Fruit and Vegetable Intake and Risk of Hip Fracture: A Cohort Study of Swedish Men and Women

Abstract

Dietary guidelines recommend a daily intake of 5 servings of fruits and vegetables. Whether such intakes are associated with a lower risk of hip fracture is at present unclear. The aim of the present study was to investigate the dose-response association between habitual fruit and vegetable intake and hip fracture in a cohort study based on 40,644 men from the Cohort of Swedish Men (COSM) and 34,947 women from the Swedish Mammography Cohort (SMC) (total n ¼ 75,591), free from cardiovascular disease and cancer, who answered lifestyle questionnaires in 1997 (age 45 to 83 years). Intake of fruits and vegetables (servings/day) was assessed by food frequency questionnaire and incident hip fractures were retrieved from the Swedish Patient Register (1998 to 2010). The mean follow-up time was 14.2 years. One-third of the participants reported an intake of fruits and vegetables of >5 servings/day, one-third reported >3 to 5 servings/day, 28% reported >1 to 3 servings/day, and 6% reported 1 serving/day. During 1,037,645 personyears we observed 3644 hip fractures (2266 or 62% in women). The dose-response association was found to be strongly nonlinear (p < 0.001). Men and women with zero consumption had 88% higher rate of hip fracture compared with those consuming 5 servings/ day; adjusted hazard ratio (HR) was 1.88 (95% CI, 1.53 to 2.32). The rate was gradually lower with higher intakes; adjusted HR for 1 versus 5 servings/day was 1.35 (95% CI, 1.21 to 1.58). However, more than 5 servings/day did not confer additionally lower HRs (adjusted HR for 8 versus 5 servings/day was 0.96; 95% CI, 0.90 to 1.03). Similar results were observed when men and women were analyzed separately. We conclude that there is a dose-response association between fruit and vegetable intake and hip fracture such that an intake below the recommended five servings/day confers higher rates of hip fracture. Intakes above this recommendation do not seem to further lower the risk.

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

“…These data indicate that an increase in the consumption of protein, calcium, and potassium–rich foods during adulthood was associated with less endosteal resorption and thus reduced cortical thinning, which would be protective against bone fragility. These data support evidence from previous studies that have shown reduced hip fracture risk in those with better diets 5, 19…”

“…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.…”

“…Data from the Canadian Multicentre Osteoporosis Study (CAMOS) cohort showed that a healthy pattern was associated with lower risk of low‐trauma fractures in postmenopausal women (hazard ratio 0.86; 95% CI, 0.76 to 0.9) 5. In two Swedish cohorts higher rates of hip fracture in women were associated with a fruit and vegetable intake of less than five portions per day; less than one serving per day was associated with a 50% increased risk of fracture (hazard ratio 1.49; 95% CI, 1.32 to 1.68) 19. The PrCaK‐rich dietary pattern identified in the current study supports current guidelines produced for the prevention of osteoporosis 49.…”

“…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…”

Dietary Approaches for Bone Health: Lessons from the Framingham Osteoporosis Study

“…A systematic review of eight studies concluded that in post-menopausal women, cross-sectional studies support the positive relation between fruit and vegetable intake with bone health; however, the evidence of a beneficial effect of fruits and vegetables in osteoporosis prevention in prospective cohorts and randomized controlled trials is less clear. [6] A more recent study in middle-aged and older men and women linked fruit and vegetable intake less than the recommended 5 servings/day with higher risk of hip fracture [7]. In the Framingham Original cohort, fruit and vegetable intake was positively associated with BMD in both men and women cross-sectionally; and with less BMD loss at the hip in men [8].…”