Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans

Thorpe, Donna; Beeson, W. Lawrence; Knutsen, Raymond; Fraser, Gary E.; Knutsen, Synnøve F.

doi:10.1093/ajcn/nqab095

Cited by 32 publications

(20 citation statements)

References 52 publications

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“…Prospective evidence of hip fracture risk in individuals on meat-free diets is limited. Our findings largely concur with the results of the only other two cohort studies on this topic [ 8 , 9 ], strengthening the evidence of a higher risk of hip fracture in UK vegetarian women.…”

Section: Discussionsupporting

confidence: 90%

“…The slightly higher effect estimate in our study (33%) may be due to our reference group being regular meat-eaters, whereas the reference group in the EPIC-Oxford cohort was meat-eaters of any amount. The AHS-2 also found limited evidence of a 17% higher risk of hip fracture in US vegetarian women [ 9 ]. Differences in estimates between the AHS-2 and our results may be due to the different adjustment strategies when accounting for confounders; in the AHS-2, attained age was used as the time frame, and adjustment was made for age and energy, calcium, potassium, and vitamin D intakes at recruitment amongst other factors.…”

Section: Discussionmentioning

confidence: 99%

“…Cross-sectional studies show lower BMD in vegetarians compared to non-vegetarians [ 25 , 26 ], but prospective studies comparing the risk of hip fracture in these diet groups over time are scarce and limited [ 8 , 9 ]. The recently published European Prospective Investigation into Cancer (EPIC)-Oxford cohort study of UK men and women showed a greater risk of hip fracture in pescatarians, vegetarians, and vegans compared to meat-eaters [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The recently published European Prospective Investigation into Cancer (EPIC)-Oxford cohort study of UK men and women showed a greater risk of hip fracture in pescatarians, vegetarians, and vegans compared to meat-eaters [ 8 ]. The Adventist Health Study-2 (AHS-2) also showed a greater risk of hip fracture in vegans but not vegetarians compared to meat-eaters in US women, but with outcome data based on self-administered questionnaires [ 9 ]. To our knowledge, no other prospective study has compared the risk of hip fracture in vegetarians and non-vegetarians; therefore, associations between these diet groups and hip fracture risk require further investigation.…”

Section: Introductionmentioning

confidence: 99%

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Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study

Webster

Greenwood

Cade

2022

BMC Med

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Background The risk of hip fracture in women on plant-based diets is unclear. We aimed to investigate the risk of hip fracture in occasional meat-eaters, pescatarians, and vegetarians compared to regular meat-eaters in the UK Women’s Cohort Study and to determine if potential associations between each diet group and hip fracture risk are modified by body mass index (BMI). Methods UK women, ages 35–69 years, were classified as regular meat-eaters (≥ 5 servings/week), occasional meat-eaters (< 5 servings/week), pescatarian (ate fish but not meat), or vegetarian (ate neither meat nor fish) based on a validated 217-item food frequency questionnaire completed in 1995–1998. Incident hip fractures were identified via linkage to Hospital Episode Statistics up to March 2019. Cox regression models were used to estimate the associations between each diet group and hip fracture risk over a median follow-up time of 22.3 years. Results Amongst 26,318 women, 822 hip fracture cases were observed (556,331 person-years). After adjustment for confounders, vegetarians (HR (95% CI) 1.33 (1.03, 1.71)) but not occasional meat-eaters (1.00 (0.85, 1.18)) or pescatarians (0.97 (0.75, 1.26)) had a greater risk of hip fracture than regular meat-eaters. There was no clear evidence of effect modification by BMI in any diet group (p-interaction = 0.3). Conclusions Vegetarian women were at a higher risk of hip fracture compared to regular meat-eaters. Further research is needed to confirm this in men and non-European populations and to identify factors responsible for the observed risk difference. Further research exploring the role of BMI and nutrients abundant in animal-sourced foods is recommended. Trial registration ClinicalTrials.gov, NCT05081466

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study

Webster

Greenwood

Cade

2022

BMC Med

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“…are not consumed. Additional expenses for supplements (e.g., vitamin B 12 and D) need to be considered [32][33][34] Isolated carbohydrates are apparently the cheapest nutrients. Diets with carbohydrate restriction-including the Mediterranean diet-may be very effective for metabolic amelioration, but require a substantially higher household budget for food.…”

