Mediterranean diet and hip fracture incidence among older adults: the CHANCES project
The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk.
Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults.
A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis.
A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92–0.99, pheterogeneity = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87–0.99) and high (HR 0.94; 95% CI 0.87–1.01) adherence to the score compared with those with low adherence.
In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.
KeywordsAging Bone health CHANCES Dietary patterns Hip fractures Mediterranean diet
Compliance with ethical standards
Conflicts of interest
Francine Grodstein declares unrestricted research gift from California Walnut Commission. Other authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 6.McTiernan A, Wactawski-Wende J, Wu L, Rodabough RJ, Watts NB, Tylavsky F, Women's Health Initiative Investigators et al (2009) Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: the Women's Health Initiative Dietary Modification Trial. Am J Clin Nutr 89(6):1864–1876CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Langsetmo L, Hanley DA, Prior JC, Barr SI, Anastassiades T, Towheed T, Goltzman D, Morin S, Poliquin S, Kreiger N, CaMos Research Group (2011) Dietary patterns and incident low-trauma fractures in postmenopausal women and men aged ≥ 50 y: a population-based cohort study. Am J Clin Nutr 93(1):192–199CrossRefPubMedGoogle Scholar
- 8.Benetou V, Orfanos P, Pettersson-Kymmer U, Bergström U, Svensson O, Johansson I, Berrino F, Tumino R, Borch KB, Lund E, Peeters PHM, Grote V, Li K, Altzibar JM, Key T, Boeing H, von Ruesten A, Norat T, Wark PA, Riboli E, Trichopoulou A (2013) Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24(5):1587–1598CrossRefPubMedGoogle Scholar
- 10.Feart C, Lorrain S, Ginder Coupez V, Samieri C, Letenneur L, Paineau D et al (2013) Adherence to a Mediterranean diet and risk of fractures in French older persons. Osteoporos Int 2013;24(12):3031–3041Google Scholar
- 20.Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martínez-González MÁ, Martínez-Lapiscina EH, Fitó M, Pérez-Heras A, Salas-Salvadó J, Estruch R, Ros E (2015) Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med 175(7):1094–1103CrossRefPubMedGoogle Scholar
- 22.Harmon BE, Boushey CJ, Shvetsov YB, Ettienne R, Reedy J, Wilkens LR, le Marchand L, Henderson BE, Kolonel LN (2015) Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr 101(3):587–597CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Boffetta P, Bobak M, Borsch-Supan A, Brenner H, Eriksson S, Grodstein F, Jansen E, Jenab M, Juerges H, Kampman E, Kee F, Kuulasmaa K, Park Y, Tjonneland A, van Duijn C, Wilsgaard T, Wolk A, Trichopoulos D, Bamia C, Trichopoulou A (2014) The Consortium on Health and Ageing: network of cohorts in Europe and the United States (CHANCES) project—design, population and data harmonization of a large-scale, international study. Eur J Epidemiol 29(12):929–936CrossRefPubMedGoogle Scholar
- 24.Kuulasmaa K, Palosaari T (2014) Editors. Contributors from partners of the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). CHANCES cohort descriptions, assessment of the availability and quality data and definitions of variables. MORGAM Project e-publications [internet]; URT: http://www.thl.fi/publications/morgam/chances_d9/index.html
- 34.Rautiainen S, Serafini M, Morgenstern R, Prior RL, Wolk A (2008) The validity and reproducibility of food-frequency questionnaire-based total antioxidant capacity estimates in Swedish women. Am J ClinNutr 87(5):1247–1253Google Scholar
- 40.Nutrition and bone health. Michael F Holick, Jeri W. Nieves Editors. Second Edition, 2015. Humana PressGoogle Scholar
- 43.Jacobs DR Jr, Steffen LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78(3Suppl):508S–513SGoogle Scholar
- 45.Schousboe JT, Paudel ML, Taylor BC, Virnig BA, Cauley JA, Curtis JR, Ensrud KE (2013) Magnitude and consequences of misclassification of incident hip fractures in large cohort studies: the study of osteoporotic fractures and Medicare claims data. Osteoporos Int 24(3):801–810CrossRefPubMedGoogle Scholar
- 48.Benetou V, Orfanos P, Benetos IS, Pala V, Evangelista A, Frasca G, Giurdanella MC, Peeters PHM, van der Schouw YT, Rohrmann S, Linseisen J, Boeing H, Weikert C, Pettersson U, van Guelpen B, Bueno-de-Mesquita HB, Altzibar J, Boffetta P, Trichopoulou A (2011) Anthropometry, physical activity and hip fractures in the elderly. Injury 42(2):188–193CrossRefPubMedGoogle Scholar