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Mediterranean dietary pattern and bone mineral density: a systematic review and dose-response meta-analysis of observational studies

European Journal of Clinical Nutrition volume 76, pages 1657–1664 (2022)Cite this article

Subjects

Abstract

Background

We aimed to systematically review the literature and test the dose-response relationship between adherence to the Mediterranean diet (MedDiet) and values of bone mineral density (BMD) in adults.

Methods

Relevant observational studies were selected through searching PubMed, Scopus, and Web of Science databases up to March 4, 2021. A random-effects dose-response meta-analysis was performed to estimate the change in total and regional-specific BMD for a 2-point increment in the score of adherence to the MedDiet, and to clarify the shape of these associations.

Results

Seven cross-sectional and one cohort studies with a total number of 13,209 participants were included in the final analyses. Each 2-point increment in the score of adherence to the MedDiet was associated with 0.009 (95% CI: 0.002, 0.016; I2 = 34%, n = 7), 0.006 (95% CI: 0.001, 0.012; I2 = 34%, n = 7), 0.005 (95% CI: 0.003, 0.007; I2 = 1%, n = 4), 0.005 (95% CI: 0.002, 0.008; I2 = 0%, n = 3), and 0.007 (95% CI: 0.005, 0.009; I2 = 0%, n = 4) gr/cm2 higher BMD of lumbar spine, femoral neck, hip, trochanter, and whole body, respectively. There was a positive linear relationship between the MedDiet adherence score and BMD of hip and trochanter. A nonlinear relationship was seen for lumbar spine, femoral neck, and whole body, with sharper increase in the BMD at lower MedDiet scores. The associations remained significant after controlling for important confounders including body weight, physical activity, smoking status, and energy intake.

Conclusion

Greater adherence to the MedDiet was associated with a small but important increase in BMD at the lumbar spine, femoral neck, hip, trochanter, and whole body. Adopting a Mediterranean-style eating pattern may have modest beneficial effects on bone health.

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Fig. 1
Fig. 2: Dose-response association of adherence to the Mediterranean diet and bone mineral density of lumbar, femoral neck, and whole body.
Fig. 3: Dose-response association of adherence to the Mediterranean diet and bone mineral density of hip and trochanter.

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Data availability

Data supporting findings from this study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Maryam Noori

  2. Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

    Ahmad Jayedi

  3. Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Ahmad Jayedi & Sakineh Shab-Bidar

  4. Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON, Canada

    Tauseef Ahmad Khan

  5. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Tauseef Ahmad Khan

  6. Halal Research Center of IRI, FDA, Tehran, Iran

    Sajjad Moradi

  7. Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Sajjad Moradi

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Contributions

AJ and SSB conceived and designed the study; MN and AJ conducted systematic search, screen articles, and extracted data; AJ and TAK performed the analyses; MN, AJ, and SM write the first draft of the manuscript; SSB and TAK critically revised the manuscript. SSB in the guarantor.

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Correspondence to Sakineh Shab-Bidar.

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Noori, M., Jayedi, A., Khan, T.A. et al. Mediterranean dietary pattern and bone mineral density: a systematic review and dose-response meta-analysis of observational studies. Eur J Clin Nutr 76, 1657–1664 (2022). https://doi.org/10.1038/s41430-022-01093-7

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