Section: Discussionmentioning

confidence: 99%

Affordability of Different Isocaloric Healthy Diets in Germany—An Assessment of Food Prices for Seven Distinct Food Patterns

et al. 2021

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Affordability of different isocaloric healthy diets in Germany—an assessment of food prices for seven distinct food patterns Background: For decades, low-fat diets were recommended as the ideal food pattern to prevent obesity, type 2 diabetes and their long-term complications. Nowadays, several alternatives considering sources and quantity of protein, fat and carbohydrates have arisen and clinical evidence supports all of them for at least some metabolic outcomes. Given this variety in diets and the lack of a single ideal diet, one must evaluate if patients at risk, many of which having a lower income, can actually afford these diets. Aim: We modelled four-week food plans for a typical family of two adults and two school children based on seven different dietary patterns: highly processed standard omnivore diet (HPSD), freshly cooked standard omnivore diet (FCSD), both with German average dietary composition, low-protein vegan diet (VeganD), low-fat vegetarian diet (VegetD), low-fat omnivore diet (LFD), Mediterranean diet (MedD) and high-fat moderate-carb diet (MCD). The isocaloric diets were designed with typical menu variation for all meal times. We then assessed the lowest possible prices for all necessary grocery items in 12 different supermarket chains, avoiding organic foods, special offers, advertised exotic super foods and luxury articles. Prices for dietary patterns were compared in total, stratified by meal time and by food groups. Results: Among all seven dietary patterns, price dispersion by supermarket chains was 12–16%. Lowest average costs were calculated for the VegetD and the FCSD, followed by HPSD, LFD, VeganD, MedD and—on top—MCD. VeganD, MedD and MCD were about 16%, 23% and 67% more expensive compared to the FCSD. Major food groups determining prices for all diets are vegetables, salads and animal-derived products. Calculations for social welfare severely underestimate expenses for any kind of diet. Conclusions: Food prices are a relevant factor for healthy food choices. Food purchasing is financially challenging for persons with very low income in Germany. Fresh-cooked plant-based diets are less pricy than the unhealthy HPSD. Diets with reduced carbohydrate content are considerably more expensive, limiting their use for people with low income. Minimum wage and financial support for long-term unemployed people in Germany are insufficient to assure a healthy lifestyle.

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Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women

Sotos-Prieto,

Rodriguez-Artalejo,

Fung

et al. 2024

JAMA Netw Open

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ImportancePrevious research has found that vegetarian diets are associated with lower bone mineral density and higher risk of fractures, but these studies did not differentiate the quality of the plant-based foods.ObjectiveTo examine the association between the quality of plant-based diets (not necessarily vegan but also omnivorous) and hip fracture risk among postmenopausal women in the Nurses’ Health Study.Design, Setting, and ParticipantsThis cohort study analyzed data from 70 285 postmenopausal women who participated in the US Nurses’ Health Study from 1984 through 2014. Data were analyzed from January 1 to July 31, 2023.Main outcomes and MeasuresHip fractures were self-reported on biennial questionnaires. Diet was assessed every 4 years using a validated semiquantitative food frequency questionnaire. Plant-based diet quality was assessed using 2 previously established indices: the healthful Plant-Based Diet Index (hPDI), for which healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea or coffee) received positive scores, whereas less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets or desserts) and animal foods received reversed scores; and the unhealthful Plant-Based Diet Index (uPDI), for which positive scores were given to less healthy plant foods and reversed scores to healthy plant and animal foods. Quintile scores of 18 food groups were summed, with a theoretical range for both indices of 18 to 90 (highest adherence). Cox proportional hazards regression with time-varying covariates was used to compute hazard ratios (HRs) and 95% CIs for hip fracture.ResultsIn total, 70 285 participants (mean [SD] age, 54.92 [4.48] years; 100% White women) were included, and 2038 cases of hip fracture were ascertained during the study and for up to 30 years of follow-up. Neither the hPDI (HR for highest vs lowest quintile, 0.97 [95% CI, 0.83-1.14]) nor the uPDI (HR for highest vs lowest quintile, 1.02 [95% CI, 0.87-1.20]) for long-term diet adherence was associated with hip fracture risk. However, when examining recent intake for the highest vs lowest quintiles, the hPDI was associated with 21% lower risk of hip fracture (HR, 0.79 [95% CI, 0.68-0.92]; P = .02 for trend), and the uPDI was associated with 28% higher risk (1.28 [95% CI, 1.09-1.51]; P = .008 for trend).Conclusions and RelevanceFindings of this cohort study indicated that long-term adherence to healthful or unhealthful plant-based diets as assessed by hPDI and uPDI scores was not associated with hip fracture risk. Future research should clarify whether the associations observed with recent dietary intake are due to short-term effects of these dietary patterns, reverse causality, or both.

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Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans

Cited by 32 publications

References 52 publications

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study

Affordability of Different Isocaloric Healthy Diets in Germany—An Assessment of Food Prices for Seven Distinct Food Patterns

Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women

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