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

Abstract

Evidence for the contribution of individual foods and nutrients to bone health is weak. Few studies have considered hypothesis‐based dietary patterns and bone health. We investigated whether a protein‐calcium‐potassium–rich (PrCaK‐rich) dietary pattern over the adult life course, was positively associated with bone outcomes at 60 to 64 years of age. Diet diaries were collected at ages 36, 46, 53, and 60 to 64 years in 1263 participants (661 women) from the MRC National Survey of Health and Development. DXA and pQCT measurements were obtained at age 60 to 64 years, including size‐adjusted bone mineral content (SA‐BMC) and volumetric bone mineral density (vBMD). A food‐based dietary pattern best explaining dietary calcium, potassium, and protein intakes (g/1000 kcal) was identified using reduced rank regression. Dietary pattern Z‐scores were calculated for each individual, at each time point. Individual trajectories in dietary pattern Z‐scores were modeled to summarize changes in Z‐scores over the study period. Regression models examined associations between these trajectories and bone outcomes at age 60 to 64 years, adjusting for baseline dietary pattern Z‐score and other confounders. A consistent PrCaK‐rich dietary pattern was identified within the population, over time. Mean ± SD dietary pattern Z‐scores at age 36 years and age 60 to 64 years were –0.32 ± 0.97 and 2.2 ± 1.5 (women) and –0.35 ± 0.98 and 1.7 ± 1.6 (men), respectively. Mean trajectory in dietary pattern Z‐scores ± SD was 0.07 ± 0.02 units/year. Among women, a 0.02‐SD unit/year higher trajectory in dietary pattern Z‐score over time was associated with higher SA‐BMC (spine 1.40% [95% CI, 0.30 to 2.51]; hip 1.35% [95% CI, 0.48 to 2.23]), and vBMD (radius 1.81% [95% CI, 0.13 to 3.50]) at age 60 to 64 years. No statistically significant associations were found in men. During adulthood, an increasing score for a dietary pattern rich in protein, calcium, and potassium was associated with greater SA‐BMC at fracture‐prone sites in women. This study emphasizes the importance of these nutrients, within the context of the whole diet, to bone health. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).

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 most frequent measurement sites were lumber spine (14-24, 37, 39, 40, 48, 49), femoral neck (15, 17, 19-22, 25, 36, 37, 40, 48, 49, 51), and total body (22,23,39,44,46,49,50). Some studies also measured BMD at the trochanter (22,36,37,49), Ward's area (22,36,49), total hip (15,16,39), distal radius (13,39,41,60), radius shaft (18,36,39), total femur (24,37), calcaneus (43,47), intertrochanteric area (49), distal ulna (13), whole arm, whole leg and whole pelvis (23), distal and ultradistal forearm (45), and distal tibia and tibia shaft (38). Bone mineral content (BMC) also was measured in some studies (n = 7) (13,14,16,19,(42)(43)(44).…”

“…Two studies used peripheral quantitative computed tomography to measure trabecular and cortical BMD at the distal tibia and tibia shaft (38) and distal radius and radius shaft (39). Only a limited number of studies used other methods, such as lunar dual-photon and single-photon absorptiometry (n = 1) (36) and single-energy X-ray absorptiometry (n = 1) (45).…”

“…The number of retained dietary patterns could have been as many as the number of response variables. Only one study conducted RRR to derive dietary patterns in older adults with the use of bone-related nutrients (protein, calcium, and potassium) as response variables (39). Results showed that a protein, calcium, and potassium-rich dietary pattern was positively associated with BMC and BMD (39).…”

From paediatrics to geriatrics: a life course perspective on the MRC National Survey of Health and Development

“…With these data, we showed, for example, the effects of childhood and adult risk factors on bone, lean and fat mass [41–48], on cardiac and vascular structure and function [49–51], and on functional change [52–54]. Variation in midlife physical and cognitive capability was meaningful in terms of later mortality risk [55, 56].…”