Adherence to a Mediterranean-style diet and incident fractures: pooled analysis of observational evidence.
OBJECTIVE
The Mediterranean diet is associated with decreased morbidity and mortality from various chronic diseases. Adherence to a Mediterranean-style diet has been suggested to have protective effects on bone health and decreases the incidence of bone fractures, but the evidence is not clear. We conducted a systematic review and meta-analysis of available observational studies to quantify the association between adherence to a Mediterranean-style diet, as assessed by the Mediterranean Diet Score (MDS), and the risk of fractures in the general population.


METHODS
Relevant studies were identified in a literature search of MEDLINE, EMBASE, Web of Science, and reference lists of relevant studies to October 2016. Relative risks (RRS) with 95% confidence intervals (CIs) were aggregated using random-effects models.


RESULTS
Five observational studies with data on 353,076 non-overlapping participants and 33,576 total fractures (including 6,881 hip fractures) were included. The pooled fully adjusted RR (95% CI) for hip fractures per 2-point increment in adherence to the MDS was 0.82 (0.71-0.96). Adherence to the MDS was not associated with the risk of any or total fractures based on pooled analysis of only two studies.


CONCLUSIONS
Limited observational evidence supports a beneficial effect of adherence to a Mediterranean-style diet on the incidence of hip fractures. Well-designed intervention studies are needed to elucidate the relationship between adherence to a Mediterranean-style diet and the risk of adverse bone health outcomes such as fractures.
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK. skk31@cantab.net.
Setor K
http://orcid.org/0000-0002-2625-0273
SK
Kunutsor
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.|Central Finland Central Hospital, Jyväskylä, Finland.
Jari A
JA
Laukkanen
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
Michael R
MR
Whitehouse
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
Ashley W
AW
Blom
D038441:Diet, Mediterranean; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012306:Risk
Bone; Fractures; Mediterranean diet; Nutrition