Prospective Associations of Dietary and Nutrient Patterns with Fracture Risk: A 20-Year Follow-Up Study

Abstract

Studies on long-term exposure to foods/nutrients and its associations with fracture risk are scarce. Using data from the China Health and Nutrition Survey (CHNS), we determined the prospective association of dietary and nutrient patterns with fractures. Data from 15,572 adults aged ≥18 years were analyzed. Fracture occurrence was self-reported and dietary intake data were collected using a 24-h recall method for three consecutive days, for each individual across nine waves (1989–2011). We used cumulative and overall mean, recent and baseline dietary and nutrient exposures. Hazard ratios (HR) were used to determine the associations. Two dietary (traditional and modern) and two nutrient (plant- and animal-sourced) patterns were identified. After adjusting for potential confounders, study participants in the third tertiles (highest intake) of the modern dietary and animal-sourced nutrient patterns’ cumulative scores had a 34% (HR = 1.34; 95% CI: 1.06–1.71) and 37% (HR = 1.37; 95% CI: 1.08–1.72) increase in fracture risks compared to those in the first tertiles, respectively. While the overall mean factor scores of dietary and nutrient patterns had a similar (or stronger) pattern of association as the cumulative scores, no association between recent and baseline scores and fracture was found. Greater adherence to a modern dietary and/or an animal-sourced nutrient pattern is associated with a higher risk of total fractures. This suggests that a modern animal based diet is related to bone fragility. A repeated three-day 24-h recall dietary assessment provides a stronger association with fracture compared to a recent or baseline exposure.

High Consumption of Soft Drinks Is Associated with an Increased Risk of Fracture: A 7-Year Follow-Up Study

“…Data of fracture were self-reported in each wave in 2004,2006,2009 and 2011 by the question "Have you ever had a fracture?" along with age when the first fracture occurred [11]. In the analysis, the incident fracture was defined if a participant reported a new history of fracture.…”

“…Moreover, diets rich in fruits and vegetables provide high levels of trace elements and vitamins can increase bone density and reduce the risk of fractures [10]. While the role of protein on bone health is still inconclusive, studies on the overall dietary pattern and fracture have attracted attention [11].…”

“…Accompanied by the dietary transition, the burden of chronic diseases increased. A study using China Health and Nutrition Survey (CHNS) data suggested a direct association between modern dietary pattern (characterized by a high intake of energy-dense and processed food) and fracture [11]. However, the associations between individual food items in the modern diet and fracture have not been well studied.…”

Association between nutrient patterns and serum lipids in Chinese adult women: A cross‐sectional study

“…Participants in the CAF pattern had more animal fat and carbohydrate, because they consumed more animal oil and cereals than others. Previous studies suggested that nutrient patterns that were rich in carbohydrate and fat were associated with obesity and might increase the risk of fractures . People following the PFS pattern consumed more plant fats and sodium, but they had relatively low intakes of vitamins except for vitamin E. Presumably because they consumed too high a proportion of convenience foods, which are low in nutrients and high in calories.…”

“…Previous studies suggested that nutrient patterns that were rich in carbohydrate and fat were associated with obesity 29 and might increase the risk of fractures. 30 People following the PFS pattern consumed more plant fats and sodium, but they had relatively low intakes of vitamins except for vitamin E. Presumably because they consumed too high a proportion of convenience foods, which are low in nutrients and high in calories. The characteristic foods in this pattern represented a newly emerging food pattern in China titled 'snacks'.…”