Skip to main content
Top
Published in: Osteoporosis International 8/2014

01-08-2014 | Original Article

Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: a case–control study

Authors: F.F. Zeng, W.Q. Xue, W.T. Cao, B.H. Wu, H.L. Xie, F. Fan, H.L. Zhu, Y.M. Chen

Published in: Osteoporosis International | Issue 8/2014

Login to get access

Abstract

Summary

This case–control study compared the associations of four widely used diet-quality scoring systems with the risk of hip fractures and assessed their utility in elderly Chinese. We found that individuals avoiding a low-quality diet have a lower risk of hip fractures in elderly Chinese.

Introduction

Few studies examined the associations of diet-quality scores on bone health, and no studies were available in Asians and compared their validity and utility in a study. We assessed the associations and utility of four widely used diet-quality scoring systems with the risk of hip fractures.

Methods

A case–control study of 726 patients with hip fractures (diagnosed within 2 weeks) aged 55–80 years and 726 age– (within 3 years) and gender-matched controls was conducted in Guangdong, China (2009–2013). Dietary intake was assessed using a 79-item food frequency questionnaire with face-to-face interviews, and the Healthy Eating Index-2005 (HEI-2005, 12 items), the alternate Healthy Eating Index (aHEI, 8 items), the Diet Quality Index-International (DQI-I, 17 items), and the alternate Mediterranean Diet Score (aMed, 9 items) (the simplest one) were calculated.

Results

All greater values of the diet-quality scores were significantly associated with a similar decreased risk of hip fractures (all p trends <0.001). The multivariate-adjusted odds ratios (ORs) and 95 % confidential intervals (95 % CIs) comparing the extreme groups of diet-quality scores were 0.29 (0.18, 0.46) (HEI-2005), 0.20 (0.12, 0.33) (aHEI), 0.25 (0.16, 0.39) (DQI-I), and 0.28 (0.18, 0.43) (aMed) in total subjects; and the corresponding ORs ranged from 0.04 to 0.27 for men and from 0.26 to 0.44 for women (all p trends <0.05), respectively.

