Abstract. To assess the association of dietary patterns and bone mineral density (BMD), 340 healthy Iranian adults (mean age 41.5 ± 7.7 y; 79.1% female) participated in this cross-sectional study. Lumbar spine and femoral neck BMDs were measured using dual-energy X-ray absorptiometry. Dietary intakes were evaluated by a valid and reliable 168-item food frequency questionnaire, and three major dietary patterns were identified using principal component factor analysis. Mean values for lumbar spine and femoral neck BMDs in participants were 0.96 ± 0.13 and 0.92 ± 0.12 g/cm2, respectively. After controlling for age, body mass index, physical activity, energy intake, sunlight exposure, gender, education, employment status, supplement intake, and smoking in the analysis of covariance models, multivariable adjusted means of femoral neck BMD of participants in the highest tertile of the prudent pattern score (rich in green leafy vegetables, other vegetables, tomatoes, yellow vegetables, fruits and fruit juices, olives, nuts, fish, low-fat dairy products, and Doogh) were significantly higher than those in the lowest tertile (mean difference and 95% CI: 0.043 [0.003; 0.083] g/cm2, P = 0.032). In contrast, multivariable adjusted means of lumbar spine BMD of participants in the highest tertile of the traditional pattern score (high in Abgoosht, vegetable oils, salt, legumes, pickles, cruciferous vegetables, refined grains, potatoes, and organ meats) were significantly lower than those in the lowest tertile (mean difference and 95% CI: −0.057 [−0.098; −0.015] g/cm2, P = 0.003). The Western pattern was not associated with BMD. In conclusion, the prudent and traditional dietary patterns are positively and negatively associated with BMD in Iranian adults, respectively.
1 . Osteoporosis: a still increasing prevalence. Bone. 2006;38:4–9.
2 . Dietary patterns in relation to low bone mineral density and fracture risk: a systematic review and meta-analysis. Adv Nutr. 2019;10:219–236.
3 . Prevalence of osteoporosis in Iran: A meta-analysis. J Res Med Sci. 2013;18:759–766.
4 . Genetic and environmental determinants of peak bone mass in young men and women. J Bone Miner Res. 2002;17:1273–1279.
5 . Current evidence on the association of dietary patterns and bone health: a scoping review. Adv Nutr. 2017;8:1–16.
6 . Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.
7 . Dietary patterns in an elderly population and their relation with bone mineral density: The Rotterdam Study. Eur J Nutr. 2018;57:61–73.
8 . Dietary patterns in relation to bone mineral density among menopausal Iranian women. Calcif Tissue Int. 2012;91:40–49.
9 . The associations between dietary patterns and bone health, according to the TGF-β1 T869→ C polymorphism, in postmenopausal Iranian women. Aging Clin Exp Res. 2018;30:563–571.
10 . Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab. 2010;57:193–203.
11 East and North Africa consensus on osteoporosis. J Musculoskelet Neuronal Interact. 2007;7:131–143.
12 . Major dietary patterns in relation to general obesity and central adiposity among Iranian women. J Nutr. 2008;138:358–363.
13 Association of major dietary patterns with general and abdominal obesity in Iranian patients with type 2 diabetes mellitus. Int J Vitam Nutr Res. 2015;85:145–155.
14 . Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol. 2010;20:150–158.
15 . Reliability, comparative validity and stability of dietary patterns derived from an FFQ in the Tehran Lipid and Glucose Study. Br J Nutr. 2012;108:1109–1117.
16 . Guidelines for the data processing and analysis of the International Physical Activity Questionnaire. http://www.ipaq.ki.se. Accessed 25 June 2018.
17 . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395.
18 . The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability. World Appl Sci J. 2012;18:1073–1080.
19 . Factor analysis: statistical methods and practical issues. Thousand Oaks, CA: Sage Publications; 1978.
20 . Sample size in factor analysis. Psychol Methods. 1999;4:84–99.
21 . Dietary patterns, approaches, and multicultural perspective. Appl Physiol Nutr Metab. 2010;35:211–218.
22 . A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:2029–2049.
23 . Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop. 2016;7:171–181.
24 . The role of diet in osteoporosis prevention and management. Curr Osteoporos Rep. 2012;10:296–302.
25 . Risk factors for spinal osteoporosis as compared with femoral osteoporosis in urban Iranian women. Iran J Public Health. 2012;41:52–59.
26 . Risk factors of osteoporosis in women over 50 years of age: a population based study in the north of Iran. J Turk Ger Gynecol Assoc. 2008;9:38–44.
27 . Association between dietary patterns and low bone mineral density among adults aged 50 years and above: findings from the North West Adelaide Health Study (NWAHS). Br J Nutr. 2016;116:1437–1446.
28 . Dietary patterns, bone resorption and bone mineral density in early post-menopausal Scottish women. Eur J Clin Nutr. 2011;65:378–385.
