lifetime veganism: osteoporosis and vertebral fracture 1 thuc lan ho-pham, 2 nguyen nd, 3 thu a. le,...
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Lifetime Veganism: Osteoporosis and Vertebral fracture
1Thuc Lan Ho-Pham, 2Nguyen ND ,3Thu A. Le, 2Tuan V. Nguyen
*Coauthors:, 1Vu BQ, 3Pham NH, 1Nguyen LP, 1Le TT, 1Doan AT, and 1Tran N.1Pham Ngoc Thach College of Medicine,Ho Chi Minh City, Vietnam, 2Garvan Institute of Medical Research, Sydney, Australia; 3Cho Ray Hospital, Ho Chi Minh City, Vietnam.
OSTEOPOROSIS AND FRACTURE
OSTEOPOROSIS: High prevalence
• 20% postmenopausal women1
• 10% men ( > 50 year-old)1
• Vietnam : 23% postmenopausal women2
OSTEOPOROTIC FRACTURE : High lifetime risk3
• Any fracture 50%
• Hip fracture 17%
• Vertebral fracture 25%
1 Nguyen DN, Nguyen TV. Osteoporosis 3rd edition
2 Nguyen.T.T.Huong, Nguyen TV. New Zealand Bone Miner Soci 2006
3 Nguyen DN, et al. J Bone Miner Res 2007
ROLE OF DIET IN OSTEOPOROSIS PREVENTION
• Prevention is preferable to treatment
• Diet and nutrition are important components in osteoporosis prevention
VEGETARIAN AND OMNIVORE DIETS
Semi/demi vegetarian
Lacto-ovo vegetarian
Lacto vegetarian
Vegan (Asian veg)
VEGANISM AND BONE HEALTH
• Whether lifelong vegetarian diet has any negative effect on bone health, a contentious issue1,2.
• Lack of information about prevalence of osteoporosis and vertebral fracture in postmenopausal Vietnamese women.
1 EMC Lau, et al. JC Nutrition 1998
2 Fontana L, et al. Arch In Med 2005
AIMS
• Examine the association between lifelong vegetarian diet and osteoporosis.
• Estimate the prevalence and risk factors of vertebral fracture in postmenopausal Vietnamese women.
METHODS AND STUDY DESIGN
A cross-sectional study
Vegetarian (Buddhist nuns)
n=105
Omnivoresn=105
• 50+ years old
• From 15 monasteries in Ho Chi Minh City
• Random sample
• 50+ years old
• From various districts in Ho Chi Minh City
• Random sample
OUTCOME MEASUREMENTS
BMD measurement (Hologic QDR 4500).
Lumbar spine
Femoral neck
Total body (eg lean mass and fat mass)
Vertebral fracture (X-ray, Genant’s semi-quantitative method).
COVARIATES
• Anthropometric measurements.
• Daily dietary energy and nutrient intakes (24h recall questionnaire).
• Lifestyle factors.
• Comorbidity (CVD, diabetes, osteoarthritis, etc).
• A history of fall (past 3 months)
• Prior fracture (after the age of 50).
Characteristics of participants by dietVegetarians Omnivores P-value
(n=105) (n=105)
Age (y) 62 (10) 62 (10) 0.95
Weight (kg) 53 (9) 54 (7) 0.59
Height (cm) 148 (6) 149 (6) 0.15
BMI (kg/m2) 24 (4) 24 (3) 0.78
Total body fat (kg) 19 (5) 19 (5) 0.77
Total body lean (kg) 32 (5) 33 (4) 0.47
Highest education (n,%) 0.007
≤ Primary 27 (25.7) 28 (26.7)
Secondary 66 (62.9) 48 (45.2)
Tertiary 12 (11.4) 29 (27.6)
Morning exercise (n,%) 82 (78.1) 81 (77.1) 0.86
Coffee drinking (n,%) 28 (26. 7) 48 (45.2) 0.004
Major comorbidity (n,%) 47 (44.8) 52 (49.5) 0.49
Values are mean (SD), unless otherwise specified.
