title: Mediterranean diet and incidence of hip fractures in a European cohort.
abstract: Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men.
  
  
  BACKGROUND
  Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries.
  
  
  METHODS
  A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders.
  
  
  RESULTS
  Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79-0.94) and high fruit (HR = 0.89; 95 % CI = 0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32-2.31) was also a risk factor.
  
  
  CONCLUSIONS
  In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.
authors.affiliation: WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 Mikras Asias street, 115 27 Athens, Greece. vben@nut.uoa.gr
authors.forename: V
authors.initials: V
authors.lastname: Benetou
authors.forename: P
authors.initials: P
authors.lastname: Orfanos
authors.forename: U
authors.initials: U
authors.lastname: Pettersson-Kymmer
authors.forename: U
authors.initials: U
authors.lastname: Bergström
authors.forename: O
authors.initials: O
authors.lastname: Svensson
authors.forename: I
authors.initials: I
authors.lastname: Johansson
authors.forename: F
authors.initials: F
authors.lastname: Berrino
authors.forename: R
authors.initials: R
authors.lastname: Tumino
authors.forename: K B
authors.initials: KB
authors.lastname: Borch
authors.forename: E
authors.initials: E
authors.lastname: Lund
authors.forename: P H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: V
authors.initials: V
authors.lastname: Grote
authors.forename: K
authors.initials: K
authors.lastname: Li
authors.forename: J M
authors.initials: JM
authors.lastname: Altzibar
authors.forename: T
authors.initials: T
authors.lastname: Key
authors.forename: H
authors.initials: H
authors.lastname: Boeing
authors.forename: A
authors.initials: A
authors.lastname: von Ruesten
authors.forename: T
authors.initials: T
authors.lastname: Norat
authors.forename: P A
authors.initials: PA
authors.lastname: Wark
authors.forename: E
authors.initials: E
authors.lastname: Riboli
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D038441:Diet, Mediterranean / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors