251-5

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