Protective Effects of Dietary Carotenoids on Risk of Hip Fracture in Men: The Singapore Chinese Health Study

Abstract

Experimental and epidemiologic data suggest that carotenoids in vegetables and fruits may benefit bone health due to their antioxidant properties. The relationship between dietary total and specific carotenoids, as well as vegetables and fruits, and risk of hip fracture was examined among Chinese in Singapore. We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 men and women who were of ages 45–74 years between 1993 and 1998. At recruitment, subjects were interviewed on lifestyle factors and medical history. Usual diet was measured using a validated food frequency questionnaire. During a mean follow-up of 9.9 years, we identified 1,630 hip fracture incident cases. Among men, consumption of vegetables was associated with lower hip fracture risk. Similarly, dietary total carotenoids and specific carotenoids, α-, β-carotene and lutein/zeaxanthin were inversely associated with hip fracture risk. Compared to men in the lowest quartile of nutrient density, men in the highest quartile had statistically significant 26% to 39% risk reduction (all Ps for trend < 0.05). When stratified by body mass index, the greatest protective effects of total vegetables and carotenoids were found in men with body mass index < 20kg/m2 (P for trend≤0.004). There was no association between dietary carotenoids or vegetables/fruits and hip fracture risk among women. This study suggests that adequate intake of vegetables may reduce risk of osteoporotic fractures among elderly men and that the antioxidant effects of carotenoids may counteract the mechanism of osteoporosis related to leanness.

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

“…No significant associations were observed with other carotenoids. Data from other cohorts support the link between individual carotenoids and reduction of hip fracture risk [34]. Specific to lycopene, restriction studies of lycopene have shown significant increases in oxidative stress parameters and the bone resorption marker N-telopeptide of type I collagen in postmenopausal women, which were reversed with lycopene supplementation [35, 36].…”

The role of vitamin A and retinoic acid receptor signaling in post-natal maintenance of bone

“…These studies have yielded a range of different results with some identifying an association between poor bone health and either low serum retinol (42)(43)(44)(45) or excess vitamin A (4-10, 46), or no difference between study groups (47)(48)(49)(50)(51)(52)(53)(54)(55)(56). For a detailed review see Conaway et al (57).…”

Association between change in body weight after midlife and risk of hip fracture—the Singapore Chinese Health Study

“…This study is the first to examine weight change in relation to risk of hip fracture in lean participants with BMI <20 kg/m 2 , which is an independent risk factor for hip fracture [14, 15]. We found that weight loss ≥10%did not further affect the risk of hip fracture among these lean individuals whose baseline BMI was already <20 kg/m 2 .…”

“…We used BMI <20 kg/m 2 as the cutoff for leanness, because it was a significant risk factor for hip fracture in this cohort [15] as well as in a meta-analysis that examined BMI and fracture risk [14]. We used the current recommendation by the World Health Organization of BMI ≥25 kg/m 2 as the cutoff for the overweight category [19].…”

“…We have also reported that low body mass index (BMI) increased the risk of hip fracture among men in our cohort of middle-aged and elderly Chinese in Singapore [15]. Asian populations have lower BMI and possibly different weight change patterns during aging as compared to their Western counterparts.…”