Conclusions

Avoiding a low-quality diet is associated with a lower risk of hip fractures, and the aMed score is the best scoring system due to its equivalent performance and simplicity for the user.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cashman KD (2007) Diet, nutrition, and bone health. J Nutr 137:2507S–2512SPubMed Cashman KD (2007) Diet, nutrition, and bone health. J Nutr 137:2507S–2512SPubMed
3.
go back to reference Dargent-Molina P, Sabia S, Touvier M, Kesse E, Breart G, Clavel-Chapelon F, Boutron-Ruault MC (2008) Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. J Bone Miner Res 23:1915–1922. doi:10.1359/jbmr.080712 PubMedCentralPubMedCrossRef Dargent-Molina P, Sabia S, Touvier M, Kesse E, Breart G, Clavel-Chapelon F, Boutron-Ruault MC (2008) Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. J Bone Miner Res 23:1915–1922. doi:10.​1359/​jbmr.​080712 PubMedCentralPubMedCrossRef
4.
go back to reference Jacobs DR Jr, Steffen LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78:508S–513SPubMed Jacobs DR Jr, Steffen LM (2003) Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 78:508S–513SPubMed
6.
go back to reference Zeng FF, Wu BH, Fan F, Xie HL, Xue WQ, Zhu HL, Chen YM (2013) Dietary patterns and the risk of hip fractures in elderly Chinese: a matched case–control study. J Clin Endocrinol Metab 98:2347–2355. doi:10.1210/jc.2013–1190 PubMedCrossRef Zeng FF, Wu BH, Fan F, Xie HL, Xue WQ, Zhu HL, Chen YM (2013) Dietary patterns and the risk of hip fractures in elderly Chinese: a matched case–control study. J Clin Endocrinol Metab 98:2347–2355. doi:10.​1210/​jc.​2013–1190 PubMedCrossRef
7.
go back to reference Langsetmo L, Poliquin S, Hanley DA, Prior JC, Barr S, Anastassiades T, Towheed T, Goltzman D, Kreiger N (2010) Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density. BMC Musculoskelet Disord 11:20. doi:10.1186/1471–2474–11–20 PubMedCentralPubMedCrossRef Langsetmo L, Poliquin S, Hanley DA, Prior JC, Barr S, Anastassiades T, Towheed T, Goltzman D, Kreiger N (2010) Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density. BMC Musculoskelet Disord 11:20. doi:10.​1186/​1471–2474–11–20 PubMedCentralPubMedCrossRef
8.
go back to reference Tucker KL, Chen H, Hannan MT, Cupples LA, Wilson PW, Felson D, Kiel DP (2002) Bone mineral density and dietary patterns in older adults: the Framingham osteoporosis study. Am J Clin Nutr 76:245–252PubMed Tucker KL, Chen H, Hannan MT, Cupples LA, Wilson PW, Felson D, Kiel DP (2002) Bone mineral density and dietary patterns in older adults: the Framingham osteoporosis study. Am J Clin Nutr 76:245–252PubMed
9.
go back to reference Samieri C, Ginder Coupez V, Lorrain S, Letenneur L, Alles B, Feart C, Paineau D, Barberger-Gateau P (2013) Nutrient patterns and risk of fracture in older subjects: results from the three-city study. Osteoporos Int 24:1295–1305. doi:10.1007/s00198–012–2132–5 PubMedCrossRef Samieri C, Ginder Coupez V, Lorrain S, Letenneur L, Alles B, Feart C, Paineau D, Barberger-Gateau P (2013) Nutrient patterns and risk of fracture in older subjects: results from the three-city study. Osteoporos Int 24:1295–1305. doi:10.​1007/​s00198–012–2132–5 PubMedCrossRef
11.
go back to reference Langsetmo L, Hanley DA, Prior JC, Barr SI, Anastassiades T, Towheed T, Goltzman D, Morin S, Poliquin S, Kreiger N (2011) Dietary patterns and incident low-trauma fractures in postmenopausal women and men aged ≥50 y: a population-based cohort study. Am J Clin Nutr 93:192–199. doi:10.3945/ajcn.110.002956 PubMedCrossRef Langsetmo L, Hanley DA, Prior JC, Barr SI, Anastassiades T, Towheed T, Goltzman D, Morin S, Poliquin S, Kreiger N (2011) Dietary patterns and incident low-trauma fractures in postmenopausal women and men aged ≥50 y: a population-based cohort study. Am J Clin Nutr 93:192–199. doi:10.​3945/​ajcn.​110.​002956 PubMedCrossRef
14.
go back to reference McCullough ML, Feskanich D, Giovannucci ELSMJ, RimmEB HFB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76:1261–1271PubMed McCullough ML, Feskanich D, Giovannucci ELSMJ, RimmEB HFB, Spiegelman D, Hunter DJ, Colditz GA, Willett WC (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76:1261–1271PubMed
15.
go back to reference Kim S, Haines PS, Siega-Riz AM, Popkin BM (2003) The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr 133:3476–3484PubMed Kim S, Haines PS, Siega-Riz AM, Popkin BM (2003) The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr 133:3476–3484PubMed
18.
go back to reference Willett W (2001) Medical school guide to healthy eating: eat, drink, and be healthy. The Harvard New York Free Press, NY Willett W (2001) Medical school guide to healthy eating: eat, drink, and be healthy. The Harvard New York Free Press, NY
20.
go back to reference Reedy J, MitrouPN K-SSM, Wirfält E, Flood A, Kipnis V, Leitzmann M, Mouw T, Hollenbeck A, Schatzkin A, Subar AF (2008) Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP diet and health study. Am J Epidemiol 168:38–48. doi:10.1093/aje/kwn097 PubMedCrossRef Reedy J, MitrouPN K-SSM, Wirfält E, Flood A, Kipnis V, Leitzmann M, Mouw T, Hollenbeck A, Schatzkin A, Subar AF (2008) Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP diet and health study. Am J Epidemiol 168:38–48. doi:10.​1093/​aje/​kwn097 PubMedCrossRef
22.
