Adherence to the 2006 American Heart Association Diet and Lifestyle Recommendations for cardiovascular disease risk reduction is associated with bone health in older Puerto Ricans

Abstract

Background: Cardiovascular disease (CVD) and osteoporosis are 2 major public health problems that share common pathophysiological mechanisms. It is possible that strategies to reduce CVD risk may also benefit bone health.

Objective: We tested the hypothesis that adherence to the 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) is associated with bone health.

Design: We previously developed a unique diet and lifestyle score (American Heart Association Diet and Lifestyle Score; AHA-DLS) to assess adherence to the AHA-DLR. In a cross-sectional study of 933 Puerto Ricans aged 47-79 y, we modified the AHA-DLS to test associations with bone health. Bone mineral density (BMD) at the femoral neck, trochanter, total hip, and lumbar spine (L2-L4) was measured by using dual-energy X-ray absorptiometry.

Results: For every 5-unit increase in the modified AHA-DLS, BMD at the femoral neck, trochanter, total hip, and lumbar spine (L2-L4) was associated with a 0.005-0.008-g/cm(2) (P < 0.05) higher value. No component of the AHA-DLR alone was responsible for the observed positive associations. For every 5-unit increase in the modified AHA-DLS, the odds for osteoporosis or osteopenia at the trochanter, total hip, and lumbar spine (L2-L4) were lower by 14% (OR: 0.86; 95% CI: 0.79, 0.92), 17% (OR: 0.83; 95% CI: 0.76, 0.92), and 9% (OR: 0.91; 95% CI: 0.84, 0.99), respectively.

Conclusions: Dietary guidelines for CVD risk reduction may also benefit bone health in this Hispanic cohort. Synchronizing dietary guidelines for these 2 common diseases may provide a simplified public health message. This trial was registered at clinicaltrials.gov as NCT01231958.

Figures

FIGURE 1.

Adjusted mean (±SEM) BMD across energy-adjusted quartiles of modified AHA-DLS. The bars from left to right are quartiles 1, 2, 3, and 4 of energy-adjusted modified AHA-DLS. Data were adjusted for age (y), sex, BMI (kg/m2), height (m), current smoking (yes or no), educational status (<9th grade, 9th–12th grade, or college/some graduate school), season of bone mineral density measurement (summer, spring, fall, or winter), plasma vitamin D status (ng/mL), intakes of total energy (kcal/d) and calcium (mg/d), osteoporosis medication use (yes or no), multivitamin supplement use (yes or no), acculturation (%), and perceived stress score based on ANCOVA (PROC GLM; SAS Institute). Adjustment for multiple comparisons was performed by using Dunnett's adjustment. Median (range): quartile 1, 18.8 (5.7–22.9), n = 233; quartile 2, 26.0 (23.0–28.9), n = 233; quartile 3, 32.4 (29.0–36.2), n = 234; quartile 4, 42.2 (36.3–60.6), n = 233. *P < 0.05 and **P < 0.01 compared with quartile 1 (Dunnett's adjustment). AHA-DLS, American Heart Association Diet and Lifestyle Score; BMD, bone mineral density.

FIGURE 2.

ORs (95% CIs) of osteoporosis or osteopenia for every 5-unit increase in the modified American Heart Association Diet and Lifestyle score. Data were adjusted for age (y), sex, BMI (kg/m2), height (m), current smoking (yes or no), educational status (<9th grade, 9th–12th grade, or college/some graduate school), season of bone mineral density measurement (summer, spring, fall, or winter), plasma vitamin D status (ng/mL), intakes of total energy (kcal/d) and calcium (mg/d), osteoporosis medication use (yes or no), multivitamin supplement use (yes or no), acculturation (%), and perceived stress score based on logistic regression (PROC LOGISTIC; SAS Institute). Femoral neck, n = 896; trochanter, n = 896; total femur, n = 887; lumbar spine, n = 894.