Table 2.
Risks of total and site-specific fractures by diet group in EPIC-Oxford, with varying levels of adjustments
| Fracture site/diet group | N cases | Person-years | Age at eventa | Hazard ratios (95% confidence intervals) | ||||
|---|---|---|---|---|---|---|---|---|
| Model 1b | Model 2c | Model 3d | Model 4e | Model 5f | ||||
| Total fractures (N = 54,898) | ||||||||
| Meat eaters | 2468 | 511,459 | 68.5 (13.1) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 464 | 138,851 | 64.3 (14.5) | 0.97 (0.87, 1.07) | 0.95 (0.86, 1.05) | 0.95 (0.85, 1.05) | 0.94 (0.84, 1.04) | 0.94 (0.84, 1.05) |
| Vegetarians | 862 | 260,112 | 60.7 (16.4) | 1.11 (1.02, 1.21) | 1.09 (1.00, 1.19) | 1.08 (1.00, 1.18) | 1.07 (0.97, 1.17) | 1.07 (0.97, 1.18) |
| Vegans | 147 | 33,510 | 59.9 (17.4) | 1.50 (1.26, 1.78) | 1.43 (1.20, 1.70) | 1.31 (1.10, 1.57) | 1.39 (1.16, 1.67) | 1.30 (1.08, 1.56) |
| p-heterogeneityg | < 0.001 | < 0.001 | 0.003 | 0.001 | 0.009 | |||
| Arm fractures (N = 55,014) | ||||||||
| Meat eaters | 352 | 525,955 | 69.9 (12.4) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 62 | 141,853 | 66.1 (13.0) | 0.93 (0.71, 1.24) | 0.92 (0.69, 1.22) | 0.92 (0.69, 1.22) | 0.85 (0.64, 1.13) | 0.85 (0.64, 1.13) |
| Vegetarians | 130 | 265,518 | 63.7 (15.4) | 1.28 (1.03, 1.60) | 1.25 (1.00, 1.56) | 1.25 (1.00, 1.56) | 1.12 (0.87, 1.43) | 1.12 (0.87, 1.43) |
| Vegans | 22 | 34,503 | 58.0 (16.1) | 1.67 (1.07, 2.61) | 1.56 (0.99, 2.44) | 1.54 (0.96, 2.46) | 1.39 (0.87, 2.22) | 1.39 (0.86, 2.25) |
| p-heterogeneityg | 0.020 | 0.049 | 0.056 | 0.19 | 0.20 | |||
| Wrist fractures (N = 55,013) | ||||||||
| Meat eaters | 565 | 523,913 | 67.3 (11.4) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 110 | 141,606 | 64.4 (13.6) | 0.93 (0.75, 1.15) | 0.90 (0.73, 1.11) | 0.90 (0.73, 1.12) | 0.92 (0.74, 1.15) | 0.94 (0.75, 1.17) |
| Vegetarians | 185 | 265,177 | 60.2 (14.4) | 1.03 (0.86, 1.24) | 1.00 (0.83, 1.19) | 1.00 (0.83, 1.20) | 1.03 (0.84, 1.26) | 1.05 (0.86, 1.29) |
| Vegans | 29 | 34,431 | 58.8 (16.2) | 1.33 (0.91, 1.96) | 1.24 (0.84, 1.82) | 1.14 (0.76, 1.70) | 1.28 (0.86, 1.90) | 1.19 (0.79, 1.79) |
| p-heterogeneityg | 0.39 | 0.49 | 0.70 | 0.49 | 0.67 | |||
| Hip fractures (N = 55,026) | ||||||||
| Meat eaters | 610 | 525,706 | 76.8 (9.5) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 122 | 141,856 | 74.6 (11.4) | 1.33 (1.08, 1.62) | 1.26 (1.02, 1.54) | 1.26 (1.03, 1.54) | 1.24 (1.01, 1.53) | 1.25 (1.01, 1.55) |
| Vegetarians | 172 | 265,548 | 74.5 (11.9) | 1.34 (1.12, 1.61) | 1.25 (1.04, 1.50) | 1.24 (1.03, 1.49) | 1.20 (0.98, 1.47) | 1.21 (0.99, 1.49) |
| Vegans | 41 | 34,489 | 74.1 (13.3) | 2.64 (1.90, 3.67) | 2.31 (1.66, 3.22) | 1.97 (1.39, 2.79) | 2.21 (1.56, 3.12) | 1.94 (1.35, 2.77) |
| p-heterogeneityg | < 0.001 | < 0.001 | < 0.001 | < 0.001 | 0.002 | |||
| Leg fractures (N = 55,019) | ||||||||
| Meat eaters | 227 | 526,617 | 68.7 (12.3) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 48 | 141,993 | 62.8 (13.8) | 1.06 (0.77, 1.47) | 1.07 (0.77, 1.48) | 1.06 (0.77, 1.47) | 1.06 (0.76, 1.49) | 1.05 (0.75, 1.47) |
