TABLE 3.

Summary of studies evaluating the association between bone preclinical and clinical outcomes and dietary patterns, derived with the use of data-driven or a priori dietary pattern approaches in participants <18 y of age¹

Study, location and design (reference)	Participant information	Bone outcomes and methods of measurement	Dietary patterns: foods positively associated with them	Results
Factor analysis
Korean adolescents’ study, Korea, cross-sectional (Shin et al. 2013) (40)	196 girls and boys, aged 12–15 y	FN BMD, LS BMD by DXA	1) Traditional Korean, 2) fast food, 3) milk and cereals, 4) snacks	Pattern (3) was directly associated with LS BMD
Cluster analysis
EPITeen Cohort, Portugal, longitudinal and cross-sectional (Monjardino et al. 2015) (41)	543 girls and 464 boys; aged 13 y at baseline, follow-up to 17 y	Distal radius BMD by DXA	1) Healthier, 2) dairy products, 3) fast foods and sweets, 4) lower intake	No association was observed between BMD at age 13 y and any of the clusters; cluster (4) was inversely associated with BMD increase from age 13 to 17 y compared with other clusters
RRR
Young children’s study, United States, longitudinal (Wosje et al. 2010) (42)	325 girls and boys, aged 3.8–7.8 y	TB BMC (except the skull) and fat mass by DXA; RRR with TB BMC and fat mass as a response variable	1) Nonwhole grains, cheese, processed meats, eggs, fried potatoes, discretionary fats, and artificially sweetened beverages; 2) dark-green vegetables, deep-yellow vegetables, and processed meats	Pattern (1) was directly associated with fat mass and bone mass independent of energy intake; pattern (2) was inversely associated with fat mass and positively with bone mass independent of energy intake
School girls’ study, Korea, longitudinal (Noh et al. 2011) (43)	198 girls, aged 9–11 y at baseline	Calcaneus BMD, BMC by DXA; RRR with change in BMI, body fat, BMD, and BMC during 22 mo as response variables	1) Fruit, nuts, milk beverages, egg, and grain; 2) egg and rice	Pattern (1) was directly associated with increases in BMI, fat mass, and BMC; pattern (2) was directly associated with increases in BMI and fat mass and inversely associated with increases in BMC
Young adults born to mothers in the Western Australian Pregnancy Cohort, Australia, longitudinal (Hooven et al. 2015) (44)	500 girls and 524 boys, aged 14 y at baseline	TB BMD, BMC, and bone area by DXA at age 20 y; RRR (PLS procedure) with protein, calcium, and potassium as response variable	1) High protein, calcium, and potassium; 2) high protein, low calcium and potassium	Pattern (1) at age 14 y was directly associated with BMD and BMC at age 20 y
Dietary indexes
EPITeen Cohort, Portugal, longitudinal and cross-sectional (Monjardino et al. 2014) (60)	673 girls and 591 boys, aged 13 y at baseline and 17 y at follow-up	Distal radius BMD by DXA	Kids Mediterranean Diet Score	Directly associated with BMD at age 13 y in boys, but not with its annual variation or BMD at age 17 y
			Dietary Approaches to Stop Hypertension	No significant association
			Oslo Health Study Index	No significant association
Clinical trial, Spain (Seiquer et al. 2008) (61)	Intervention group: 20 boys aged 11–14 y (mean ± SD age: 13 ± 1 y); no control group	Bone resorption biomarkers: urinary DPD; bone formation biomarker: serum BAP; calcium absorption and retention at baseline and after 28-d intervention	Mediterranean-based dietary pattern (28 d of intervention)	Directly associated with calcium absorption and retention and urinary DPD; no significant association with BAP

¹BAP, bone-specific alkaline phosphatase; BMC, bone mineral content; BMD, bone mineral density; DPD, deoxypyridinoline; EPITeen, Epidemiological Health Investigation of Teenagers in Porto; FN, femoral neck; LS, lumbar spine; PLS, partial least squares; RRR, reduced rank regression; TB, total body.