title: Dietary Inflammatory Index, Bone Mineral Density, and Risk of Fracture in Postmenopausal Women: Results From the Women's Health Initiative.
abstract: Previous studies suggest that bone loss and fracture risk are associated with higher inflammatory milieu, potentially modifiable by diet. The primary objective of this analysis was to evaluate the association of the dietary inflammatory index (DII), a measure of the inflammatory potential of diet, with risk of hip, lower-arm, and total fracture using longitudinal data from the Women's Health Initiative Observational Study and Clinical Trials. Secondarily, we evaluated changes in bone mineral density (BMD) and DII scores. DII scores were calculated from baseline food frequency questionnaires (FFQs) completed by 160,191 participants (mean age 63 years) without history of hip fracture at enrollment. Year 3 FFQs were used to calculate a DII change score. Fractures were reported at least annually; hip fractures were confirmed by medical records. Hazard ratios for fractures were computed using multivariable-adjusted Cox proportional hazard models, further stratified by age and race/ethnicity. Pairwise comparisons of changes in hip BMD, measured by dual-energy X-ray absorptiometry from baseline, year 3, and year 6 were analyzed by quartile (Q1 = least inflammatory diet) of baseline DII scores in a subgroup of women (n = 10,290). Mean DII score improved significantly over 3 years (p < 0.01), but change was not associated with fracture risk. Baseline DII score was only associated with hip fracture risk in younger white women (HR Q4,1.48; 95% CI, 1.09 to 2.01; p = 0.01). There were no significant associations among white women older than 63 years or other races/ethnicities. Women with the least inflammatory DII scores had less loss of hip BMD (p = 0.01) by year 6, despite lower baseline hip BMD, versus women with the most inflammatory DII scores. In conclusion, a less inflammatory dietary pattern was associated with less BMD loss in postmenopausal women. A more inflammatory diet was associated with increased hip fracture risk only in white women younger than 63 years. © 2016 American Society for Bone and Mineral Research.
authors.affiliation: Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH, USA.
authors.forename: Tonya
authors.initials: T
authors.lastname: Orchard
authors.affiliation: Women's Health Initiative Midwest Regional Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
authors.forename: Vedat
authors.initials: V
authors.lastname: Yildiz
authors.affiliation: Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Steck
authors.affiliation: Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Mossavar-Rahmani
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Sattari
authors.affiliation: Harvard Medical School, Harvard University, Boston, MA, USA.
authors.forename: Meryl
authors.initials: M
authors.lastname: LeBoff
authors.affiliation: Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.affiliation: Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Jackson
mesh_terms: D000368:Aged; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D005518:Food Preferences; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D017698:Postmenopause / Q000378:metabolism*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016387:Women's Health
keywords: EPIDEMIOLOGY; FRACTURE RISK ASSESSMENT; MENOPAUSE; NUTRITION; OSTEOPOROSIS