Abstract
Objective:
To explore the association between fat intake, serum lipids and the risk of osteoporotic fractures in the elderly.
Design:
A hospital-based case–control study.
Setting:
The study was conducted at a tertiary centre and referral hospital for the province of Jaén (Spain).
Subjects:
Cases (n=167) were patients aged 65 years or more with a low-energy fracture selected from the population attended at the hospital. Controls (patients without antecedents of any fracture) were 1:1 matched to cases by sex and age (n=167).
Methods:
Diet was assessed by a semiquantitative food frequency questionnaire. Serum total cholesterol and high-density lipoprotein (HDL) cholesterol were also measured.
Results:
Participants in the two upper quartiles of polyunsaturated fat (PUFA) intake showed an increased risk of fracture, with statistically significant differences with respect to the first quartile in the adjusted model (odds ratio (OR)=3.59; 95% confidence interval (CI)=1.06–12.1 and OR=5.88; 95% CI=1.38–25.02); P=0.01 for the trend test). A higher ratio of monounsaturated fat (MUFA) to PUFA was associated with a reduced risk of fracture (OR=0.20; 95% CI=0.07–0.60 for the fourth quartile; P=0.002 for the trend test). The intake of omega-6 fatty acids was associated with an elevated risk of fracture (OR=3.41; 95% CI=1.05–11.15 for the fourth quartile; P=0.01 for the trend test). HDL-cholesterol levels were inversely associated with the risk of fracture (test for trend P=0.03 across quartiles).
Conclusions:
PUFA intake was associated with an increased risk of osteoporotic fractures in the elderly, whereas a high ratio of MUFA:PUFA was associated with decreased risk.
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References
Albertazzi P, Coupland K (2002). Polyunsaturated fatty acids. Is there a role in postmenopausal osteoporosis prevention? Maturitas 42, 13–22.
Barzi F, Woodward M, Marfisi RM, Tavazzi L, Valagussa F, Marchioli R, GISSI-Prevenzione Investigators (2003). Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr 57, 604–611.
Beauchamp GK, Keast RS, Morel D, Lin J, Pika J, Han Q et al. (2005). Phytochemistry: ibuprofen-like activity in extra-virgin olive oil. Nature 437, 45–46.
Carrasco-Pancorbo A, Cerretani L, Bendini A, Segura-Carretero A, Del Carlo M, Gallina-Toschi T et al. (2005). Evaluation of the antioxidant capacity of individual phenolic compounds in virgin olive oil. J Agric Food Chem 53, 8918–8925.
Corwin RL, Hartman TJ, Maczuga SA, Graubard BI (2006). Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III. J Nutr 136, 159–165.
de La Puerta Vázquez R, Martínez-Domínguez E, Sánchez Perona J, Ruiz-Gutíérrez V (2004). Effects of different dietary oils on inflammatory mediator generation and fatty acid composition in rat neutrophils. Metabolism 53, 59–65.
Esposito K, Marfella R, Ciotola M, Di Palo C, Guigliano F, Giugliano G et al. (2004). Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. JAMA 292, 1440–1446.
Fernández-Jarne E, Martínez-Losa E, Prado-Santamaría M, Brugarolas-Brufau C, Serrano-Martínez M, Martínez-González MA (2002). Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case–control study in Spain. Int J Epidemiol 31, 474–480.
Folstein MF, Folstein SE, McHugh PR (1975). ‘Mini mental state’, A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 12, 189–198.
Hernán MA, Hernández-Díaz S, Werler MM, Mitchell AA (2002). Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Am J Epidemiol 155, 176–184.
Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z et al. (2006). Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 83, 146–154.
Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA et al. (2005). Smoking and fracture risk: a meta-analysis. Osteoporos Int 16, 155–162.
Kato I, Toniolo P, Zeleniuch-Jacquotte A, Shore RE, Koenig KL, Akhmedkhanov A et al. (2000). Diet, smoking and anthropometric indices and postmenopausal bone fractures: a prospective study. Int J Epidemiol 29, 85–92.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963). Studies of illness in the aged. The index ADL: a standardized measure of biological and psychosocial function. JAMA 185, 914–919.
Katz S, Downs TD, Cash HR, Grotz RC (1970). Progress in development of the index of ADL. Gerontologist 10, 20–30.
Keen RW (2003). Burden of osteoporosis and fractures. Curr Osteoporos Rep 1, 66–70.
Macdonald HM, New SA, Golden MH, Campbell MK, Reid DM (2004). Nutritional associations with bone loss during the menopausal transition: evidence of a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids. Am J Clin Nutr 79, 155–165.
Martín Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernández Rodríguez JC, Salvini S et al. (1993). Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 22, 512–519.
Martínez-González MA, López-Fontana C, Varo JJ, Sánchez-Villegas A, Martínez JA (2005). Validation of the Spanish version of the physical activity questionnaire used in the Nurses Health Study and Health Professionals Follow-up study. Public Health Nutr 8, 920–927.
Martínez-González MA, Sánchez-Villegas A, de Irala-Estévez J, Marti A, Martínez JA (2002). Mediterranean diet and stroke: objectives and design of the SUN Projet. Nutr Neurosci 5, 65–73.
Mataix J (2003). Tablas de composición de alimentos [Food composition tables] 4th edn. Universidad de Granada: Granada.
McLean RR, Jacques PF, Selhub J, Tucker KL, Samelson EJ, Broe KE et al. (2004). Homocysteine as a predictive factor for hip fracture in older persons. New Engl J Med 350, 2042–2049.
