TABLE 2.
Summary of studies evaluating the association between bone preclinical and clinical outcomes and dietary patterns, derived with the use of a priori dietary pattern approaches in participants aged ≥18 y1
| Study, location, and design (reference) | Participant information | Bone outcomes and methods of measurement | Dietary pattern score or index | Results |
| BMD/BMC | ||||
| Greek women’s study, Greece, cross-sectional (Kontogianni et al. 2009) (14) | 196 pre- and perimenopausal women, aged 48 ± 2 y | LS BMD and TB BMC by DXA | Mediterranean Diet Score | No significant association |
| Oslo Health Study, Norway, cross-sectional (Hostmark et al. 2011) (45) | 1255 women and 871 men, aged 30–60 y | Distal and ultradistal forearm, by SXA | Oslo Health Study Index | Inversely associated with distal forearm BMD |
| Northern Ireland Young Heart Project, Ireland, cross-sectional (Whittle et al. 2012) (19) | 238 women and 251 men, aged 20–25 y | FN BMD, FN BMC, LS BMD, LS BMC by DXA | Mediterranean Diet Score | No significant association |
| Dietary Diversity Score | Directly associated with FN BMD in women, but not in men | |||
| Nutritional Risk Score | No significant association | |||
| UMass Vitamin D Status Study, United States, cross-sectional (Zagarins et al. 2012) (46) | 226 women, aged 18–30 y | TB BMD and BMAD [BMAD = BMC/(bone area2/height)] | Recommended Food Score | Inversely associated with BMAD |
| Alternative Healthy Eating Index | No significant association | |||
| Southern Spain women study, Spain, cross-sectional (Rivas et al. 2013) (47) | 100 premenopausal (aged 34 ± 7 y), 100 postmenopausal (aged 54 ± 6 y) women, aged 18–65 y | Calcaneus BMD by DXA | Mediterranean Diet Score | Directly associated with BMD in all subjects |
| Postmenopausal women, Iran, cross-sectional (Shivappa et al. 2016) (48) | 160 postmenopausal women, aged 50–85 y | FN BMD and LS BMD by DXA | Dietary Inflammatory Index | Inversely associated with LS BMD |
| Community based Chinese adults, China, cross-sectional (Chen et al. 2016) (49) | 1678 women and 693 men, aged 40–75 y | TB BMD, FN BMD, LS BMD, BMD of all hip sites by DXA | Alternate Mediterranean Score | Directly associated with BMD at all sites |
| The FLAMENCO project, Spain, cross-sectional (Aparicio et al. 2016) (50) | 197 women, aged 45–60 y | TB BMD by DXA | Mediterranean Diet Score | No significant association |
| The Rotterdam Study, Netherlands, longitudinal and cross-sectional (de Jonge et al. 2015) (51) | 2932 women and 2211 men, aged ≥55 y at baseline (median: 67 y; IQR: 61–73 y) | FN BMD by DXA, at baseline and 3 subsequent visits | BMD Diet Score | Directly associated with FN BMD |
| Healthy Diet Indicator | Directly associated with FN BMD, but 3 times weaker than BMD Diet Score | |||
| Biomarkers | ||||
| NHANES 1999–2002, United States, cross-sectional (Hamidi et al. 2011) (52) | 827 postmenopausal women aged ≥45 y | Bone formation: serum BAP; bone resorption: urinary N-telopeptide or creatinine | Healthy Eating Index 2005 | No association was found |
| Osteoporosis | ||||
| Fourth Korean National Health and Nutritional Examination Survey (2007 and 2008), Korea, cross-sectional (Lee et al. 2013) (53) | 5320 women and men, aged 30–80 y | Osteoporosis history | Korean Diet Score | Inversely associated with risk of osteoporosis |
| Fifth Korean National Health and Nutritional Examination Survey (2010) Korea, cross-sectional (Go et al. 2014) (54) | 847 postmenopausal women | Osteoporosis and osteopenia based on WHO BMD T-score criteria | Mean Nutrient Adequacy Ratio | No association was found |
| Dietary Diversity Score | Inversely associated with risk of osteoporosis and osteopenia | |||
| Calcium source assessment | Milk, anchovy, and sea mustard were inversely associated with risk of osteoporosis and osteopenia | |||
| Food Group Intake Pattern | No association was found | |||
| Fractures | ||||
| China, case–control (Zeng et al. 2014) (55) | 549 women pairs and 177 men pairs, age-matched; aged 55–80 y | Hip fracture | Healthy Eating Index 2005 | Inversely associated with hip fracture risk |
| Three-City Study, France, longitudinal (Feart et al. 2013) (56) | 932 women and 550 men, aged ≥67 y at baseline, 8 y follow-up | Hip, vertebral, and wrist fractures; self-reported every biennial interview | Mediterranean Diet Score | No significant association |
| European Prospective Investigation into Cancer and Nutrition study, 10 European countries, lon-gitudinal (Benetou et al. 2013) (57) | 139,981 women and 48,814 men, aged 35–70 y at baseline (mean 48.6 y) | Hip fracture incidence over 9 y | Mediterranean Diet Score | Inversely associated with hip fracture risk |
| Singapore Chinese Healthy Study, China, longitudinal (Dai et al. 2014) (34) | 35,241 women and 27,913 men, aged 45–74 y | Hip fracture from nationwide hospital discharge database | Alternative Healthy Eating Index 2010 | Inversely associated with hip fracture risk |
| Alternative Healthy Eating Index | Inversely associated with hip fracture risk | |||
| Diet Quality Index–International | Inversely associated with hip fracture risk | |||
| Mediterranean Diet Score | Inversely associated with hip fracture risk | |||
| Alternate Mediterranean Score | ||||
| Women’s Health Initiative observational study, United States, longitudinal (Haring et al. 2016) (58) | 90,014 postmenopausal women, aged 50–79 y (63 ± 7) at baseline, 16–21 y follow-up | Total and hip fracture | Mediterranean Diet Score | Inversely associated with hip fracture risk |
| Alternate Mediterranean Score | ||||
| Healthy Eating Index 2010 | No significant association | |||
| Alternative Healthy Eating Index 2010 | No significant association | |||
| Dietary Approaches to Stop Hypertension | No significant association | |||
| Swedish men and women cohort, longitudinal (Byberg et al. 2016) (59) | 33,403 women and 37,903 men, mean age 60 y | Hip fracture by national patient register between 1998 and 2012 | Modified Mediterranean Diet Score | Inversely associated with hip fracture risk |
1
BAP, bone-specific alkaline phosphatase; BMAD, bone mineral apparent density; BMC, bone mineral content; BMD, bone mineral density; FLAMENCO, Fitness League Against MENopause COst; FN, femoral neck; LS, lumbar spine; SXA, single-energy X-ray absorptiometry; TB, total body.