title: Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: a case-control study.
abstract: This case-control study compared the associations of four widely used diet-quality scoring systems with the risk of hip fractures and assessed their utility in elderly Chinese. We found that individuals avoiding a low-quality diet have a lower risk of hip fractures in elderly Chinese.
  
  
  BACKGROUND
  Few studies examined the associations of diet-quality scores on bone health, and no studies were available in Asians and compared their validity and utility in a study. We assessed the associations and utility of four widely used diet-quality scoring systems with the risk of hip fractures.
  
  
  METHODS
  A case-control study of 726 patients with hip fractures (diagnosed within 2 weeks) aged 55-80 years and 726 age- (within 3 years) and gender-matched controls was conducted in Guangdong, China (2009-2013). Dietary intake was assessed using a 79-item food frequency questionnaire with face-to-face interviews, and the Healthy Eating Index-2005 (HEI-2005, 12 items), the alternate Healthy Eating Index (aHEI, 8 items), the Diet Quality Index-International (DQI-I, 17 items), and the alternate Mediterranean Diet Score (aMed, 9 items) (the simplest one) were calculated.
  
  
  RESULTS
  All greater values of the diet-quality scores were significantly associated with a similar decreased risk of hip fractures (all p trends <0.001). The multivariate-adjusted odds ratios (ORs) and 95% confidential intervals (95% CIs) comparing the extreme groups of diet-quality scores were 0.29 (0.18, 0.46) (HEI-2005), 0.20 (0.12, 0.33) (aHEI), 0.25 (0.16, 0.39) (DQI-I), and 0.28 (0.18, 0.43) (aMed) in total subjects; and the corresponding ORs ranged from 0.04 to 0.27 for men and from 0.26 to 0.44 for women (all p trends <0.05), respectively.
  
  
  CONCLUSIONS
  Avoiding a low-quality diet is associated with a lower risk of hip fractures, and the aMed score is the best scoring system due to its equivalent performance and simplicity for the user.
authors.affiliation: Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: F F
authors.initials: FF
authors.lastname: Zeng
authors.forename: W Q
authors.initials: WQ
authors.lastname: Xue
authors.forename: W T
authors.initials: WT
authors.lastname: Cao
authors.forename: B H
authors.initials: BH
authors.lastname: Wu
authors.forename: H L
authors.initials: HL
authors.lastname: Xie
authors.forename: F
authors.initials: F
authors.lastname: Fan
authors.forename: H L
authors.initials: HL
authors.lastname: Zhu
authors.forename: Y M
authors.initials: YM
authors.lastname: Chen
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D004032:Diet / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D004034:Diet Surveys; D038441:Diet, Mediterranean / Q000706:statistics & numerical data; D005247:Feeding Behavior; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors; D012959:Socioeconomic Factors