Carotenoid dietary intakes and plasma concentrations are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort - CORRIGENDUM.

1 Carotenoids are found in abundance in fruits and vegetables and may be involved in the 2 positive association of these foods with bone health. This study aimed to explore associations 3 of dietary carotenoid intakes and plasma concentrations with bone density status and 4 osteoporotic fracture risk in a European population. Cross-sectional analyses (n=14,803) of 5 bone density status, using calcaneal broadband ultrasound attenuation (BUA), and 6 longitudinal analyses (n=25,439) of fractures cases were conducted on data from the 7 prospective EPIC-Norfolk cohort of middle-aged and older men and women. Health and 8 lifestyle questionnaires were completed, and dietary nutrient intakes were derived from 7-day 9 food diaries. Multiple regression demonstrated significant positive trends in BUA for women 10 across quintiles of dietary alpha-carotene intake (p=0.029), beta-carotene intake (p=0.003), 11 beta-cryptoxanthin (p=0.031), combined lutein and zeaxanthin (p=0.010), and lycopene 12 (p=0.005). No significant trends across plasma carotenoid concentration quintiles were 13 apparent (n=4,570). Prentice-weighted Cox regression showed no trends in fracture risk 14 across dietary carotenoid intake quintiles (mean follow-up 12.5 years), except for lower risk 15 of wrist fracture for women with higher lutein and zeaxanthin intake (p=0.022); nevertheless, 16 inter-quintile differences in fracture risk were found for both sexes. Analysis of plasma 17 carotenoid data (mean follow-up 11.9 years) showed lower hip fracture risk in men across 18 higher plasma alpha-carotene (p=0.026) and beta-carotene (p=0.027) quintiles. This study 19 provides novel evidence that dietary carotenoid intake is relevant to bone health in men and 20 women, demonstrating that associations with bone density status and fracture risk exist for 21 dietary intake of specific carotenoids and their plasma concentrations. 22 23

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