Haring Bernhard, Crandall Carolyn J, Wu Chunyuan, LeBlanc Erin S, Shikany James M, Carbone Laura, Orchard Tonya, Thomas Fridtjof, Wactawaski-Wende Jean, Li Wenjun, Cauley Jane A, Wassertheil-Smoller Sylvia
Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Bavaria, Germany.
Department of Medicine, David Geffen School of Medicine, UCLA (University of California at Los Angeles).
JAMA Intern Med. 2016 May 1;176(5):645-52. doi: 10.1001/jamainternmed.2016.0482.
Considerable efforts have been undertaken to relate single nutrients to bone health. To this point, results are inconsistent. Suboptimal single nutrient intake does not occur in isolation but rather reflects a poor diet quality.
To assess the association between adherence to a diet quality index constructed on the basis of dietary recommendations or existing healthy dietary patterns and fractures in postmenopausal women.
DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis was conducted of longitudinal data from 40 clinical centers throughout the United States included in the Women's Health Initiative (WHI) observational study. Participants in the prospective cohort included 93 676 women who were eligible for the WHI if they were aged 50 to 79 years. Recruitment was conducted from October 1, 1993, to December 31, 1998, with the study ending August 29, 2014. The WHI food frequency questionnaire was used to derive nutrient and food intake at baseline. Diet quality and adherence were assessed by scores on the alternate Mediterranean Diet (aMED), a 9-category measure of adherence to a Mediterranean dietary pattern; the Healthy Eating Index 2010 (HEI-2010), a 100-point measure of 12 food components; the 11-item Alternate Healthy Eating Index 2010 (AHEI-2010); or the 8-component Dietary Approaches to Stop Hypertension (DASH) diet score.
Outcome measures included incident total and hip fractures. Hazard ratios (HRs) by quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses.
Of the 93 676 participants, 90 014 were included in the analysis (mean [SD] age, 63.6 [7.4]) years. During a median follow-up time of 15.9 years, there were 2121 cases of hip fractures and 28 718 cases of total fractures. Women scoring in the highest quintile (Q5) of the aMED index had a lower risk for hip fractures (HR, 0.80; 95% CI, 0.66-0.97), with an absolute risk reduction of 0.29% and a number needed to treat of 342 (95% CI, 249-502). No association between the aMED score and total fractures was observed (Q5 HR, 1.01; 95% CI, 0.95-1.07). Higher HEI-2010 or DASH scores tended to be inversely related to hip fracture risk, but the results were nonsignificant (Q5 HR, 0.87; 95% CI, 0.75-1.02; and Q5 HR, 0.89; 95% CI, 0.75-1.06, respectively). The AHEI-2010 score was associated with neither hip nor total fractures.
Higher adherence to a Mediterranean diet is associated with a lower risk for hip fractures. These results support that a healthy dietary pattern may play a role in maintaining bone health in postmenopausal women.
人们已付出相当大的努力来研究单一营养素与骨骼健康的关系。到目前为止，结果并不一致。单一营养素摄入不足并非孤立发生，而是反映出饮食质量较差。
评估遵循基于饮食建议或现有健康饮食模式构建的饮食质量指数与绝经后女性骨折之间的关联。
设计、地点和参与者：对纳入女性健康倡议（WHI）观察性研究的美国40个临床中心的纵向数据进行事后分析。前瞻性队列中的参与者包括93676名年龄在50至79岁之间、符合WHI条件的女性。招募工作于1993年10月1日至1998年12月31日进行，研究于2014年8月29日结束。使用WHI食物频率问卷得出基线时的营养素和食物摄入量。通过替代地中海饮食（aMED）评分评估饮食质量和依从性，aMED是一种对遵循地中海饮食模式的9分类测量；健康饮食指数2010（HEI - 2010），一种对12种食物成分的100分测量；11项替代健康饮食指数2010（AHEI - 2010）；或8成分的终止高血压饮食方法（DASH）饮食评分。
结局指标包括新发的全骨折和髋部骨折。使用Cox比例风险回归分析按饮食指数评分的五分位数估计风险比（HR）。
93676名参与者中，90014名被纳入分析（平均[标准差]年龄，63.6[7.4]岁）。在中位随访时间15.9年期间，有2121例髋部骨折病例和28718例全骨折病例。aMED指数最高五分位数（Q5）的女性髋部骨折风险较低（HR，0.80；95%CI，0.66 - 0.97），绝对风险降低0.29%，需治疗人数为342（95%CI，249 - 502）。未观察到aMED评分与全骨折之间的关联（Q5 HR，1.01；95%CI，0.95 - 1.07）。较高的HEI - 2010或DASH评分往往与髋部骨折风险呈负相关，但结果无统计学意义（Q5 HR，0.87；95%CI，0.75 - 1.02；以及Q5 HR，0.89；95%CI，0.75 - 1.06）。AHEI - 2010评分与髋部骨折和全骨折均无关联。
更高程度地遵循地中海饮食与较低的髋部骨折风险相关。这些结果支持健康的饮食模式可能在维持绝经后女性骨骼健康中发挥作用。
