Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Clin Nutr. 2020 Feb;39(2):516-523. doi: 10.1016/j.clnu.2019.02.031. Epub 2019 Feb 21.
BACKGROUND & AIMS: Aging is characterized by progressive decline in physiologic reserves and functions as well as prolonged inflammation, increasing susceptibility to disease. Diet plays an important role in maintaining health, and reducing morbidity and mortality, especially in older populations. This study was designed to determine prospective associations between dietary inflammatory index (DII®) scores and bone health, sarcopenia-related outcomes, falls risk and incident fractures in community-dwelling Australian older adults.
A total of 1098 [51% male; age (mean ± SD) 63.0 ± 7.5 years] non-institutionalized older adults who participated in the Tasmanian Older Adult Cohort Study (TASOAC) at baseline, 768 at 5 years, and 566 at 10 years follow-up were included in this analysis. Baseline energy-adjusted DII (E-DII) scores were calculated using a validated Food Frequency Questionnaire. Changes in bone mineral density (BMD) and appendicular lean mass (ALM) were measured over ten years using dual-energy x-ray absorptiometry. Ten-year changes in hand grip, knee extensor and whole lower-limb muscle strength and quality were assessed by dynamometers and change in falls risk score using the Physical Profile Assessment (PPA). Incident fractures at any site and non-vertebral fractures over 10 years were self-reported.
The E-DII range was -3.48 to +3.23 in men and -3.80 to +2.74 in women. Higher E-DII score (indicating a more pro-inflammatory diet) was associated with lower total hip (B: -0.009; 95% CI: -0.017, 0.000) and lumbar spine BMD (B: -0.013; 95% CI: -0.024, -0.002), and higher falls risk score (B: 0.040; 95% CI: 0.002, 0.078) over 10 years in men. Women with higher E-DII scores had higher whole lower-limb muscle quality over 10 years (B: 0.109; 95% CI: 0.002, 0.215). For every unit increase in E-DII score, incident fracture rates increased by 9.0% in men (IRR: 1.090; 95% CI: 1.011, 1.175) and decreased by 12.2% in women (IRR: 0.878; 95% CI: 0.800, 0.964) in a fully adjusted model.
Higher E-DII scores were associated with lower bone density, higher falls risk, and increased incidence of fractures in community-dwelling older men, but decreased fracture incidence in women, over 10 years. This suggests pro-inflammatory diets may be more detrimental to musculoskeletal health in older men than in women. Additional studies are warranted to elucidate these sex differences.
衰老的特征是生理储备和功能逐渐下降，以及炎症持续时间延长，从而增加了患病的易感性。饮食在维持健康、降低发病率和死亡率方面起着重要作用，尤其是在老年人群中。本研究旨在确定饮食炎症指数（DII®）评分与骨健康、与肌肉减少症相关的结局、跌倒风险和社区居住的澳大利亚老年人骨折之间的前瞻性关联。
共有 1098 名（51%为男性；年龄（平均值±标准差）63.0±7.5 岁）非住院的老年成年人参加了塔斯马尼亚老年队列研究（TASOAC），他们在基线时、5 年时和 10 年随访时分别有 1098 名、768 名和 566 名。使用验证的食物频率问卷计算了能量调整的 DII（E-DII）得分。使用双能 X 射线吸收法在 10 年内测量骨矿物质密度（BMD）和四肢瘦体重（ALM）的变化。通过测力计评估手部握力、膝关节伸肌和整个下肢肌肉力量和质量 10 年的变化，并使用身体状况评估（PPA）评估跌倒风险评分的变化。任何部位的新发骨折和 10 年内的非脊柱骨折均通过自我报告。
男性的 E-DII 范围为-3.48 至+3.23，女性的 E-DII 范围为-3.80 至+2.74。较高的 E-DII 评分（表明饮食更具促炎作用）与男性总髋部（B：-0.009；95%CI：-0.017，0.000）和腰椎 BMD（B：-0.013；95%CI：-0.024，-0.002）降低以及男性跌倒风险评分（B：0.040；95%CI：0.002，0.078）升高有关，在 10 年内，女性的全下肢肌肉质量更高（B：0.109；95%CI：0.002，0.215）。E-DII 评分每增加一个单位，男性的骨折发生率增加 9.0%（IRR：1.090；95%CI：1.011，1.175），女性的骨折发生率降低 12.2%（IRR：0.878；95%CI：0.800，0.964），在完全调整的模型中。
在 10 年内，较高的 E-DII 评分与男性骨密度降低、跌倒风险增加和骨折发生率增加有关，但与女性骨折发生率降低有关。这表明促炎饮食可能对老年男性的肌肉骨骼健康比女性更有害。需要进一步的研究来阐明这些性别差异。
