Diet, Cardiovascular Disease Risk Factors, and Bone Health in older Puerto Ricans.
Bhupathiraju, Shilpa.
2011
-
Abstract: Background:
Cardiovascular diseases (CVD) and osteoporosis are two major public health problems in
the aging population. Prior research has established an association between the two
conditions. However, it remains unclear how risk factors for CVD, as opposed to incident
CVD events, affect bone health. Puerto Rican adults living in Massachusetts have
documented health disparities ... read moreand have a disproportionate cardiometabolic risk burden
compared to other Hispanic subgroups, but little is known about bone health in this
population. It is therefore important to understand the association between CVD risk
factors and bone health in this high risk group. Objectives: The objectives of this
dissertation work were to (1) Investigate the association between ten-year risk of
coronary heart disease (CHD) and bone health; (2) Explore the association between
central fat mass and bone health; (3) Examine the association between C-reactive protein
(CRP), pro-inflammatory cytokines (interleukin-6 (IL-6) and tumor necrosis
factor-&alpha (TNF-&alpha)), and bone health; (4) Develop a diet and lifestyle
score based on the 2006 American Heart Association (AHA) Diet and Lifestyle
recommendations (AHA-DLR) and examine its association (i) with available CVD risk
factors, and (ii) bone health. Study Design: Participants (n=636, with variation by
objective based on data availability and exclusion criteria), aged 47-79 years, were
enrolled in the Boston Puerto Rican Osteoporosis study, an ancillary study to the Boston
Puerto Rican Health Study. Results: Among women, the ten-year Framingham CHD risk score
was inversely associated with bone mineral density (BMD) at the femoral neck (FN)
(P=0.03). Borderline associations were seen at the trochanter (TR) and total hip (TH)
(P>0.05). No associations were seen at the lumbar spine (LS). Central fat mass was
inversely associated with BMD (P<0.008) at all four bone sites, among women. Among
men, higher central fat mass was associated with lower BMD at all three hip sites
(P<0.02) but not at the LS. Postmenopausal women in the second tertile of
TNF-&alpha (2.4-4.1 pg/mL) and intermediate concentration (1-3 mg/L) of CRP,
compared to the lowest categories, had lower LS BMD (P<0.05). Women in the second
tertile of TNF-&alpha had lower FN BMD (P< 0.05). An inverse trend at the LS BMD
(P for trend=0.04) was observed across tertiles of IL-6 (pg/mL). Postmenopausal women
with multiple exposures to elevated inflammatory markers had a lower LS BMD (P for
trend=0.04). In Puerto Rican men and women, greater adherence to the AHA-DLR was
significantly associated with higher HDL cholesterol (P=0.001), lower waist
circumference (P<0.0001), ten-year risk of CHD (P=0.01 in women), insulin (P=0.0003),
glucose (P=0.01 in those with BMI<25), and CRP concentrations (P=0.02). Among men and
women, the AHA diet and lifestyle score was associated with higher BMD at the FN, TR,
and TH (P<0.05). No component of the AHA-DLR, alone, was responsible for the observed
positive associations. Conclusions: CVD risk factors are associated with poor bone
health in the Puerto Rican population. Importantly, guidelines intended for CVD risk
reduction were consistent with better bone health. This underscores the need to
synchronize guidelines for general chronic disease prevention that provide a simpler
public health message. The results of this dissertation provide foundational data
guiding further research and policy development. They suggest that interventions
yielding reductions in CVD risk factors may have significant impact on reducing both CVD
and osteoporosis.
Thesis (Ph.D.)--Tufts University, 2011.
Submitted to the Dept. of Nutritional Epidemiology.
Advisor: Katherine Tucker.
Committee: Alice Lichtenstein, Bess Dawson-Hughes, and Marian Hannan.
Keywords: Nutrition, Epidemiology, and Aging.read less - ID:
- n87103362
- Component ID:
- tufts:20264
- To Cite:
- TARC Citation Guide EndNote
