Research Papers

Diet Can Play Preventive Role Against Hip Fractures, Particularly Protein, Tea and Coffee


Hip fractures are extremely common, particularly among older women and contribute to decreased quality of life and increased mortality. Currently, there is insufficient evidence to conclude whether diet modification plays a role in the prevention of hip fractures, particularly in relation to weight and body mass index (BMI). This study is a prospective cohort study of over 35,000 middle-aged women across the United Kingdom. Dietary, lifestyle and other relevant health information were collected at recruitment. The women completed a food questionnaire containing 217 items. Associations between food quantity and nutrient intake with hip fracture risk was assessed over more than 22 years. The results showed that tea or coffee was associated with a 4% reduced risk of hip fracture and that a 25 gram per day increase in protein consumption was associated with a 14% reduced risk of hip fracture. When the authors looked at BMI, there was a reduced risk of hip fracture if overweight individuals consumed protein, sufficient calcium and tea. Risk of hip fracture in underweight participants was also 45% lower for every 25 gram of protein consumed per day, again highlighting the protective role of protein rich foods. This is the first study of its kind to measure hip fracture risk against nutrients and BMI and suggests that there are potentially significant roles that certain foods can play in hip fracture prevention, particularly protein, tea and coffee in underweight women.

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Background and aims: Hip fracture affects 1.6 million people globally each year, and increases morbidity and mortality. There is potential for risk reduction through diet modification, but prospective evidence for associations between intake of several foods and nutrients and hip fracture risk is limited. This study aimed to investigate associations between food and nutrient intakes and hip fracture risk in the UK Women’s Cohort Study, and to determine the role of body mass index (BMI) as a potential effect modifier. Methods: Dietary, lifestyle, anthropometric, and socio-economic information of UK women, ages 35–69 years, were collected in a survey at recruitment (1995–1998), and included a validated 217-item food frequency questionnaire. Hip fracture cases were identified by linking participant data at recruitment with their Hospital Episode Statistics (HES) up to March 2019. Cox regression models were used to estimate associations between standard portions of food and nutrient intakes and hip fracture risk over a median follow-up time of 22.3 years. Results: Among 26,318 women linked to HES data (556,331 person-years), 822 hip fracture cases were identified. After adjustment for confounders, every additional cup of tea or coffee per day was associated with a 4% lower risk of hip fracture (HR (95% CI): 0.96 (0.92, 1.00)). A 25 g/day increment of dietary protein intake was also associated with a 14% lower risk of hip fracture (0.86 (0.73, 1.00)). In subgroup analyses, BMI modified linear associations between dietary intakes of protein, calcium, total dairy, milk, and tea and hip fracture risk (pinteraction = 0.02, 0.002, 0.003, 0.001, and 0.003, respectively); these foods and nutrients were associated with a reduced risk of hip fracture in underweight but not healthy or overweight participants. In particular, risk of hip fracture in underweight participants (28 cases, 545 participants) was 45% lower for every 25 g/day protein consumed (0.55 (0.38, 0.78)). Conclusions: This is the first prospective cohort study internationally of multiple food and nutrient intakes in relation to hip fracture risk by BMI using linkage to hospital records. Results suggest that the potential roles of some foods and nutrients in hip fracture prevention, particularly protein, tea and coffee in underweight women, merit confirmation.

Article Publication Date: 8/11/2022
DOI: 10.1016/j.clnu.2022.11.008

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