Mediterranean‐style Dietary Pattern is associated with Hip Bone Mineral Density Among Older Puerto Rican Adults
Authors: Noel Sabrina E , Bigornia Sherman J , Mangano Kelsey M , Tucker Katherine L 
Published: November 2023

ObjectiveTo examine associations between a Mediterranean diet score (MDS) and its components with bone mineral density (BMD) of the lumbar spine and hip among older Puerto Ricans adults.MethodsParticipants were from the Boston Puerto Rican Osteoporosis Study, an ancillary study to the Boston Puerto Rican Health Study (BPRHS). Dietary intake over the past year was assessed at baseline of the BPRHS using a FFQ that was adapted and validated for use in this population. MDS (range 0 to 9) was calculated by assigning 1 point for intakes higher than the energy‐adjusted and sex‐specific median servings for whole grains (0.65 and 0.69 s/d, men and women, respectively), fruit (1.05 and 1.11 s/d), vegetables (1.6 and 1.5 s/d), legumes (5.5 and 4.7 s/wk), fish (0.90 and 0.82 s/d) and monounsaturated to saturated fatty acid ratio (1.16 and 1.17 units/d); and by assigning 1 point for lower intakes of meat (4.7 and 4.1 s/d, for men and women respectively) or dairy (1.8 and 1.6 s/d). One point was given for moderate alcohol consumption (up to 2 s/d for men or 1/s for women). BMD of the total hip, femoral neck, trochanter and lumbar spine (L2–L4) was measured using DXA approximately 2 y after baseline.ResultsIn multivariable models, MDS was associated with greater BMD of the trochanter and total hip [mean (95% CI); 0.85 g/cm2 (0.83, 0.87) for MDS 6–9 and 0.83 g/cm2 (0.81, 0.85) MDS 0–2; P‐trend=0.04; and mean (95% CI); 1.04 g/cm2 (1.02, 1.06) for MDS 6–9 and 1.02 g/cm2 (1.0, 1.05) MDS 0–2; P‐trend=0.04, respectively; Table]. For MDS components, whole grain and legume consumption were associated with lumbar spine BMD [1.16 g/cm2 (1.14, 1.18) and 1.14 g/cm2 (1.12, 1.16) for above vs. below median intake; P=0.03; and 1.16 g/cm2 (1.14, 1.18) and 1.14 g/cm2 (1.12, 1.16) for above vs. below median intake; P=0.02, respectively. Fruit intake was associated with femoral neck BMD [1.15 g/cm2 (1.13, 1.17) and 1.15 g/cm2 (1.13, 1.17) for above vs. below median intake; P=0.007] and fish was associated with trochanter [0.85 g/cm2 (0.83, 0.86) and 0.82 g/cm2 (0.81, 0.84) for above vs. below the median intake; P=0.008] and total hip BMD [1.04 g/cm2 (1.03, 1.07) and 1.02 g/cm2 (1.00, 1.03) for above vs. below median intake; P=0.01]. Other MDS components were not associated with BMD.ConclusionsMediterranean‐style diet was associated with greater BMD among older Puerto Ricans; however, this index does not emphasize all foods and nutrients known to be important for bone health. Developing a dietary quality index that is specific for bone may improve our understanding of the effect of diet on bone health and may be important for providing dietary recommendations for osteoporosis prevention.Support or Funding InformationNational Institutes of Health (P01 AG023394, R01 AG027087)

Association between Mediterranean Diet Score and BMD of the lumbar spine and hip sites

Mediterranean Diet Score

0 to 2
3
4
5
6 to 9
P‐trend

n=119
n=146
n=193
n=179
n=229

Spine (L2–L4)
1.14 (1.11, 1.18)
1.14 (1.11, 1.17)
1.15 (1.12, 1.18)
1.14 (1.11, 1.16)
1.17 (1.14, 1.19)
0.23

Femoral Neck
0.93 (0.90, 0.95)
0.92 (0.90, 0.94)
0.94 (0.92, 0.96)
0.93 (0.91, 0.95)
0.95 (0.93, 0.97)
0.08

Trochanter
0.83 (0.81, 0.85)
0.81 (0.79, 0.83)
0.84 (0.82, 0.86)
0.84 (0.82, 0.86)
0.85 (0.83, 0.87)
0.04

Total Hip
1.02 (1.00, 1.05)
1.01 (0.99, 1.04)
1.03 (1.01, 1.05)
1.03 (1.01, 1.05)
1.04 (1.02, 1.06)
0.04

Models are adjusted for sex, age, height, BMI, menopausal status (postmenopausal or not), energy intake, physical activity score, smoking status (currently or not) and time between baseline and DXA scan. Mediterranean diet score was derived for 866 participants with available baseline diet and covariates and who attended the DXA visit. Sample sizes vary due to exclusion of participants with T‐scores ≤ 4, leaving remaining participants for spine (n=845), femoral neck (n=863), trochanter (n=863), and total hip (n=854). BMD was assessed a median of 2.7 yr (inter‐quartile range: 2.2 to 3.5) from baseline. Models were adjusted for menopausal status rather than estrogen replacement therapy because only 17 women were on estrogen replacement therapy.