title: Midlife women, bone health, vegetables, herbs and fruit study. The Scarborough Fair study protocol.
abstract: BACKGROUND
  Bone loss is accelerated in middle aged women but increased fruit/vegetable intake positively affects bone health by provision of micronutrients essential for bone formation, buffer precursors which reduce acid load and phytochemicals affecting inflammation and oxidative stress. Animal studies demonstrated bone resorption inhibiting properties of specific vegetables, fruit and herbs a decade ago.
  
  
  OBJECTIVE
  To increase fruit/vegetable intake in post menopausal women to 9 servings/day using a food specific approach to significantly reduce dietary acid load and include specific vegetables, fruit and herbs with bone resorbing inhibiting properties to assess effect on bone turnover, metabolic and inflammatory markers.
  
  
  METHODS
  The Scarborough Fair Study is a randomised active comparator controlled multi centre trial. It aimed to increase fruit and vegetable intake in 100 post menopausal women from ≤ 5 servings/day to ≥ 9 servings/day for 3 months. The women in the dietary intervention were randomly assigned to one of the two arms of the study. Both groups consumed ≥ 9 servings/day of fruit/vegetables and selected herbs but the diet of each group emphasised different fruit/vegetables/herbs with one group (B) selecting from a range of vegetables, fruit and culinary herbs with bone resorbing inhibiting properties. 50 women formed a negative control group (Group C usual diet). Primary outcome variables were plasma bone markers assessed at baseline, 6 weeks and 12 weeks. Secondary outcome variables were plasma inflammation and metabolic markers and urinary electrolytes (calcium, magnesium, potassium and sodium) assessed at baseline and 12 weeks. Dietary intake and urine pH change also were outcome variables. The dietary change was calculated with 3 day diet diaries and a 24 hour recall. Intervention participants kept a twice weekly record of fruit, vegetable and herb intake and urine pH.
  
  
  CONCLUSIONS
  This study will provide information on midlife women's bone health and how a dietary intervention increasing fruit and vegetable/herb intake affects bone, inflammatory and metabolic markers and urinary electrolyte excretion. It assesses changes in nutrient intake, estimated dietary acid load and sodium: potassium ratios. The study also explores whether specific fruit/vegetables and herbs with bone resorbing properties has an effect on bone markers.
  
  
  BACKGROUND
  ACTRN 12611000763943.
authors.affiliation: Institute of Food, Nutrition and Human Health, Massey University, Private Bag 11222, Palmerston North, 4442, New Zealand. c.a.gunn@massey.ac.nz
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Gunn
authors.forename: Janet L
authors.initials: JL
authors.lastname: Weber
authors.forename: Marlena C
authors.initials: MC
authors.lastname: Kruger
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001842:Bone and Bones / Q000378:metabolism*; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D005638:Fruit; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control*; D010946:Plants, Medicinal; D016896:Treatment Outcome; D014675:Vegetables
chemical_list: D015415:Biomarkers