Dairy Intake Is Protective against Bone Loss in Older Vitamin D Supplement Users: The Framingham Study.

Background: Previous studies showed beneficial effects of specific dairy foods on bone health in middle-aged adults.Objective: We examined the association of milk, yogurt, cheese, cream, fluid dairy (milk + yogurt), and milk + yogurt + cheese intakes with bone mineral density (BMD) and 4-y percentage of change in BMD [▵%BMD; femoral neck, trochanter, and lumbar spine (LS)]. We further assessed whether these associations were modified by vitamin D supplement use in this cohort of older adults.Methods: Food-frequency questionnaire responses, baseline BMD (hip and spine, n = 862 in 1988-1989), and follow-up BMD (n = 628 in 1992-1993) were measured in the Framingham study, a prospective cohort study of older Caucasian men and women aged 67-93 y. Outcomes included baseline BMD and ▵%BMD. Dairy-food intakes (servings per week) were converted to energy-adjusted residuals, and linear regression was used, adjusting for covariates. These associations were further examined by vitamin D supplement use.Results: The mean age of the participants was 75 y. In the full sample, dairy-food items were not associated with BMD (P = 0.11-0.99) or with ▵%BMD (P = 0.29-0.96). Among vitamin D supplement users, but not among nonusers, higher milk, fluid dairy, and milk + yogurt + cheese intakes were associated with higher LS BMD (P = 0.011-0.009). Among vitamin D supplement users, but not among nonusers, higher milk + yogurt + cheese intakes were protective against trochanter BMD loss (P = 0.009).Conclusions: In this population of older adults, higher intakes of milk, fluid dairy, and milk + yogurt + cheese were associated with higher LS BMD, and a higher intake of milk + yogurt + cheese was protective against trochanter BMD loss among vitamin D supplement users but not among nonusers. These findings underscore that the benefits of dairy intake on the skeleton may be dependent on vitamin D intake.

[1]  C. Barton,et al.  Vitamin D fortification in the United States and Canada: current status and data needs. , 2004, The American journal of clinical nutrition.

[2]  J. Souberbielle,et al.  Consumption of vitamin D-and calcium-fortified soft white cheese lowers the biochemical marker of bone resorption TRAP 5b in postmenopausal women at moderate risk of osteoporosis fracture. , 2012, The Journal of nutrition.

[3]  E. Rimm,et al.  Correlations of vitamin A and E intakes with the plasma concentrations of carotenoids and tocopherols among American men and women. , 1992, The Journal of nutrition.

[4]  Y. Manios,et al.  Skeletal site-dependent response of bone mineral density and quantitative ultrasound parameters following a 12-month dietary intervention using dairy products fortified with calcium and vitamin D: the Postmenopausal Health Study , 2006, British Journal of Nutrition.

[5]  B. Lanphear,et al.  Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. , 2003, The American journal of clinical nutrition.

[6]  David Felson,et al.  Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. , 2002, The American journal of clinical nutrition.

[7]  W Willett,et al.  Total energy intake: implications for epidemiologic analyses. , 1986, American journal of epidemiology.

[8]  G A Colditz,et al.  Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. , 1992, American journal of epidemiology.

[9]  Christine L. Taylor,et al.  Dietary Reference Intakes for Calcium and Vitamin D , 2016, Pediatric Clinical Practice Guidelines & Policies.

[10]  Nicholas Harvey,et al.  Osteoporosis: impact on health and economics , 2010, Nature Reviews Rheumatology.

[11]  R. Rizzoli Dairy products, yogurts, and bone health. , 2014, The American journal of clinical nutrition.

[12]  G. McCabe,et al.  Dairy intakes affect bone density in the elderly. , 2004, The American journal of clinical nutrition.

[13]  R. Heaney Calcium, Dairy Products and Osteoporosis , 2000, Journal of the American College of Nutrition.

[14]  R. Lyle,et al.  Previous milk consumption is associated with greater bone density in young women. , 1999, The American journal of clinical nutrition.

[15]  K. Khaw,et al.  Milk consumption and bone mineral density in middle aged and elderly women , 1994, BMJ.

[16]  D. Felson,et al.  Bone mineral density in elderly men and women: Results from the framingham osteoporosis study , 1992 .

