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Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort.
Am J Clin Nutr 2015; 102(6):1416-24AJ

Abstract

BACKGROUND

Vitamin C sufficiency may help prevent osteoporosis and fractures by mediating osteoclastogenesis, osteoblastogenesis, and bone collagen synthesis.

OBJECTIVE

We determined whether dietary intakes and plasma concentrations of vitamin C were associated with a heel ultrasound and hip and spine fracture risks in older men and women.

DESIGN

Participants were recruited from the European Prospective Investigation into Cancer in Norfolk study with 7-d diet diary estimates of vitamin C intake and plasma concentrations. A random subset (4000 of 25,639 subjects) was available for the cross-sectional (ultrasound) study of broadband ultrasound attenuation (BUA) and velocity of sound (VOS), which were determined during the second health examination. The prospective (fracture) study was a case-cohort sample of all participants with a fracture up to March 2009 and the random subset (n = 5319). ANCOVA-determined associations between quintiles of vitamin C intake and plasma status with adjusted BUA and VOS and adjusted Prentice-weighted Cox proportional HRs were calculated for fracture risk.

RESULTS

Women were 58% of the population (39-79 y old), and the median follow-up was 12.6 y (range: 0-16 y). Positive associations across all quintiles of vitamin C intake but not plasma status were significant for VOS in men (β = 2.47 m/s, P = 0.008) and BUA in women (β = 0.82 dB/MHz, P = 0.004). Vitamin C intake was not associated with fracture risk, but there was an inverse association with plasma concentrations in men, with quintile 4 having significantly lower risks of hip fractures (HR: 0.35; 95% CI: 0.16, 0.80) and spine fractures (HR: 0.26; 95% CI: 0.10, 0.69) than quintile 1.

CONCLUSIONS

Higher vitamin C intake was significantly associated with higher heel ultrasound measures in men and women, and higher plasma vitamin C concentrations were significantly associated with reduced fracture risk in men only. Our findings that vitamin C intake and status were inconsistently associated with bone health variables suggest that additional research is warranted.

Authors+Show Affiliations

Departments of Population Health and Primary Care.Medicine, and.Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom.Nutrition, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom; and.Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom.Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom.Departments of Population Health and Primary Care, a.welch@uea.ac.uk.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26537939

Citation

Finck, Henriette, et al. "Cross-sectional and Prospective Associations Between Dietary and Plasma Vitamin C, Heel Bone Ultrasound, and Fracture Risk in Men and Women in the European Prospective Investigation Into Cancer in Norfolk Cohort." The American Journal of Clinical Nutrition, vol. 102, no. 6, 2015, pp. 1416-24.
Finck H, Hart AR, Lentjes MA, et al. Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort. Am J Clin Nutr. 2015;102(6):1416-24.
Finck, H., Hart, A. R., Lentjes, M. A., Jennings, A., Luben, R. N., Khaw, K. T., & Welch, A. A. (2015). Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort. The American Journal of Clinical Nutrition, 102(6), pp. 1416-24. doi:10.3945/ajcn.115.111971.
Finck H, et al. Cross-sectional and Prospective Associations Between Dietary and Plasma Vitamin C, Heel Bone Ultrasound, and Fracture Risk in Men and Women in the European Prospective Investigation Into Cancer in Norfolk Cohort. Am J Clin Nutr. 2015;102(6):1416-24. PubMed PMID: 26537939.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort. AU - Finck,Henriette, AU - Hart,Andrew R, AU - Lentjes,Marleen A H, AU - Jennings,Amy, AU - Luben,Robert N, AU - Khaw,Kay-Tee, AU - Welch,Ailsa A, Y1 - 2015/11/04/ PY - 2015/03/28/received PY - 2015/09/23/accepted PY - 2015/11/6/entrez PY - 2015/11/6/pubmed PY - 2016/4/14/medline KW - ascorbic acid KW - collagen KW - fracture risk KW - osteoporosis KW - vitamin C SP - 1416 EP - 24 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 102 IS - 6 N2 - BACKGROUND: Vitamin C sufficiency may help prevent osteoporosis and fractures by mediating osteoclastogenesis, osteoblastogenesis, and bone collagen synthesis. OBJECTIVE: We determined whether dietary intakes and plasma concentrations of vitamin C were associated with a heel ultrasound and hip and spine fracture risks in older men and women. DESIGN: Participants were recruited from the European Prospective Investigation into Cancer in Norfolk study with 7-d diet diary estimates of vitamin C intake and plasma concentrations. A random subset (4000 of 25,639 subjects) was available for the cross-sectional (ultrasound) study of broadband ultrasound attenuation (BUA) and velocity of sound (VOS), which were determined during the second health examination. The prospective (fracture) study was a case-cohort sample of all participants with a fracture up to March 2009 and the random subset (n = 5319). ANCOVA-determined associations between quintiles of vitamin C intake and plasma status with adjusted BUA and VOS and adjusted Prentice-weighted Cox proportional HRs were calculated for fracture risk. RESULTS: Women were 58% of the population (39-79 y old), and the median follow-up was 12.6 y (range: 0-16 y). Positive associations across all quintiles of vitamin C intake but not plasma status were significant for VOS in men (β = 2.47 m/s, P = 0.008) and BUA in women (β = 0.82 dB/MHz, P = 0.004). Vitamin C intake was not associated with fracture risk, but there was an inverse association with plasma concentrations in men, with quintile 4 having significantly lower risks of hip fractures (HR: 0.35; 95% CI: 0.16, 0.80) and spine fractures (HR: 0.26; 95% CI: 0.10, 0.69) than quintile 1. CONCLUSIONS: Higher vitamin C intake was significantly associated with higher heel ultrasound measures in men and women, and higher plasma vitamin C concentrations were significantly associated with reduced fracture risk in men only. Our findings that vitamin C intake and status were inconsistently associated with bone health variables suggest that additional research is warranted. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/26537939/Cross_sectional_and_prospective_associations_between_dietary_and_plasma_vitamin_C_heel_bone_ultrasound_and_fracture_risk_in_men_and_women_in_the_European_Prospective_Investigation_into_Cancer_in_Norfolk_cohort_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.115.111971 DB - PRIME DP - Unbound Medicine ER -