title: Dietary patterns in men and women are simultaneously determinants of altered glucose metabolism and bone metabolism.
abstract: We hypothesized that diet would have direct effects on glucose metabolism with direct and indirect effects on bone metabolism in a cohort of Canadian adults. We assessed dietary patterns (Prudent [fruit, vegetables, whole grains, fish, and legumes] and Western [soft drinks, potato chips, French fries, meats, and desserts]) from a semiquantitative food frequency questionnaire. We used fasting blood samples to measure glucose, insulin, homeostatic model assessment insulin resistance (HOMA-IR), 25-hydroxyvitamin D (25OHD), parathyroid hormone, bone-specific alkaline phosphatase (a bone formation marker), and serum C-terminal telopeptide (CTX; a bone resorption marker). We used multivariate regression models adjusted for confounders and including/excluding body mass index. In a secondary analysis, we examined relationships through structural equations models. The Prudent diet was associated with favorable effects on glucose metabolism (lower insulin and HOMA-IR) and bone metabolism (lower CTX in women; higher 25OHD and lower parathyroid hormone in men). The Western diet was associated with deleterious effects on glucose metabolism (higher glucose, insulin, and HOMA-IR) and bone metabolism (higher bone-specific alkaline phosphatase and lower 25OHD in women; higher CTX in men). Body mass index adjustment moved point estimates toward the null, indicating partial mediation. The structural equation model confirmed the hypothesized linkage with strong effects of Prudent and Western diet on metabolic risk, and both direct and indirect effects of a Prudent diet on bone turnover. In summary, a Prudent diet was associated with lower metabolic risk with both primary and mediated effects on bone turnover, suggesting that it is a potential target for reducing fracture risk.
authors.affiliation: CaMos National Coordinating Centre, McGill University, Montreal, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Langsetmo
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Susan I
authors.initials: SI
authors.lastname: Barr
authors.affiliation: McGill University, Montreal, Canada.
authors.forename: Kaberi
authors.initials: K
authors.lastname: Dasgupta
authors.affiliation: CaMos National Coordinating Centre, McGill University, Montreal, Canada.
authors.forename: Claudie
authors.initials: C
authors.lastname: Berger
authors.affiliation: Memorial University, St Johns, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.affiliation: McMaster University, Hamilton, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: University of Calgary, Calgary, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Jerilynn C
authors.initials: JC
authors.lastname: Prior
authors.affiliation: Laval University, Quebec City, Canada.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
authors.affiliation: McGill University, Montreal, Canada.
authors.forename: Suzanne N
authors.initials: SN
authors.lastname: Morin
authors.affiliation: University of Victoria, Victoria, Canada.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Davison
authors.affiliation: McGill University, Montreal, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goltzman
authors.affiliation: University of Toronto, Toronto, Canada. Electronic address: nancy.kreiger@utoronto.ca.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kreiger
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D016723:Bone Remodeling; D001842:Bone and Bones / Q000378:metabolism*; D002170:Canada; D024042:Collagen Type I / Q000097:blood; D004032:Diet; D015930:Diet Records; D066273:Diet, Western; D002523:Edible Grain; D007887:Fabaceae; D005215:Fasting; D005260:Female; D005399:Fishes; D005638:Fruit; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000097:blood; D011795:Surveys and Questionnaires; D014675:Vegetables; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D024042:Collagen Type I; D007328:Insulin; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D005947:Glucose
keywords: Bone formation; Bone resorption; Cohort study; Factor analysis; Human; Type 2 diabetes; Western diet