[17]  D. Kiel,et al.  Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study , 2013, Archives of Osteoporosis.

[18]  S. Chan,et al.  The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia , 2003, Osteoporosis International.

[19]  A. Norman Intestinal calcium absorption: a vitamin D-hormone-mediated adaptive response. , 1990, The American journal of clinical nutrition.

[20]  Y. Fujita,et al.  Greater milk intake is associated with lower bone turnover, higher bone density, and higher bone microarchitecture index in a population of elderly Japanese men with relatively low dietary calcium intake: Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Study , 2015, Osteoporosis International.

[21]  D. Kiel,et al.  The effects of analytic software and scan analysis technique on the comparison of dual X‐ray absorptiometry with dual photon absorptiometry of the hip in the elderly , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[22]  I. Reid Effects of vitamin D supplements on bone density , 2014, Journal of Endocrinological Investigation.

[23]  G. McCabe,et al.  Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss. , 2005, The Journal of clinical endocrinology and metabolism.

[24]  B. Nordin,et al.  An open, crossover trial of calcium‐fortified milk in prevention of early postmenopausal bone los , 2001, The Medical journal of Australia.

[25]  D. Cocchi,et al.  Invited review: Dairy intake and bone health: a viewpoint from the state of the art. , 2011, Journal of dairy science.

[26]  F. Tylavsky,et al.  Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: a 2-y randomized trial. , 2005, The American journal of clinical nutrition.

[27]  E. Barrett-Connor,et al.  Lifetime milk consumption and bone mineral density in older women. , 1994, American journal of public health.

[28]  R. E. Johnson,et al.  Treatment of Vitamin D Insufficiency in Postmenopausal Women: A Randomized Clinical Trial. , 2015, JAMA internal medicine.

[29]  R. Lew,et al.  Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study. , 1990, The Journal of clinical endocrinology and metabolism.

[30]  R L Weinsier,et al.  Dairy foods and bone health: examination of the evidence. , 2000, The American journal of clinical nutrition.

[31]  Robert P. Heaney,et al.  Dairy Intake, Dietary Adequacy, and Lactose Intolerance12 , 2013, Advances in nutrition.

[32]  R. Heaney Vitamin D and calcium interactions: functional outcomes. , 2008, The American journal of clinical nutrition.

[33]  A. Prentice Dairy products in global public health. , 2014, The American journal of clinical nutrition.

[34]  S. Bass,et al.  The skeletal benefits of calcium- and vitamin D3-fortified milk are sustained in older men after withdrawal of supplementation: an 18-mo follow-up study. , 2008, The American journal of clinical nutrition.

[35]  S. McGuire,et al.  U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, January 2011. , 2011, Advances in nutrition.

[36]  E. Evans,et al.  A diet high in protein, dairy, and calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional high-carbohydrate diet in adults. , 2008, The Journal of nutrition.

[37]  R. Rizzoli,et al.  Dairy foods and osteoporosis: an example of assessing the health-economic impact of food products , 2012, Osteoporosis International.

[38]  C. Cooper,et al.  Effects of Dairy Products Consumption on Health: Benefits and Beliefs—A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases , 2015, Calcified Tissue International.

[39]  C. Gordon,et al.  The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations , 2016, Osteoporosis International.

[40]  W. Willett,et al.  Comparison of micronutrient intake measured by a dietary questionnaire and biochemical indicators of micronutrient status. , 1993, The American journal of clinical nutrition.

[41]  T. Dawber,et al.  Epidemiological approaches to heart disease: the Framingham Study. , 1951, American journal of public health and the nation's health.

[42]  G A Colditz,et al.  Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. , 1989, International journal of epidemiology.

[43]  L. Ragolia,et al.  Vitamin D supplementation increases calcium absorption without a threshold effect. , 2014, The American journal of clinical nutrition.

[44]  T. Marshall,et al.  Dietary Guidelines for Americans, 2010: an update. , 2011, Journal of the American Dental Association.

[45]  K. Zhu,et al.  Dairy Food Intake, Peripheral Bone Structure, and Muscle Mass in Elderly Ambulatory Women , 2014, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.