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Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study.
Am J Clin Nutr 2014; 99(4):934-40AJ

Abstract

BACKGROUND

The effects of dietary protein on bone health are controversial.

OBJECTIVE

We examined the relation between protein intake with fracture and bone mineral density (BMD) within the Women's Health Initiative (WHI).

DESIGN

This prospective analysis included 144,580 women aged 50-79 y at baseline in the WHI clinical trials (CTs) and observational study (OS) that recruited participants in 1993-1998 with follow-up through 2011. Self-reported clinical fractures were collected semiannually through the original end of the trials (WHI CTs) and annually (WHI OS) by questionnaires. Hip fracture was adjudicated by a central review of radiology reports. BMDs for total body, hip, and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry. Protein intake was assessed via food-frequency questionnaire and calibrated by using biomarkers of energy and protein intakes. Associations between protein intake and fracture were estimated by using Cox proportional hazards regression, and the relation between protein intake and BMD was estimated by using linear regression.

RESULTS

Median biomarker-calibrated protein intake was 15% of energy intake. Per 20% increase in calibrated protein intake (percentage of energy), there was no significant association with total fracture (HR: 0.99; 95% CI: 0.97, 1.02) or hip fracture (HR: 0.91; 95% CI: 0.84, 1.00), but there was an inverse association with forearm fracture (HR: 0.93; 95% CI: 0.88, 0.98). Each 20% increase in calibrated protein intake was associated with a significantly higher BMD for total body (mean 3-y change: 0.003 g/cm²; 95% CI: 0.001, 0.005 g/cm²) and hip (mean 3-y change: 0.002 g/cm²; 95% CI: 0.001, 0.004 g/cm²).

CONCLUSIONS

Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs. These data suggest higher protein intake is not detrimental to bone health in postmenopausal women.

Authors+Show Affiliations

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (JMB); the Fred Hutchinson Cancer Research Center, Seattle, WA (AZL, JCL, YH, MLN, LFT, and RLP); the Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, OH (RJ); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa (LS); the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (KCJ); and the Department of Family Medicine and Epidemiology, Memorial Hospital of Rhode Island Center for Primary Care and Prevention, Pawtucket, RI (CBE).

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24552750

Citation

Beasley, Jeannette M., et al. "Biomarker-calibrated Protein Intake and Bone Health in the Women's Health Initiative Clinical Trials and Observational Study." The American Journal of Clinical Nutrition, vol. 99, no. 4, 2014, pp. 934-40.
Beasley JM, LaCroix AZ, Larson JC, et al. Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study. Am J Clin Nutr. 2014;99(4):934-40.
Beasley, J. M., LaCroix, A. Z., Larson, J. C., Huang, Y., Neuhouser, M. L., Tinker, L. F., ... Prentice, R. L. (2014). Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study. The American Journal of Clinical Nutrition, 99(4), pp. 934-40. doi:10.3945/ajcn.113.076786.
Beasley JM, et al. Biomarker-calibrated Protein Intake and Bone Health in the Women's Health Initiative Clinical Trials and Observational Study. Am J Clin Nutr. 2014;99(4):934-40. PubMed PMID: 24552750.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study. AU - Beasley,Jeannette M, AU - LaCroix,Andrea Z, AU - Larson,Joseph C, AU - Huang,Ying, AU - Neuhouser,Marian L, AU - Tinker,Lesley F, AU - Jackson,Rebecca, AU - Snetselaar,Linda, AU - Johnson,Karen C, AU - Eaton,Charles B, AU - Prentice,Ross L, Y1 - 2014/02/19/ PY - 2014/2/21/entrez PY - 2014/2/21/pubmed PY - 2014/5/23/medline SP - 934 EP - 40 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 99 IS - 4 N2 - BACKGROUND: The effects of dietary protein on bone health are controversial. OBJECTIVE: We examined the relation between protein intake with fracture and bone mineral density (BMD) within the Women's Health Initiative (WHI). DESIGN: This prospective analysis included 144,580 women aged 50-79 y at baseline in the WHI clinical trials (CTs) and observational study (OS) that recruited participants in 1993-1998 with follow-up through 2011. Self-reported clinical fractures were collected semiannually through the original end of the trials (WHI CTs) and annually (WHI OS) by questionnaires. Hip fracture was adjudicated by a central review of radiology reports. BMDs for total body, hip, and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry. Protein intake was assessed via food-frequency questionnaire and calibrated by using biomarkers of energy and protein intakes. Associations between protein intake and fracture were estimated by using Cox proportional hazards regression, and the relation between protein intake and BMD was estimated by using linear regression. RESULTS: Median biomarker-calibrated protein intake was 15% of energy intake. Per 20% increase in calibrated protein intake (percentage of energy), there was no significant association with total fracture (HR: 0.99; 95% CI: 0.97, 1.02) or hip fracture (HR: 0.91; 95% CI: 0.84, 1.00), but there was an inverse association with forearm fracture (HR: 0.93; 95% CI: 0.88, 0.98). Each 20% increase in calibrated protein intake was associated with a significantly higher BMD for total body (mean 3-y change: 0.003 g/cm²; 95% CI: 0.001, 0.005 g/cm²) and hip (mean 3-y change: 0.002 g/cm²; 95% CI: 0.001, 0.004 g/cm²). CONCLUSIONS: Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs. These data suggest higher protein intake is not detrimental to bone health in postmenopausal women. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/24552750/Biomarker_calibrated_protein_intake_and_bone_health_in_the_Women's_Health_Initiative_clinical_trials_and_observational_study_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.113.076786 DB - PRIME DP - Unbound Medicine ER -