Table 3.
Associations between Trimethylamine N-oxide (TMAO) and Incident Hip Fracture, shown as Hazard Ratios of Incident Hip Fracture per Doubling of Baseline Log2-transformed TMAO level, Total and Stratified by Body Mass Index (BMI) Category
| Hazard Ratio and 95% Confidence Interval | |||||||
|---|---|---|---|---|---|---|---|
| Women (n=3099) | Men (n=1920) | Overall (5019) | |||||
| All Participants | Model 0a | 1.02 | (0.94, 1.10) | 1.10 | (0.95, 1.27) | 1.02 | (0.95, 1.10) |
| Model 1b | 1.00 | (0.92, 1.09) | 1.07 | (0.92, 1.25) | 1.01 | (0.94, 1.09) | |
| Model 2c | 1.00 | (0.91, 1.09) | 1.12 | (0.94, 1.32) | 1.02 | (0.94, 1.10) | |
| Model 3d | 1.00 | (0.92, 1.09) | 1.12 | (0.95, 1.33) | 1.02 | (0.94, 1.10) | |
| Model 4e | 1.00 | (0.91, 1.09) | 1.10 | (0.92, 1.31) | 1.02 | (0.94, 1.10) | |
| Normal weight or underweightf | Model 0a | 0.92 | (0.83, 1.03) | 1.04 | (0.84, 1.29) | 0.93 | (0.84, 1.03) |
| Model 1b | 0.91 | (0.82, 1.02) | 1.03 | (0.82, 1.30) | 0.93 | (0.84, 1.03) | |
| Model 2c | 0.88 | (0.78, 0.999) § | 0.98 | (0.74, 1.29) | 0.90 | (0.81, 1.01) | |
| Model 3d | 0.88 | (0.78, 1.00) | 0.99 | (0.75, 1.30) | 0.90 | (0.81, 1.01) | |
| Model 4e | 0.90 | (0.79, 1.02) | 1.00 | (0.75, 1.34) | 0.92 | (0.82, 1.03) | |
| Overweight or obeseg | Model 0a | 1.17 | (1.04, 1.32) § | 1.16 | (0.96, 1.40) | 1.16 | (1.05, 1.28) § |
| Model 1b | 1.14 | (1.01, 1.28) § | 1.11 | (0.91, 1.35) | 1.13 | (1.02, 1.25) § | |
| Model 2c | 1.15 | (1.02, 1.31) § | 1.23 | (0.98, 1.55) | 1.18 | (1.05, 1.31) § | |
| Model 3d | 1.15 | (1.01, 1.31) § | 1.23 | (0.98, 1.54) | 1.17 | (1.05, 1.31) § | |
| Model 4e | 1.13 | (0.99, 1.29) | 1.20 | (0.95, 1.52) | 1.15 | (1.03, 1.28) § | |
| Obeseh | Model 0a | 1.24 | (0.998, 1.55) | 0.77 | (0.44, 1.35) | 1.15 | (0.94, 1.42) |
| Model 1b | 1.22 | (0.98, 1.53) | 0.73 | (0.41, 1.29) | 1.13 | (0.92, 1.39) | |
| Model 2c | 1.37 | (1.08, 1.73) § | 2.56 | (0.84, 7.81) | 1.33 | (1.07, 1.65) § | |
| Model 3d | 1.37 | (1.08, 1.74) § | 3.10 | (1.08, 8.89) § | 1.33 | (1.07, 1.65) § | |
| Model 4e | 1.32 | (1.03, 1.70) § | 1.45 | (0.49, 4.29) | 1.25 | (0.99, 1.58) | |
Indicates statistical significance
Model 0: Unadjusted
Model 1: Adjusted for age, race, sex (overall only), study site, education level
Model 2: Adjusted for the covariates in Model 1 + smoking status, pack-year smoking history, alcohol use, prevalent diabetes, prevalent CVD, BMI, physical activity, presence of a limitation in ADLs, presence of a limitation in iADLs, frailty, osteoporosis medications (vitamin D, calcium, estrogens, selective estrogen receptor modifiers, bisphosphonates), oral corticosteroid use, and other medications affecting bone metabolism (loop diuretic, thiazide diuretic, SSRI, anticonvulsants, benzodiazepines, sedative/hypnotics, proton pump inhibitors, thiazolidinediones, and thyroid medications)
Model 3: Adjusted for the covariates in Model 2 + CRP and total animal source foods (unprocessed red meat, processed meat, fish, chicken and eggs)
Model 4: Adjusted for the covariates in Model 3 + eGFR
Normal weight or underweight defined as BMI < 25 kg/m2
Overweight or obese defined as BMI ≥ 25 kg/m2
Obese defined as BMI ≥ 30 kg/m2