go back to reference Benetou V, Orfanos P, Pettersson-Kymmer U, Bergström U, Svensson O, Johansson I, Berrino F, Tumino R, Borch KB, Lund E, Peeters PH, Grote V, Li K, AltzibarJM KT, Boeing H, von Ruesten A, Norat T, Wark PA, Riboli E, Trichopoulou A (2012) Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24:1587–1598. doi:10.1007/s00198–012–2187–3 PubMedCrossRef Benetou V, Orfanos P, Pettersson-Kymmer U, Bergström U, Svensson O, Johansson I, Berrino F, Tumino R, Borch KB, Lund E, Peeters PH, Grote V, Li K, AltzibarJM KT, Boeing H, von Ruesten A, Norat T, Wark PA, Riboli E, Trichopoulou A (2012) Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 24:1587–1598. doi:10.​1007/​s00198–012–2187–3 PubMedCrossRef
26.
go back to reference Zhang CX, Ho SC (2009) Validity and reproducibility of a food frequency questionnaire among Chinese women in Guangdong province. Asia Pac J Clin Nutr 18:240–250PubMed Zhang CX, Ho SC (2009) Validity and reproducibility of a food frequency questionnaire among Chinese women in Guangdong province. Asia Pac J Clin Nutr 18:240–250PubMed
27.
go back to reference Yang YX, Wang GY, Pan XC (2002) China food composition table. Peking University Medical Press, Beijing Yang YX, Wang GY, Pan XC (2002) China food composition table. Peking University Medical Press, Beijing
34.
go back to reference Mangiafico RA, Malaponte G, Pennisi P, Li Volti G, Trovato G, Mangiafico M, Bevelacqua Y, Mazza F, Fiore CE (2007) Increased formation of 8-iso-prostaglandinF (2alpha) is associated with altered bone metabolism and lower bone mass in hypercholesterolaemic subjects. J Intern Med 261:587–596. doi:10.1111/j.1365–2796.2007.01784.x PubMedCrossRef Mangiafico RA, Malaponte G, Pennisi P, Li Volti G, Trovato G, Mangiafico M, Bevelacqua Y, Mazza F, Fiore CE (2007) Increased formation of 8-iso-prostaglandinF (2alpha) is associated with altered bone metabolism and lower bone mass in hypercholesterolaemic subjects. J Intern Med 261:587–596. doi:10.​1111/​j.​1365–2796.​2007.​01784.​x PubMedCrossRef
36.
go back to reference Farina EK, Kiel DP, Roubenoff R, Schaefer EJ, Cupples LA, Tucker KL (2011) Protective effects of fish intake and interactive effects of long-chain polyunsaturated fatty acid intakes on hip bone mineral density in older adults: the Framingham Osteoporosis study. Am J Clin Nutr 93:1142–1151. doi:10.3945/ajcn.110.005926 PubMedCentralPubMedCrossRef Farina EK, Kiel DP, Roubenoff R, Schaefer EJ, Cupples LA, Tucker KL (2011) Protective effects of fish intake and interactive effects of long-chain polyunsaturated fatty acid intakes on hip bone mineral density in older adults: the Framingham Osteoporosis study. Am J Clin Nutr 93:1142–1151. doi:10.​3945/​ajcn.​110.​005926 PubMedCentralPubMedCrossRef
37.
go back to reference Feskanich D, Willett WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77:504–511PubMed Feskanich D, Willett WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77:504–511PubMed
38.
go back to reference Suzuki T, Yoshida H, Hashimoto T, Yoshimura N, Fujiwara S, Fukunaga M, Nakamura T, Yoh K, Inoue T, Hosoi T, Orimo H (1997) Case-control study of risk factors for hip fractures in the Japanese elderly by a Mediterranean Osteoporosis Study (MEDOS) questionnaire. Bone 21:461–467. doi:10.1016/S8756–3282(97)00179–8 PubMedCrossRef Suzuki T, Yoshida H, Hashimoto T, Yoshimura N, Fujiwara S, Fukunaga M, Nakamura T, Yoh K, Inoue T, Hosoi T, Orimo H (1997) Case-control study of risk factors for hip fractures in the Japanese elderly by a Mediterranean Osteoporosis Study (MEDOS) questionnaire. Bone 21:461–467. doi:10.​1016/​S8756–3282(97)00179–8 PubMedCrossRef
39.
go back to reference Hu JF, Zhao XH, Parpia B, Campbell TC (1993) Dietary intakes and urinary excretion of calcium and acids: a cross-sectional study of women in China. Am J Clin Nutr 58:398–406PubMed Hu JF, Zhao XH, Parpia B, Campbell TC (1993) Dietary intakes and urinary excretion of calcium and acids: a cross-sectional study of women in China. Am J Clin Nutr 58:398–406PubMed
40.
go back to reference McTiernan A, Wactawski-Wende J, Wu L, Rodabough RJ, Watts NB, Tylavsky F, Freeman R, Hendrix S, Jackson R (2009) Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: the Women’s Health Initiative Dietary Modification Trial. Am J Clin Nutr 89:1864–1876. doi:10.3945/ajcn.2008.26956 PubMedCentralPubMedCrossRef McTiernan A, Wactawski-Wende J, Wu L, Rodabough RJ, Watts NB, Tylavsky F, Freeman R, Hendrix S, Jackson R (2009) Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: the Women’s Health Initiative Dietary Modification Trial. Am J Clin Nutr 89:1864–1876. doi:10.​3945/​ajcn.​2008.​26956 PubMedCentralPubMedCrossRef
45.
go back to reference Kant AK, Schatzkin A, Ziegler RG (1995) Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study. J Am Coll Nutr 14:233–238PubMedCrossRef Kant AK, Schatzkin A, Ziegler RG (1995) Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study. J Am Coll Nutr 14:233–238PubMedCrossRef
Metadata
Title
Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: a case–control study
Authors
F.F. Zeng
W.Q. Xue
W.T. Cao
B.H. Wu
H.L. Xie
F. Fan
H.L. Zhu
Y.M. Chen
Publication date
01-08-2014
Publisher
Springer London
Published in
Osteoporosis International / Issue 8/2014
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-014-2741-2

Other articles of this Issue 8/2014

Osteoporosis International 8/2014 Go to the issue