Daily dietary energy and nutrient intakes
Non-vegan Vegan
500
1500
2500
3500
(Kca
l/day
)
(P<0.0001)
Non-vegan Vegan
010
0020
00
(Gra
ms/
day)
(P<0.0001)
Non-vegan Vegan
020
4060
80
(Gra
ms/
day)
(P<0.0001)
Non-vegan Vegan
1030
5070
(Gra
ms/
day)
(P<0.1112)
Non-vegan Vegan
010
2030
4050
(Gra
ms/
day)
(P<0.0001)
Non-vegan Vegan
020
4060
(Gra
ms/
day)
(P<0.2262)
Energy intake Calcium
Animal source protein Vegetable source protein
Vegetable source lipidAnimal source lipid
Whole body Femoral neck Lumbar spine
Vegetarians (n=105)Omnivores (n=105)
Bon
e m
iner
al d
ensi
ty (
g/cm
2 )
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Bone mineral density in vegetarians and omnivores
Values are mean and 95% CI
Prevalence of osteoporosis (T-scores < -2.5) by diet
18.1%
No significant difference in prevalence of osteoporosis between lifetime vegans and non-vegans
Vegans Omnivores
15.2%
Osteoporosis: BMD T-scores ≤-2.5 at the femoral neck
Unit of ↑SD of BMD R-square
change (95% CI)
Femoral neck 0.36
Age (y) +10 -0.5 (0.4, 0.6)
Lean mass (kg) +4 0.3 (0.2, 0.4)
Lumbar spine 0.36
Age (y) +10 -0.5 (0.4, 0.7)
Weight (kg) +8 0.3 (0.1, 0.4)
Animal source protein (g/d) +20 0.2 (0.0, 0.3)
Association between factors and BMD (multivariable analysis)
Bayesian averaging method (BMA) was used to select the best fit model for FNBMD and LSBMD. All potential explainable factors were included in selecting independent factor process.
Prevalence of vertebral fracture
n % (95% CI)
Any vertebral fracture 48/209 23.0 (17.3, 28.7)
By age group:
50-59 18/106 17.0 (9.8, 24.1)
60-69 10/53 18.9 (8.3, 29.4)
70+ 20/50 40.0 (26.4, 53.6)
By diet:
Buddhist vegetarians 23/104 22.1 (14.1, 30.1)
Non-vegetarians 25/105 23.8 (15.7, 32.0)
Risk factors for vertebral fracture (bivariate analysis)
Factor Unit change OR (95% CI)
Age (y) +10 1.6 (1.1, 2.2)
Weight (kg) +8 1.1 (0.8, 1.6)
BMI (kg/m2) +3 1.3 (0.9, 1.7)
FNBMD (g/cm2) -0.11 1.3 (0.9, 1.8)
LSBMD (g/cm2) -0.14 1.7 (1.2, 2.5)
Prior fracture yes 1.9 (1.0, 3.8)
Back pain yes 1.2 (0.6, 2.4)
Calcium intake (g/d) -370 1.2 (0.9, 1.6)
Vegan yes 0.9 (0.5, 1.7)
There was no significant association between vertebral fracture and other factors
Risk factors for vertebral fracture (multivariable logistic regression analysis)
Factor Unit changeOdds ratio (95% CI)
Age (y) +10 1.2 (1.0, 1.8)
LSBMD (g/cm2) -0.14 1.5 (1.0, 2.2)
Prior fracture yes 1.5 (0.7, 3.1)LSBMD, lumbar spine bone mineral density
Veganism: osteoporosis and vertebral fracture
• Vegetarians:
– much lower dietary energy, protein and calcium intakes than omnivores.
– no adverse effect on bone health, in terms of osteoporosis and vertebral fracture risk.
Osteoporosis and vertebral fracture in postmenopausal Vietnamese women
• Prevalence of vertebral fracture in postmenopausal Vietnamese women was as common as in Caucasian women.
Acknowledgements
I express special thanks to Pro.Nguyen van Tuan for his excellent support this study.
I express deep appreciation to Dr Nguyen Dinh Nguyen and Miss Ha Hai Chau for their kind helping me.
Thanks also to my students for their meticulous assistance.
