Applied nutritional investigationAssociation between dietary patterns and indices of bone mass in a sample of Mediterranean women
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.
References (41)
- et al.
Are dietary patterns useful for understanding the role of diet in chronic disease?
Am J Clin Nutr
(2001) - et al.
Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study
Am J Clin Nutr
(2002) - et al.
Dietary patterns associated with bone mineral density in premenopausal Japanese farmwomen
Am J Clin Nutr
(2006) - et al.
The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults
J Nutr
(2003) - et al.
Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk
Nutr Metab Cardiovasc Dis
(2006) - et al.
Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore
Prev Med
(2007) - et al.
Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health
Am J Clin Nutr
(2000) - et al.
Fruit and vegetable intakes and bone mineral status: a cross sectional study in 5 age and sex cohorts
Am J Clin Nutr
(2006) - et al.
Modulatory effect of n-3 polyunsaturated fatty acids on osteoblast function and bone metabolism
Prostaglandins Leukot Essent Fatty Acids
(2003) - et al.
N-3 fatty acids are positively associated with peak bone mineral density and bone accrual in healthy men: the NO2 Study
Am J Clin Nutr
(2007)
Ratio of n-6 to n-3 fatty acids and bone mineral density in older adults: the Rancho Bernardo Study
Am J Clin Nutr
Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III
J Nutr
Energy intake and monounsaturated fat in relation to bone mineral density among women and men in Greece
Prev Med
Dose–response study of effect of oleuropein, an olive oil polyphenol, in an ovariectomy/inflammation experimental model of bone loss in the rat
Clin Nutr
Fruit and vegetable intake is an independent predictor of bone mass in early pubertal children
Am J Clin Nutr
Fruit and vegetable consumption and bone mineral density: the Northern Ireland Young Hearts Project
Am J Clin Nutr
Positive effects of fruit and vegetable consumption and calcium intake on bone mineral accrual in boys during growth from childhood to adolescence: the University of Saskatchewan Pediatric Bone Mineral Accrual Study
Am J Clin Nutr
Nutritional influences on mineral density: a cross-sectional study in premenopausal women
Am J Clin Nutr
Potassium, magnesium and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women
Am J Clin Nutr
Nutritional associations with bone loss during the menopausal transition: evidence for a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids
Am J Clin Nutr
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