Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density

Abstract

BackgroundPrevious research has shown that underlying dietary patterns are related to the risk of many different adverse health outcomes, but the relationship of these underlying patterns to skeletal fragility is not well understood. The objective of the study was to determine whether dietary patterns in men (ages 25-49, 50+) and women (pre-menopause, post-menopause) are related to femoral neck bone mineral density (BMD) independently of other lifestyle variables, and whether this relationship is mediated by body mass index.MethodsWe performed an analysis of 1928 men and 4611 women participants in the Canadian Multicentre Osteoporosis Study, a randomly selected population-based longitudinal cohort. We determined dietary patterns based on the self-administered food frequency questionnaires in year 2 of the study (1997-99). Our primary outcome was BMD as measured by dual x-ray absorptiometry in year 5 of the study (2000-02).ResultsWe identified two underlying dietary patterns using factor analysis and then derived factor scores. The first factor (nutrient dense) was most strongly associated with intake of fruits, vegetables, and whole grains. The second factor (energy dense) was most strongly associated with intake of soft drinks, potato chips and French fries, certain meats (hamburger, hot dog, lunch meat, bacon, and sausage), and certain desserts (doughnuts, chocolate, ice cream). The energy dense factor was associated with higher body mass index independent of other demographic and lifestyle factors, and body mass index was a strong independent predictor of BMD. Surprisingly, we did not find a similar positive association between diet and BMD. In fact, when adjusted for body mass index, each standard deviation increase in the energy dense score was associated with a BMD decrease of 0.009 (95% CI: 0.002, 0.016) g/cm2 for men 50+ years old and 0.004 (95% CI: 0.000, 0.008) g/cm2 for postmenopausal women. In contrast, for men 25-49 years old, each standard deviation increase in the nutrient dense score, adjusted for body mass index, was associated with a BMD increase of 0.012 (95% CI: 0.002, 0.022) g/cm2.ConclusionsIn summary, we found no consistent relationship between diet and BMD despite finding a positive association between a diet high in energy dense foods and higher body mass index and a strong correlation between body mass index and BMD. Our data suggest that some factor related to the energy dense dietary pattern may partially offset the advantages of higher body mass index with regard to bone health.

Life Course Dietary Patterns and Bone Health in Later Life in a British Birth Cohort Study

“…Importantly, this PrCaK‐rich dietary pattern was also associated with lower total energy intakes, greater densities of fiber, vitamins (folate, carotene, vitamin C, vitamin D), other minerals (magnesium, phosphorus, and iron), and lower densities of carbohydrate and total sugars. The pattern identified broadly agreed with previous observational studies in which “nutrient dense” patterns were positively associated with BMC, BMD, bone turnover markers, or fracture risk 6, 7, 9, 10, 14, 19. In the majority of studies, “nutrient dense” denotes a pattern rich in fruits and vegetables, and whole grains, with low consumption of processed and sugary foods.…”

“…A “nutrient dense” dietary pattern rich in nutrients but not energy, characterized by high intakes of fruit, vegetables, and whole grains has been associated with higher bone mineral density or content (BMD/BMC) and reduced fracture risk in several studies 5, 6, 7, 9, 10, 13, 14, 15, 16, 17, 18, 19. (Nutrient‐dense dietary patterns have been defined in publications from the U.S. Department of Agriculture20 and the National Institutes of Health 21…”

“…(Nutrient‐dense dietary patterns have been defined in publications from the U.S. Department of Agriculture20 and the National Institutes of Health 216, 7, 9…”

Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review

“…Studies were conducted in >20 countries: Australia (16,44), Brazil (24), Canada (25,26,32), China (22,28,30,34,49,55), France (33,56), Greece (14), Iran (20,21,48), Ireland (19), Italy (38), Japan (13,18,31), Korea (23,27,29,40,43,53,54), Netherlands (51), Norway (45), Portugal (41,60), Scotland (17), Spain (47), Sweden (59), United Kingdom (15,39), United States (35-37, 42, 46, 52, 58), and 10 European countries (57).…”

“…The healthy dietary pattern, mainly characterized by a high intake of fruit, vegetables, whole grains, poultry and fish, nuts and legumes, and low-fat dairy products, was directly associated with BMD (13,25) and lower risk of fracture (30,32), and inversely associated with bone resorption biomarkers (17,26). The dietary patterns representing some aspects of the healthy dietary pattern, such as high consumption of fish and olive oil (14); legumes, seafood, seeds and nuts, wine, rice, and vegetables (16); nuts and meats (19); milk and root vegetables (22); and fruit, milk, and whole grains (23), was found to have beneficial impact on BMD and/or BMC.…”