| Vegetarians | 73 | 265,842 | 61.3 (16.0) | 1.00 (0.75, 1.33) | 1.01 (0.76, 1.34) | 1.00 (0.75, 1.33) | 0.99 (0.72, 1.37) | 0.99 (0.72, 1.36) |
| Vegans | 18 | 34,533 | 59.1 (19.3) | 2.04 (1.23, 3.38) | 2.05 (1.23, 3.41) | 1.83 (1.07, 3.14) | 2.02 (1.19, 3.44) | 1.81 (1.04, 3.15) |
| p-heterogeneityg | 0.044 | 0.045 | 0.16 | 0.053 | 0.17 | |||
| Ankle fractures (N = 55,021) | ||||||||
| Meat eaters | 332 | 525,449 | 63.0 (12.1) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 58 | 141,898 | 56.0 (10.2) | 0.79 (0.59, 1.05) | 0.84 (0.63, 1.12) | 0.84 (0.63, 1.12) | 0.88 (0.65, 1.19) | 0.89 (0.66, 1.20) |
| Vegetarians | 117 | 265,486 | 54.7 (14.4) | 0.94 (0.75, 1.19) | 1.01 (0.80, 1.27) | 1.01 (0.80, 1.27) | 1.10 (0.85, 1.43) | 1.11 (0.85, 1.44) |
| Vegans | 13 | 34,566 | 51.1 (14.8) | 0.90 (0.51, 1.58) | 1.03 (0.58, 1.82) | 0.91 (0.50, 1.63) | 1.13 (0.63, 2.03) | 1.00 (0.55, 1.82) |
| p-heterogeneityg | 0.44 | 0.65 | 0.65 | 0.59 | 0.60 | |||
| Other main site fracturesh (N = 55,016) | ||||||||
| Meat eaters | 287 | 526,576 | 69.1 (14.1) | Reference | Reference | Reference | Reference | Reference |
| Fish eaters | 57 | 142,051 | 63.1 (15.1) | 1.01 (0.75, 1.36) | 0.98 (0.73, 1.33) | 0.98 (0.72, 1.32) | 0.98 (0.72, 1.33) | 0.96 (0.71, 1.31) |
| Vegetarians | 100 | 265,768 | 59.4 (16.7) | 1.03 (0.80, 1.32) | 0.99 (0.77, 1.27) | 0.98 (0.76, 1.26) | 0.97 (0.73, 1.28) | 0.95 (0.72, 1.26) |
| Vegans | 23 | 34,526 | 58.2 (16.2) | 1.73 (1.11, 2.70) | 1.59 (1.02, 2.50) | 1.66 (1.03, 2.67) | 1.55 (0.97, 2.48) | 1.61 (0.98, 2.62) |
| p-heterogeneityg | 0.11 | 0.20 | 0.18 | 0.23 | 0.20 | |||
aIn cases only, as mean years (SD)
bModel 1 was stratified by sex, method of recruitment (general practice or postal), and region (7 categories), and adjusted for year of recruitment (per year from ≤ 1994 to ≥ 1999), ethnicity (white, other, unknown), Townsend deprivation index (quartiles, unknown), education level (no qualifications, basic secondary (e.g. O level), higher secondary (e.g. A level), degree, unknown), physical activity (inactive, low activity, moderately active, very active, unknown), smoking (never, former, light, heavy, unknown), alcohol consumption (< 1 g, 1–7 g, 8–15 g, 16+ g/day), dietary supplement use (no, yes, unknown), height (5 cm categories from < 155 to ≥ 185 cm, unknown), and in women menopausal status (premenopausal, perimenopausal, postmenopausal, unknown), hormone replacement therapy use (never, ever, unknown), and parity (none, 1–2, ≥ 3, unknown)
cModel 2 was model 1 plus BMI (< 18.5, 18.5–19.9, 20–22.4, 22.5–24.9, 25–27.4, 27.5–29.9, 30–32.4, ≥ 32.5 kg/m2, unknown)
dModel 3 was model 2 plus dietary calcium intake (< 525, 525–699, 700–899, 900–1199, ≥ 1200 mg)
eModel 4 was model 2 plus protein intake (< 13, 13–14.4, 14.5–15.9, 16–18.0, ≥ 18.1 of % energy)
fModel 5 was model 2 plus dietary calcium intake (< 525, 525–699, 700–899, 900–1199, ≥ 1200 mg) and protein intake (< 13, 13–14.4, 14.5–15.9, 16–18.0, ≥ 18.1 of % energy)
gp-heterogeneity represents heterogeneity in risk between diet group based on Wald’s tests
hDefined as fractures of the clavicle, rib, or vertebra