Dietary Inflammatory Index, Bone Mineral Density, and Risk of Fracture in Postmenopausal Women: Results From the Women's Health Initiative

Abstract

Previous studies suggest that bone loss and fracture risk are associated with higher inflammatory milieu, potentially modifiable by diet. The primary objective of this analysis was to evaluate the association of the dietary inflammatory index (DII), a measure of the inflammatory potential of diet, with risk of hip, lower-arm, and total fracture using longitudinal data from the Women's Health Initiative Observational Study and Clinical Trials. Secondarily, we evaluated changes in bone mineral density (BMD) and DII scores. DII scores were calculated from baseline food frequency questionnaires (FFQs) completed by 160,191 participants (mean age 63 years) without history of hip fracture at enrollment. Year 3 FFQs were used to calculate a DII change score. Fractures were reported at least annually; hip fractures were confirmed by medical records. Hazard ratios for fractures were computed using multivariable-adjusted Cox proportional hazard models, further stratified by age and race/ethnicity. Pairwise comparisons of changes in hip BMD, measured by dual-energy X-ray absorptiometry from baseline, year 3, and year 6 were analyzed by quartile (Q1 = least inflammatory diet) of baseline DII scores in a subgroup of women (n = 10,290). Mean DII score improved significantly over 3 years (p < 0.01), but change was not associated with fracture risk. Baseline DII score was only associated with hip fracture risk in younger white women (HR Q4,1.48; 95% CI, 1.09 to 2.01; p = 0.01). There were no significant associations among white women older than 63 years or other races/ethnicities. Women with the least inflammatory DII scores had less loss of hip BMD (p = 0.01) by year 6, despite lower baseline hip BMD, versus women with the most inflammatory DII scores. In conclusion, a less inflammatory dietary pattern was associated with less BMD loss in postmenopausal women. A more inflammatory diet was associated with increased hip fracture risk only in white women younger than 63 years.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

“…The first one was conducted in a large sample of American women, reported finding that high DII scores, indicating a more inflammatory diet, was associated with increased hip fracture risk. However, this finding was limited only to White women [23]. A case-control study in China, confirmed these findings, in both genders, suggesting that pro-inflammatory diet (with lower DII scores) could be positively associated with higher hip fracture risk [24].…”

“…In Australia, diet consumed by subjects with asthma was more pro-inflammatory than in healthy controls, and higher DII was associated with impaired lung function [20]. Higher DII scores, especially in males, also were associated with increased risk of colorectal cancer [23].…”

“…Recently, three studies have been conducted to examine the relationship between DII scores and fractures [23][24][25]. The first one was conducted in a large sample of American women, reported finding that high DII scores, indicating a more inflammatory diet, was associated with increased hip fracture risk.…”

The Women's Health Initiative: A Landmark Resource for Skeletal Research Since 1992

“…Higher total sodium intake was associated with a 19% significantly lower rate of hip fracture, but this association was attenuated after adjusting for potassium intake . A lower dietary inflammatory index, a measure of the inflammatory potential of diet, was modestly related to a 5% to 8% lower risk of lower arm fracture and any fracture but was unrelated to hip fracture . Higher soft drink consumption (with and without caffeine) has been linked to lower BMD, and in WHI, >14 servings per week was associated with a 26% increased risk of hip fracture (95% CI 1–56%), an association that was independent of many covariates including body mass index .…”

Inflammatory Potential of the Diet and Risk of Sarcopenia and its Components

“…To determine the in ammatory potential of the whole diet, Dietary In ammation Index (DII) has been designed and validated against circulating levels of in ammation [12,13]. This dietary index has linked with several cancers, metabolic diseases, and fractures [14][15][16]. Two longitudinal cohort studies have also shown that higher DII scores were associated with a higher incidence of frailty [17] and decreased appendicular lean mass [6].…”