Mensink RP, Katan MB (1992). Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 12, 911–919.
Mensink RP, Zock PL, Kester AD, Katan MB (2003). Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 77, 1146–1155.
Moreiras O (2003). Tablas de composición de alimentos [Food composition tables] 7th edn. Ediciones Pirámide: Madrid.
Miyamoto KI, Suzuki H, Yamamoto S, Saitoh Y, Ochiai E, Moritani S et al. (2003). Prostaglandin E2-mediated anabolic effect of a novel inhibitor of phosphodiesterase 4, XT-611, in the in vitro bone marrow culture. J Bone Miner Res 18, 1471–1477.
Parhami F, Garfinkel A, Demer L (2000). Role of lipids in osteoporosis. Arterioscler Vasc Biol 20, 2346–2348.
Parhami F, Jackson SM, Tintut Y, Le V, Balucan JP, Territo M et al. (1999). Atherogenic diet and minimally oxidized low-density lipoprotein inhibit osteogenic and promote adipogenic differentiation of marrow stromal cells. J Bone Miner Res 14, 2067–2078.
Pitsavos C, Panagiotakos DB, Tzima N, Chrysohoou C, Economou M, Zampelas A et al. (2005). Adherence to the Mediterranean diet is associated with total antioxidant capacity in healthy adults: the ATTICA study. Am J Clin Nutr 82, 694–699.
Puel C, Quintin A, Agalias A, Mathey J, Obled C, Mazur A et al. (2004). Olive oil and its main phenolic micronutrient (oleuropein) prevent inflammation-induced bone loss in the ovariectomised rat. Br J Nutr 92, 119–127.
Qi L, Shen H, Ordovás JM (2003). Hearts and bones. Nutr Metab Cardiovasc Dis 13, 165–174.
Raisz LG (1999). Prostaglandins and bone: physiology and pathophysiology. Osteoarthritis Cartilage 7, 419–421.
Ramírez-Tortosa MC, Suárez A, Gómez MC, Mir A, Ros E, Mataix J et al. (1999). Effect of extra-virgin olive oil and fish-oil supplementation on plasma lipids and susceptibility of low-density lipoprotein to oxidative alteration in free-living Spanish male patients with peripheral vascular disease. Clin Nutr 18, 167–174.
Serrano-Martínez M, Palacios M, Martínez-Losa E, Lezaun R, Maraví C, Prado M et al. (2005). A Mediterranean dietary style influences TNF-alpha and VCAM-1 coronary blood levels in unstable angina patients. Eur J Nutr 44, 348–354.
Trichopoulou A, Georgiou E, Bassiakos Y, Lipworth L, Lagiou P, Proukakis C et al. (1997). Energy intake and monounsaturated fat in relation to bone mineral density among women and men in Greece. Prev Med 26, 395–400.
Visioli F, Galli C (2002). Biological properties of olive oil phytochemicals. Crit Rev Food Sci Nutr 42, 209–221.
Watkins BA, Li Y, Allen KG, Hoffmann WE, Seifert MF (2000). Types of dietary ratio of (n-6)/(n-3) polyunsaturated fatty acids alters the fatty acids composition of bone compartments and biomarkers of bone formation in rats. J Nutr 130, 2274–2284.
Watkins BA, Li Y, Lippman HE, Feng S (2003). Modulatory effect of omega-3 polyunsaturated fatty acids on osteoblast function and bone metabolism. Prostaglandins Leukot Essent Fatty Acids 68, 387–398.
Watkins BA, Li Y, Lippman HE, Seifert MF (2001). Omega-3 polyunsaturated fatty acids and skeletal health. Exp Biol Med (Maywood) 226, 485–497.
Weiss LA, Barrett-Connor E, von Muhlen D (2005). Ratio of n-6 to n-3 fatty acids and bone mineral density in older adults: the Rancho Bernardo Study. Am J Clin Nutr 81, 934–938.
Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J et al. (1985). Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 122, 51–65.
Willett WC, Stampfer M (1998). Implications of total energy intake for epidemiologic analyses. in: Willett WC (ed), Nutritional Epidemiology 2nd edn. Oxford University Press: New York. pp 273–301.
Zheng SX, Vrindts Y, López M, De Groote D, Zangerle PF, Collette J et al. (1997). Increase in cytokine production (IL-1 beta, IL-6, TNF-alpha but not IFN-gamma, GM-jCSF or LIF) by stimulated whole blood cells in postmenopausal osteoporosis. Maturitas 26, 63–71.
Acknowledgements
This work was supported by Fondo de Investigación Sanitaria (Spanish Ministry of Health) PI011245.
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Guarantor: M Delgado-Rodríguez.
Contributors: MJ M-R, M D-R, MA M-G were responible for the study design. MJ M-R, S P, ADD-M collected the data. MA M-G, C de la F carried out the nutrient analysis. Statistical analysis was carrried out by M D-R, S P, MA M-G. Draft was prepared by MJ M-R, MA M-G and M D-R. Funding was provided by AD D-M, M D-R, MJ M-R.
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Martínez-Ramírez, M., Palma, S., Martínez-González, M. et al. Dietary fat intake and the risk of osteoporotic fractures in the elderly. Eur J Clin Nutr 61, 1114–1120 (2007). https://doi.org/10.1038/sj.ejcn.1602624
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DOI: https://doi.org/10.1038/sj.ejcn.1602624
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