Table 4.
Risks of total and site-specific fractures by diet group in EPIC-Oxford, in participants with adequate levels of dietary calcium or protein
| Fracture site/diet group | Hazard ratios (95% confidence intervals)a | |||||
|---|---|---|---|---|---|---|
| N cases | Dietary calcium ≥ 700 mg/day | N cases | Dietary protein ≥ 0.75 g per day/kg body weight | N cases | Dietary calcium ≥ 700 mg/day plus dietary protein ≥ 0.75 g per day/kg body weight | |
| Total fractures | ||||||
| Meat eaters | 2077 | Reference | 2188 | Reference | 1925 | Reference |
| Fish eaters | 377 | 0.92 (0.82, 1.03) | 376 | 0.92 (0.82, 1.03) | 332 | 0.90 (0.80, 1.02) |
| Vegetarians | 700 | 1.08 (0.98, 1.19) | 648 | 1.07 (0.97, 1.18) | 583 | 1.06 (0.96, 1.18) |
| Vegans | 49 | 1.50 (1.12, 1.99) | 103 | 1.52 (1.24, 1.87) | 44 | 1.45 (1.07, 1.97) |
| p-heterogeneityb | 0.003 | < 0.001 | 0.009 | |||
| Arm fractures | ||||||
| Meat eaters | 300 | Reference | 304 | Reference | 273 | Reference |
| Fish eaters | 54 | 0.96 (0.71, 1.30) | 49 | 0.89 (0.65, 1.21) | 46 | 0.91 (0.66, 1.26) |
| Vegetarians | 107 | 1.27 (0.99, 1.62) | 98 | 1.24 (0.97, 1.59) | 90 | 1.25 (0.96, 1.62) |
| Vegans | 8 | 1.76 (0.86, 3.61) | 15 | 1.58 (0.92, 2.70) | 7 | 1.61 (0.75, 3.46) |
| p-heterogeneityb | 0.10 | 0.091 | 0.18 | |||
| Wrist fractures | ||||||
| Meat eaters | 475 | Reference | 503 | Reference | 436 | Reference |
| Fish eaters | 89 | 0.88 (0.70, 1.11) | 96 | 0.93 (0.74, 1.16) | 82 | 0.91 (0.71, 1.16) |
| Vegetarians | 146 | 0.96 (0.79, 1.18) | 140 | 0.97 (0.79, 1.19) | 126 | 0.99 (0.80, 1.23) |
| Vegans | 9 | 1.14 (0.58, 2.22) | 21 | 1.35 (0.86, 2.12) | 9 | 1.29 (0.66, 2.52) |
| p-heterogeneityb | 0.71 | 0.47 | 0.74 | |||
| Hip fractures | ||||||
| Meat eaters | 507 | Reference | 536 | Reference | 463 | Reference |
| Fish eaters | 95 | 1.21 (0.96, 1.52) | 97 | 1.19 (0.95, 1.49) | 85 | 1.22 (0.96, 1.55) |
| Vegetarians | 136 | 1.25 (1.02, 1.54) | 130 | 1.22 (0.99, 1.50) | 115 | 1.25 (1.01, 1.56) |
| Vegans | 14 | 2.39 (1.39, 4.11) | 31 | 2.71 (1.85, 3.95) | 13 | 2.43 (1.38, 4.28) |
| p-heterogeneityb | 0.003 | < 0.001 | 0.004 | |||
| Leg fractures | ||||||
| Meat eaters | 191 | Reference | 197 | Reference | 179 | Reference |
| Fish eaters | 38 | 0.98 (0.68, 1.42) | 38 | 1.04 (0.73, 1.50) | 34 | 0.97 (0.66, 1.42) |
| Vegetarians | 61 | 1.00 (0.73, 1.37) | 51 | 0.95 (0.68, 1.32) | 46 | 0.87 (0.62, 1.24) |
| Vegans | 7 | 2.50 (1.15, 5.42) | 16 | 2.90 (1.68, 4.99) | 6 | 2.32 (1.00, 5.34) |
| p-heterogeneityb | 0.13 | 0.001 | 0.17 | |||
| Ankle fractures | ||||||
| Meat eaters | 277 | Reference | 296 | Reference | 263 | Reference |
| Fish eaters | 49 | 0.84 (0.61, 1.15) | 44 | 0.79 (0.57, 1.10) | 40 | 0.77 (0.55, 1.09) |
| Vegetarians | 88 | 0.91 (0.70, 1.19) | 79 | 0.97 (0.74, 1.27) | 72 | 0.92 (0.69, 1.23) |
| Vegans | 3 | 0.73 (0.23, 2.31) | 9 | 1.19 (0.60, 2.36) | 3 | 0.85 (0.27, 2.69) |
| p-heterogeneityb | 0.66 | 0.50 | 0.54 | |||
| Other main site fracturesc | ||||||
| Meat eaters | 249 | Reference | 254 | Reference | 229 | Reference |
| Fish eaters | 49 | 0.97 (0.70, 1.34) | 47 | 0.95 (0.68, 1.31) | 44 | 0.95 (0.68, 1.34) |
| Vegetarians | 84 | 0.97 (0.74, 1.27) | 75 | 0.93 (0.70, 1.24) | 70 | 0.93 (0.69, 1.25) |
| Vegans | 11 | 2.30 (1.23, 4.28) | 18 | 1.82 (1.10, 3.01) | 11 | 2.40 (1.28, 4.50) |
| p-heterogeneityb | 0.06 | 0.08 | 0.03 | |||
aAll analyses were 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), 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), and in women menopausal status (premenopausal, perimenopausal, postmenopausal, unknown), hormone replacement therapy use (never, ever, unknown), and parity (none, 1–2, ≥ 3, unknown)
bRepresents heterogeneity in risk between diet groups based on Wald’s tests
cDefined as fractures of the clavicle, rib, or vertebra