Fruit and vegetable intake and bones: A systematic review and meta-analysis

Abstract

Background Although intake of fruits and vegetables seemed to have a protective effect on bone metabolism, its effect on fractures remains uncertain. Methods A systematic review of randomized controlled trials (RCTs) and cohort studies (PROSPERO: CRD42016041462) was performed. RCTs and cohort studies that evaluated the combined intake of fruits and vegetables in men and women aged over 50 years were included. We considered fractures as a primary outcome measure. Changes in bone markers were considered as secondary outcomes. The search strategy included the following descriptors: fruit, vegetables, vegetable products, bone and bones, bone fractures, postmenopausal osteoporosis, and osteoporosis. PubMed, Embase, and Cochrane Library were the databases used. The appraisal of the studies was performed by two independent reviewers, and discussed and agreed upon by both examiners. The data extracted from the RCTs and cohort studies were summarized separately. The risks of fractures were combined across studies using random models. Bone resorption marker (CTx) was summarized with standardized mean differences. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate the strength of recommendations. Results Of the 1,192 studies screened, 13 articles were included in the systematic review and 10 were included in the pooled analysis (6 cohort studies and 4 RCTs). The six cohort studies included in the meta-analysis included a population of 225,062. The pooled hazard ratio (HR) (95% confidence interval (CI)) of the hip in five studies was 0.92 (0.87, 0.98). Its heterogeneity was moderate (I 2 = 55.7%, p = 0.060), GRADE ( ⊕⊕⊕ O). Two cohort studies evaluated the risk of any fracture; the HR was 0.90 (95% CI: 0.86–0.96), with aheterogeneity of 24.9% (p = 0.249, GRADE ( ⊕⊕⊕ O)). There was no association between the bone resorption marker CTx and 3 months of fruit and vegetable intake evaluated by four RCTs, GRADE ( ⊕⊕ O O). Conclusion There was an association between the increase of at least one serving of fruits and vegetables per day and decreases in the risk of fractures. The level of evidence for this association is moderate.

Strawberry-Derived Exosome-Like Nanoparticles Prevent Oxidative Stress in Human Mesenchymal Stromal Cells

“…Consumption of fruits and vegetables is associated with a reduced risk of chronic diseases, such as cardiovascular disease, diabetes, cancer, and age-related functional decline [ 23 , 24 , 25 ]. Brondani et al [ 26 ] showed that dietary patterns rich in fruits and vegetables are associated with a reduced risk of bone fractures and the prevention of osteoporotic fractures. However, the mechanisms through which plant-rich diets achieve such effects are still unclear.…”

Inhibitory Effect of a Rosmarinic Acid-Enriched Fraction Prepared from Nga-Mon (Perilla frutescens) Seed Meal on Osteoclastogenesis through the RANK Signaling Pathway

“…Plants are the main sources of phytochemicals, antioxidants, and anti-inflammatory agents [ 3 , 30 ]. There was an association between the increased intake of fruit and vegetables and the decrease of bone fracture risk [ 67 ]. It is suggested that antioxidants and anti-inflammatory compounds could be used for osteoporosis prevention and treatment.…”

Dietary Behaviors That Place Young Adults at Risk for Future Osteoporosis

“…However, it is the dairy component of these foods that is largely responsible. Increasing evidence suggests that fruit and vegetables have a positive influence on bone health as they contain micronutrients and alkaline performing properties involved in bone mineralization [ 11 , 12 ]. While no difference was observed for fruit and vegetable serves for SES, results from this study show that the mean daily intake of fruit and vegetables for females (0.6, 3.4 servings) and males (0.4, 2.8 servings) were well below recommendations.…”

“…Calcium is an essential nutrient required for PBM growth during adolescence and into adulthood [ 7 ]. There is accumulating evidence suggesting fruit and vegetables have protective effects on bone health through mediation of the body’s acid-base balance [ 11 ]. Fruit and vegetables contain alkaline-forming properties which act as a buffer for acidic-forming foods.…”