Fish consumption, bone mineral density, and risk of hip fracture among older adults: The cardiovascular health study

Jyrki K Virtanen,Jane A Cauley,Kenneth J Mukamal,David S Siscovick,John Robbins,Dariush Mozaffarian

doi:10.1002/jbmr.87

Abstract

Marine n-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may be beneficial for bone health, but few studies have investigated the association with fish consumption. Our aim was to study associations of fish and EPA + DHA consumption with bone mineral density (BMD) and hip fracture risk and determine whether high linoleic acid (LA) intake, the major dietary n-6 PUFA, modifies the associations. The study population consisted of 5045 participants aged 65 years and older from the Cardiovascular Health Study. Data on BMD were available for 1305 participants. Food-frequency questionnaire was used to assess dietary intake, and hip fracture incidence was assessed prospectively by review of hospitalization records. After multivariable adjustment, femoral neck BMD was 0.01 g/cm2 lower in the highest versus lowest tuna/other-fish intake category (p = .05 for trend). EPA + DHA intake (higher versus lower median of 0.32 g/day) was associated with lower femoral neck BMD (0.66 versus 0.71 g/cm2, p < .001) among those with LA intake greater than the median 12.1 g/day (p = .03 for interaction). No significant associations were found with total-hip BMD. During mean follow-up of 11.1 years, 505 hip fractures occurred. Fish or EPA + DHA consumption was not significantly associated with fracture incidence [hazard ratio (HR) for extreme categories: HR = 1.23, 95% confidence interval (CI) 0.83–1.84 for tuna/other fish; HR = 1.16, 95% CI 0.91–1.49 for fried fish; and HR = 0.98, 95% CI 0.71–1.36 for EPA + DHA]. High LA intake did not modify these associations. In this large prospective cohort of older adults, fish consumption was associated with very small differences in BMD and had no association with hip fracture risk. © 2010 American Society for Bone and Mineral Research.

Highlights

Polyunsaturated fatty acids (PUFAs) have an important role in the prevention of chronic diseases
Diets high in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the long-chain n-3 PUFA derived from seafood, have been shown to attenuate bone loss in ovariectomized animals compared with diets enriched in n-6 PUFAs.[5] the exact mechanisms are not known, n-6 and n-3 PUFAs have been proposed to have different effects on factors affecting bone formation and resorption, such as prostaglandins, calcium, and cytokines.[5,6] few studies have been published about the effects of fish or EPA þ DHA consumption on bone health in humans
Neither fish consumption nor estimated EPA þ DHA consumption was significantly associated with a lower incidence of hip fracture in this prospective, community-based study of older adults, a population with a potentially high risk for osteoporotic fractures

Summary

Introduction

Polyunsaturated fatty acids (PUFAs) have an important role in the prevention of chronic diseases. Imbalance between relative intakes of n-3 and n-6 PUFAs has been suggested to increase the risk of chronic diseases such as CVD and cancer,(3) but evidence from human studies is scarce.[4]. Diets high in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the long-chain n-3 PUFA derived from seafood, have been shown to attenuate bone loss in ovariectomized animals compared with diets enriched in n-6 PUFAs.[5] the exact mechanisms are not known, n-6 and n-3 PUFAs have been proposed to have different effects on factors affecting bone formation and resorption, such as prostaglandins, calcium, and cytokines.[5,6] few studies have been published about the effects of fish or EPA þ DHA consumption on bone health in humans.

Objectives

Methods

Results

Conclusion