DASH, mediterranean and alternative healthy eating indices are associated with bone health among Puerto Rican adults from the Boston Puerto Rican osteoporosis study

Authors: SABRINA, NOEL - University Of Massachusetts; MANGANO, KELSEY - University Of Massachusetts; MATTEI, JOSIEMER - Harvard University; GRIFFITH, JOHN - Northeastern University; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; BIGORNIA, SHERMAN - University Of New Hampshire; TUCKER, KATHERINE - University Of Massachusetts

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/7/2020
Publication Date: 5/9/2020
Citation: Sabrina, N.E., Mangano, K.M., Mattei, J., Griffith, J.L., Dawson-Hughes, B., Bigornia, S., Tucker, K.L. 2020. DASH, mediterranean and alternative healthy eating indices are associated with bone health among Puerto Rican adults from the Boston Puerto Rican osteoporosis study. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqaa090.
DOI: https://doi.org/10.1093/ajcn/nqaa090

Interpretive Summary: Studies of the influence of dietary patterns on bone health are inconsistent, and little evidence is available on dietary patterns and bone health in Puerto Ricans, a population at risk for osteoporosis. We examined associations of several indicators of a healthy dietary pattern with bone mineral density of the spine and hip in 865 Puerto Ricans living in the Greater Boston area. Postmenopausal women who had a higher Dietary Approaches to Stop Hypertension (DASH) score (indicating a healthier dietary pattern diet rich in fruit, vegetables and low fat dairy products and low in processed grains and sweets) had higher bone density at the spine and hip and lower odds of osteoporosis. Mediterranean and Alternative Health Eating Index-2010 dietary scores were also associated with higher bone density and lower odds of osteoporosis; however, the DASH score was more positively associated with bone outcomes. No association between dietary patterns and bone density or osteoporosis was seen in the men or premenopausal women. These findings provide additional support for an overall healthier dietary pattern for bone health; however, further research is needed to determine the impact of improving diet quality on bone health.

Technical Abstract: Background: Conflicting results on associations between dietary quality and bone have been noted across populations, and this has been understudied in Puerto Ricans, a population at higher risk of osteoporosis than previously appreciated. Objective: To compare cross-sectional associations between three dietary quality indices (Dietary Approaches to Stop Hypertension (DASH), Alternative Health Eating Index (AHEI-2010), and Mediterranean Diet Score (MeDS)), with bone outcomes. Design: Participants (n=865-896) from the Boston Puerto Rican Osteoporosis Study (BPROS) with complete bone and dietary data were included. Indices were calculated from validated food frequency data. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). Associations between dietary indices (z-scores) and their individual components, with BMD and osteoporosis were tested with ANCOVA and logistic regression, respectively, at the lumbar spine and femoral neck, stratified by male, pre-menopausal women and post-menopausal women. Results: Participants were 59.9 y plus or minus 7.6 y and mostly female (71%). Among post-menopausal women not taking estrogen, DASH (score:11-38) was associated with higher trochanter (0.026 plus or minus 0.006 g/cm2, P<0.001), femoral neck (0.022 plus or minus 0.006 g/cm^2, P<0.001), total hip (0.029 plus or minus 0.006 g/cm^2, P<0.001) and lumbar spine BMD (0.025 plus or minus 0.007 g/cm^2, P=0.001) BMD. AHEI (score:25-86) was also associated with spine and all hip sites (P<0.02), whereas, MeDS (0-9) was associated only with total hip (P=0.01) and trochanter BMD (P=0.007) in post-menopausal women. All indices were associated with lower likelihood of osteoporosis (OR from 0.54-0.75). None of the results were significant for men or pre-menopausal women. Conclusions: Although all appeared protective, DASH was more positively associated with BMD than AHEI or MeDS in post-menopausal women not taking estrogen. Methodological differences across scores suggest that a bone-specific index that builds on existing indices, and that can be used to address dietary differences across cultural and ethnic minority populations should be considered.