Elsevier

Nutrition

Volume 25, Issue 2, February 2009, Pages 165-171
Nutrition

Applied nutritional investigation
Association between dietary patterns and indices of bone mass in a sample of Mediterranean women

https://doi.org/10.1016/j.nut.2008.07.019Get rights and content

Abstract

Objective

A holistic dietary approach, examining the effect of dietary patterns in terms of chronic disease prevention and treatment, continuously gains more attention and may elucidate the association between diet and bone health. In the present study we examined whether adherence to a Mediterranean diet or other dietary patterns has any significant impact on indices of bone mass.

Methods

Two hundred twenty adult Greek women were recruited. Lumbar spine bone mineral density and total body bone mineral content were determined by using dual x-ray absorptiometry. Food intake was assessed using 3-d food records and adherence to the Mediterranean diet was evaluated through a Mediterranean diet score. Principal components analysis was used for the identification of participants' dietary patterns.

Results

Adherence to a Mediterranean diet was not found to have any significant effect on indices of bone mass. Principal components analysis identified 10 dietary patterns explaining 80% of the variance in food intake. A pattern characterized by high consumption of fish and olive oil and low intake of red meat was positively associated with lumbar spine bone mineral density (P = 0.017) and total body bone mineral content (P = 0.048), after controlling for several confounders.

Conclusion

Adherence to a Mediterranean dietary pattern was not associated with indices of bone mass in a sample of adult women, whereas adherence to a dietary pattern close to the Mediterranean diet, i.e., high consumption of fish and olive oil and low red meat intake, was positively related to bone mass, suggesting potential bone-preserving properties of this pattern throughout adult life.

Introduction

Diet is one of the important modifiable factors for the development and maintenance of bone mass [1]. The nutrients of most obvious relevance to bone health are calcium and phosphorus because they compose roughly 80% to 90% of the mineral content of bone; protein is essential because it is incorporated into the organic matrix of bone for collagen structure upon which mineralization occurs; and other minerals, trace elements, and vitamins (e.g., vitamins D and K) are also crucial in carrying out reactions and metabolic processes in bone [2]. The most consistently followed approach thus far to examine potential relations between dietary intake and skeletal health was based on particular (or a variety of) nutrients. Although this traditional analysis has been valuable for the understanding of the effect of specific nutrients (e.g., calcium) on bone health, there is still a lot of missing information and several conceptual limitations. People consume meals consisting of several food items with a combination of nutrients; furthermore, complicated or cumulative intercorrelations and interactions between nutrients are inappropriately treated by this approach. It has therefore been suggested that a holistic dietary approach, which examines the effect of dietary patterns in terms of chronic disease prevention and treatment, compared with the assessment of single nutrients, foods, or food groups may be more valuable approach in studying associations between diet and biological markers [3], [4].

Data from the Framingham Study [5], [6] showed that participants who habitually ate a diet based on fruit, vegetables, milk, and cereals had a significantly denser bone mass than those whose diet was characterized by high consumption of salty snacks, pizza, and soda or high consumption of meat, bread, and potatoes. Okubo et al. [7] evaluated associations between dietary patterns and bone mineral density (BMD) in Japanese farmwomen and found that a “healthy” pattern, described by high intakes of green and dark yellow vegetables, mushrooms, fish and shellfish, and fruit, was positively related to BMD. Moreover, the effect of vegetarian dietary patterns on skeletal health has been studied; lacto-ovo vegetarians appear to have normal bone mass when compared with omnivores [8], whereas a more recent review concluded that the scientific findings consistently support the hypothesis that vegans do have lower BMD than their non-vegan counterparts [9]. Lin et al. [10] found that the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairies, reduced serum osteocalcin by 8–11% and C-terminal telopeptide of type I collagen by 16–18%, and a low sodium intake reduced calcium excretion in the DASH diet and control groups and serum osteocalcin in the DASH group.

To our knowledge, the Mediterranean diet, a pattern rich in plant foods and olive oil, low in meat and dairy products, and with moderate intake of alcohol, has not been evaluated with regard to bone mass. Hence, the aim of the present study was to examine whether adherence to the Mediterranean diet or other dietary patterns has any significant impact on bone mass maintenance in a sample of adult Greek women.

Section snippets

Subjects

For this study, 220 Greek women were consecutively enrolled (mean age 48 ± 12 y) through an advertisement in a local magazine. After being informed of the purpose and procedures of the study, all subjects signed an informed consent form. The study protocol was approved by the ethics committee of Harokopio University. The participants were apparently healthy on physical examination. Data on general health status, medication, and smoking habits were collected using an interviewer-administered

Results

Descriptive characteristics of the study participants by menstruation status are presented in Table 1. Because there were only 16 perimenopausal women, we decided to include them in the postmenopausal group. Compared with premenopausal women, peri- and postmenopausal women were older, exhibited higher levels of BMI and waist circumference, and had lower spine BMD (P < 0.001), TBBMC (all Ps < 0.001), and physical activity level (P = 0.01). Their mean Mediterranean diet score was also higher (P =

Discussion

To our knowledge, the present study is the first to explore potential associations between adherence to the Mediterranean diet and indices of bone health, revealing no significant effect of this dietary pattern on indices of bone (i.e., lumbar spine BMD and TBBMC). However, adherence to a dietary pattern with some of the features of the Mediterranean diet, i.e., rich in fish and olive oil and low in red meat and products, was positively associated with the aforementioned indices of bone mass in

Conclusion

Α dietary pattern characterized by high consumption of fish and olive oil and low red meat intake was associated with higher BMD and TBBMC in our sample of adult women, suggesting potential bone-preserving properties of this eating pattern throughout adult life.

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