Vegetarian-style dietary pattern during adolescence has long-term positive impact on bone from adolescence to young adulthood: a longitudinal study.

BACKGROUND: The amount of bone accrued during adolescence is an important determinant of later osteoporosis risk. Little is known about the influence of dietary patterns (DPs) on the bone during adolescence and their potential long-term implications into adulthood. We examined the role of adolescent DPs on adolescent and young adult bone and change in DPs from adolescence to young adulthood. METHODS: We recruited participants from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2011). Data from 125 participants (53 females) for adolescent analysis (age 12.7 ± 2 years) and 115 participants (51 females) for adult analysis (age 28.2 ± 3 years) were included. Bone mineral content (BMC) and areal bone mineral density (aBMD) of total body (TB), femoral neck (FN) and lumbar spine (LS) were measured using dual-energy X-ray absorptiometry. Adolescent dietary intake data from multiple 24-h recalls were summarized into 25 food group intakes and were used in the principal component analysis to derive DPs during adolescence. Associations between adolescent DPs and adolescent or adult BMC/BMD were analyzed using multiple linear regression and multivariate analysis of covariance while adjusting for sex, age, the age of peak height velocity, height, weight, physical activity and total energy intake. Generalized estimating equations were used for tracking DPs. RESULTS: We derived five DPs including "Vegetarian-style", "Western-like", "High-fat, high-protein", "Mixed" and "Snack" DPs. The "Vegetarian-style" DP was a positive independent predictor of adolescent TBBMC, and adult TBBMC, TBaBMD (P < 0.05). Mean adolescent TBaBMD and young adult TBBMC, TBaBMD, FNBMC and FNaBMD were 5%, 8.5%, 6%, 10.6% and 9% higher, respectively, in third quartile of "Vegetarian-style" DP compared to first quartile (P < 0.05). We found a moderate tracking (0.47-0.63, P < 0.001) in DP scores at individual levels from adolescence to adulthood. There were an upward trend in adherence to "Vegetarian-style" DP and an downward trend in adherence to "High-fat, high-protein" DP from adolescence to young adulthood (P < 0.01). CONCLUSION: A "Vegetarian-style" DP rich in dark green vegetables, eggs, non-refined grains, 100% fruit juice, legumes/nuts/seeds, added fats, fruits and low-fat milk during adolescence is positively associated with bone health.

Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review.

Nutrition is an important modifiable factor that affects bone health. Diet is a complex mixture of nutrients and foods that correlate or interact with each other. Dietary pattern approaches take into account contributions from various aspects of diet. Findings from dietary pattern studies could complement those from single-nutrient and food studies on bone health. In this study we aimed to conduct a scoping review of the literature that assessed the impact of dietary patterns (derived with the use of both a priori and data-driven approaches) on bone outcomes, including bone mineral status, bone biomarkers, osteoporosis, and fracture risk. We retrieved 49 human studies up to June 2016 from the PubMed, Embase, and CINAHL databases. Most of these studies used a data-driven method, especially factor analysis, to derive dietary patterns. Several studies examined adherence to a variety of the a priori dietary indexes, including the Mediterranean diet score, the Healthy Eating Index (HEI), and the Alternative Healthy Eating Index (AHEI). The bone mineral density (BMD) diet score was developed to measure adherence to a dietary pattern beneficial to bone mineral density. Findings revealed a beneficial impact of higher adherence to a "healthy" dietary pattern derived using a data-driven method, the Mediterranean diet, HEI, AHEI, Dietary Diversity Score, Diet Quality Index-International, BMD Diet Score, Healthy Diet Indicator, and Korean Diet Score, on bone. In contrast, the "Western" dietary pattern and those featuring some aspects of an unhealthy diet were associated inversely with bone health. In both a priori and data-driven dietary pattern studies, a dietary pattern that emphasized the intake of fruit, vegetables, whole grains, poultry and fish, nuts and legumes, and low-fat dairy products and de-emphasized the intake of soft drinks, fried foods, meat and processed products, sweets and desserts, and refined grains showed a beneficial impact on bone health. Overall, adherence to a healthy dietary pattern consisting of the above-mentioned food groups can improve bone mineral status and decrease osteoporosis and fracture risk.

Tracking Dietary Patterns over 20 Years from Childhood through Adolescence into Young Adulthood: The Saskatchewan Pediatric Bone Mineral Accrual Study.

Dietary patterns established during adolescence might play a role in adulthood disease. We examined the stability of dietary patterns (DPs) from childhood through adolescence and into young adulthood (from age 8 to 34 years). Data from 130 participants (53 females) of Saskatchewan Pediatric Bone Mineral Accrual Study (aged 8-15 years, at baseline) were included. Multiple 24-h recalls were collected annually from 1991 to 1997, 2002 to 2005, and 2010 and 2011. Using principal component analysis, "Vegetarian-style", "Western-like", "High-fat, high-protein", "Mixed", and "Snack" DPs were derived at baseline. Applied DP scores for all annual measurements were calculated using factor loading of baseline DPs and energy-adjusted food group intakes. We analyzed data using generalized estimating equations. The tracking coefficient represents correlation between baseline dietary pattern scores and all other follow-up dietary pattern scores. We found a moderate tracking for the "Vegetarian-style" (ß = 0.44, p < 0.001) and "High-fat, high-protein" (ß = 0.39, p < 0.001) DPs in females and "Vegetarian-style" DP (ß = 0.30, p < 0.001) in males. The remaining DPs showed poor-to-fair tracking in both sexes. No tracking for "Western-like" DP in females was observed. Assessing overall change in DP scores from childhood to young adulthood showed an increasing trend in adherence to "Vegetarian-style" DP and decreasing trend in adherence to "High-fat, high-protein" DP by age in both sexes (p < 0.001), while "Western-like" and "Mixed" DP scores increased only in males (p < 0.001). These findings suggest that healthy dietary habits established during childhood and adolescence moderately continue into adulthood.