Prevalence of osteoporosis
Prese
nt st
udy
Nguye
n H, 2
007
Thai
Indo
nesia
n
Chines
e
Japa
nese
Korea
n
Austra
lian
Oste
oporo
sis
at
the f
em
ora
l neck (
%)
0
5
10
15
20
25
30
35
1723
30
1510
1710
21
Daily dietary energy and nutrient intakes
Non-vegan Vegan
500
1500
2500
3500
(Kca
l)
Daily energy intake (P<0.0001)
Non-vegan Vegan
050
015
0025
00
(Gra
ms/
day)
Calcium (P<0.0001)
Non-vegan Vegan
020
4060
80
(Gra
ms/
day)
Animal source protein (P<0.0001)
Non-vegan Vegan0
2040
60
(Gra
ms/
day)
Vegetable source protein (P<0.1112)
Non-vegan Vegan
010
2030
4050
(Gra
ms/
day)
Animal source lipid (P<0.0001)
Non-vegan Vegan
020
4060
(Gra
ms/
day)
Vegetable source lipid (P<0.2262)
Association between factors and BMD (univariate analysis)
Variables Unit of ↑ FN BMD ↑ LS BMD
change (SD, 95% CI) (SD, 95% CI)
Age (y) -10 0.5 (0.4, 0.7) 0.5 (0.4, 0.7)
Weight (kg) +8 0.4 (0.2, 0.5) 0.3 (0.2, 0.5)
Height (cm) +6 0.3 (0.2, 0.4) 0.4 (0.2, 0.4)
BMI (kg/m2) +3 0.3 (0.1, 0.4) 0.2 (0.1, 0.4)
Fat mass (kg) +5 0.2 (0.1, 0.3) 0.2 (0.1, 0.3)
Lean mass (kg) +4 0.4 (0.2, 0.5) 0.3 (0.2, 0.5)
Daily dietary intake
Energy (Kcal) +450 0.1 (0.0, 0.2) 0.1 (0.0, 0.3)
Animal source Pr (g) +20 0.0 (-0.1, 0.2) 0.2 (0.0, 0.3)
Vegetable source Pr (g) +12 0.1 (-0.1, 0.2) 0.0 (-0.1, 0.2)
Calcium (g) +370 0.1 (0.0, 0.2) 0.0 (-0.1, 0.2)
Veganism Yes -0.2 (-0.5, 0.1) -0.2 (-0.5, 0.1)
FN, femoral neck; LS, lumbar spine; BMD, bone mineral density
Characteristics of participants by fractureVertebral fracture Non-vertebral fracture P-value
(n=48) (n=161)
Age (y) 65 (11) 61 (9) 0.0065
Weight (kg) 54 (8) 53 (8) 0.4577
Height (cm) 148 (6) 149 (6) 0.2929
BMI (kg/m2) 25 (4) 24 (3) 0.161
Total body fat (kg) 19 (5) 19 (5) 0.4387
Total body lean (kg) 33 (4) 32 (4) 0.3391
FNBMD (g/cm2) 0.61 (0.13) 0.64 (0.11) 0.115
LSBMD (g/cm2) 0.70 (0.14) 0.78 (0.14) 0.0016
Daily dietary intake:
Energy (Cal)* 1320 (1007, 1538) 1266 (1051, 1547) 0.7566
Animal source protein (g)* 24 (9, 33) 31 (18, 41) 0.0955
Non-animal protein (g)* 29 (22, 35) 26 (22, 35) 0.6058
Calcium (g)* 432 (310, 645) 422 (267, 641) 0.4263
Values are mean(SD), unless otherwise specified* Median (Q1,Q3)
Vertebral fracture Non-vertebral fracture P-value
(n=48) (n=161)
Education: 0.3579
≤ Primary 14 (29.2) 41 (25.6)
Secondary 28 (58.3) 84 (52.5)
Tertiary 6 (12.5) 35 (21.9)
Morning exercise 37 (77.1) 125 (78.1) 0.8788
Hypertension 17 (35.4) 43 (26.9) 0.2519
CVD 1 (2.1) 6 (3.8) 1.000
Diabetes 3 (6.3) 11 (6.9) 0.8795
Arthritis 9 (18.8) 29 (18.1) 0.9217
Back pain 26 (54.2) 73 (45.6) 0.2987
Prior fracture 15 (31.3) 31 (19.3) 0.0790
A history of fall 4 (8.3) 17 (10.7) 0.6439
Characteristics of participants by fracture (cont.)
Values are n (%)