29 . Dietary patterns explaining differences in bone mineral density and hip structure in the elderly: the Rotterdam Study. Am J Clin Nutr. 2017;105:203–211.
30 . Dietary patterns are associated with bone mineral density in an urban Mexican adult population. Osteoporos Int. 2016;27:3033–3040.
31 . A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults. Eur J Clin Nutr. 2015;69:442–428.
32 . Dietary patterns are associated with body mass index and bone mineral density in Chinese freshmen. J Am Coll Nutr. 2014;33:120–128.
33 . Dietary patterns in college freshmen and its relation to bone mineral density. Wei Sheng Yan Jiu. 2012;41:579–584.
34 . Dietary patterns associated with bone mineral density in premenopausal Japanese farmwomen. Am J Clin Nutr. 2006;83:1185–1192.
35 . Milk-cereal and whole-grain dietary patterns protect against low bone mineral density among male adolescents and young adults. Eur J Clin Nutr. 2017;71:1101–1107.
36 . An energy-dense, nutrient-poor dietary pattern is inversely associated with bone health in women. J Nutr. 2011;141:1516–1523.
37 . Dietary patterns and bone mineral density in Brazilian postmenopausal women with osteoporosis: a cross-sectional study. Eur J Clin Nutr. 2016;70:85–90.
38 . Major nutrient patterns and bone mineral density among postmenopausal Iranian women. Calcif Tissue Int. 2014;94:648–658.
39 . Associations of dietary polyunsaturated fatty acids with bone mineral density in elderly women. Eur J Clin Nutr. 2012;66:496–503.
40 . High-calcium, vitamin D fortified milk is effective in improving bone turnover markers and vitamin D status in healthy postmenopausal Chinese women. Eur J Clin Nutr. 2012;66:856–861.
41 . Osteoporosis: the role of micronutrients. Am J Clin Nutr. 2005;81:1232–1239.
42 . Poor vitamin D status in healthy populations in India: a review of current evidence. Int J Vitam Nutr Res. 2015;85:185–201.
43 . The acid-base hypothesis: diet and bone in the Framingham Osteoporosis Study. Eur J Nutr. 2001;40:231–237.
44 . Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. Am J Physiol. 1996;271:216–222.
45 . Higher dietary acidity is associated with lower bone mineral density in postmenopausal Iranian women, independent of dietary calcium intake. Int J Vitam Nutr Res. 2014;84:206–217.
46 . Oxidative stress in bone remodelling and disease. Trends Mol Med. 2009;15:468–477.
47 . Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr. 2009;89:416–424.
48 . Effect of supplementation of vitamin C and E on oxidative stress in osteoporosis. Indian J Clin Biochem. 2007;22:101–105.
49 . Role of flavonoids on oxidative stress and mineral contents in the retinoic acid-induced bone loss model of rat. Eur J Nutr. 2014;53:1217–1227.
50 . Osteoporosis, inflammation and ageing. Immun Ageing. 2005;2:14.
51 . Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17:1689–1696.
52 . Preventive role of vitamin d in silica-induced skin fibrosis: a study in relation to oxidative stress and pro-inflammatory cytokines. Int J Vitam Nutr Res. 2016;86:88–96.
53 . A review about lycopene-induced nuclear hormone receptor signalling in inflammation and lipid metabolism via still unknown endogenous apo-10-lycopenoids. Int J Vitam Nutr Res. 2016;86:62–70.
54 . Bioactivity of carotenoids – chasms of knowledge. Int J Vitam Nutr Res. 2017. doi: 10.1024/0300-9831/a000400.
55 . Increased inflammatory potential of diet is associated with bone mineral density among postmenopausal women in Iran. Eur J Nutr. 2016;55:561–568.
56 . Dietary patterns and non communicable disease among Iranian women: a systematic review. Womens Health Bull. 2014;1:e21358.
57 Effect of high dietary sodium on bone turnover markers and urinary calcium excretion in Korean postmenopausal women with low bone mass. Eur J Clin Nutr. 2015;69:361–366.
58 . Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III. J Nutr. 2006;136:159–165.
59 . Ratio of n-6 to n-3 fatty acids and bone mineral density in older adults: the Rancho Bernardo Study. Am J Clin Nutr. 2005;81:934–938.
60 . Diet-induced acidosis: is it real and clinically relevant? Br J Nutr. 2010;103:1185–1194.
61 . Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995;95:791–797.
62 . The role of dual energy X-ray absorptiometry of lumbar spine and proximal femur in the diagnosis and follow-up of osteoporosis. Am J Med. 1995;98:33–36.
63 . Invited commentary: Factor analysis and the search for objectivity. Am J Epidemiol. 1998;148:17–19.
64 . Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol. 2004;159:935–944.