Is the Effect of Mediterranean Diet on Hip Fracture Mediated through Type 2 Diabetes and Body Mass Index?
(2021) In International Journal of Epidemiology 50(1). p.234-244- Abstract
- Background
We examined whether the inverse association between adherence to a Mediterranean diet and hip fracture risk is mediated by incident type 2 diabetes mellitus (T2DM) and body mass index (BMI).
Methods
We included 50 755 men and women from the Cohort of Swedish Men and the Swedish Mammography Cohort who answered lifestyle and medical questionnaires in 1997 and 2008 (used for calculation of the Mediterranean diet score 9mMED; low, medium, high) and BMI in 1997, and incident T2DM in 1997–2008). The cumulative incidence of hip fracture from the National Patient Register (2009–14) was considered as outcome.
Results
We present conditional odds ratios (OR) 9[95% confidence interval, CI) of hip fracture for... (More) - Background
We examined whether the inverse association between adherence to a Mediterranean diet and hip fracture risk is mediated by incident type 2 diabetes mellitus (T2DM) and body mass index (BMI).
Methods
We included 50 755 men and women from the Cohort of Swedish Men and the Swedish Mammography Cohort who answered lifestyle and medical questionnaires in 1997 and 2008 (used for calculation of the Mediterranean diet score 9mMED; low, medium, high) and BMI in 1997, and incident T2DM in 1997–2008). The cumulative incidence of hip fracture from the National Patient Register (2009–14) was considered as outcome.
Results
We present conditional odds ratios (OR) 9[95% confidence interval, CI) of hip fracture for medium and high adherence to mMED, compared with low adherence. The total effect ORs were 0.82 (0.71, 0.95) and 0.75 (0.62, 0.91), respectively. The controlled direct effect of mMED on hip fracture (not mediated by T2DM, considering BMI as an exposure-induced confounder), calculated using inverse probability weighting of marginal structural models, rendered ORs of 0.82 (0.72, 0.95) and 0.73 (0.60, 0.88), respectively. The natural direct effect ORs (not mediated by BMI or T2DM, calculated using flexible mediation analysis) were 0.82 (0.71, 0.95) and 0.74(0.61, 0.89), respectively. The path-specific indirect and partial indirect natural effects ORs (through BMI or T2DM) were close to 1.
Conclusions
Mediterranean diet has a direct effect on hip fracture risk via pathways other than through T2DM and BMI. We cannot exclude mediating effects of T2DM or BMI, or that their effects cancel each other out. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/c5c2273c-641a-4e67-ab7e-badefe832375
- author
- Mitchell, Adam LU ; Fall, Tove ; Melhus, Håkan ; Wolk, Alicja ; Michaëlsson, Karl and Byberg, Liisa
- publishing date
- 2021-03
- type
- Contribution to journal
- publication status
- published
- in
- International Journal of Epidemiology
- volume
- 50
- issue
- 1
- pages
- 234 - 244
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85102657831
- ISSN
- 1464-3685
- DOI
- 10.1093/ije/dyaa239
- language
- English
- LU publication?
- no
- id
- c5c2273c-641a-4e67-ab7e-badefe832375
- date added to LUP
- 2025-02-07 11:27:41
- date last changed
- 2025-02-08 04:01:56
@article{c5c2273c-641a-4e67-ab7e-badefe832375,
abstract = {{Background<br/>We examined whether the inverse association between adherence to a Mediterranean diet and hip fracture risk is mediated by incident type 2 diabetes mellitus (T2DM) and body mass index (BMI).<br/><br/>Methods<br/>We included 50 755 men and women from the Cohort of Swedish Men and the Swedish Mammography Cohort who answered lifestyle and medical questionnaires in 1997 and 2008 (used for calculation of the Mediterranean diet score 9mMED; low, medium, high) and BMI in 1997, and incident T2DM in 1997–2008). The cumulative incidence of hip fracture from the National Patient Register (2009–14) was considered as outcome.<br/><br/>Results<br/>We present conditional odds ratios (OR) 9[95% confidence interval, CI) of hip fracture for medium and high adherence to mMED, compared with low adherence. The total effect ORs were 0.82 (0.71, 0.95) and 0.75 (0.62, 0.91), respectively. The controlled direct effect of mMED on hip fracture (not mediated by T2DM, considering BMI as an exposure-induced confounder), calculated using inverse probability weighting of marginal structural models, rendered ORs of 0.82 (0.72, 0.95) and 0.73 (0.60, 0.88), respectively. The natural direct effect ORs (not mediated by BMI or T2DM, calculated using flexible mediation analysis) were 0.82 (0.71, 0.95) and 0.74(0.61, 0.89), respectively. The path-specific indirect and partial indirect natural effects ORs (through BMI or T2DM) were close to 1.<br/><br/>Conclusions<br/>Mediterranean diet has a direct effect on hip fracture risk via pathways other than through T2DM and BMI. We cannot exclude mediating effects of T2DM or BMI, or that their effects cancel each other out.}},
author = {{Mitchell, Adam and Fall, Tove and Melhus, Håkan and Wolk, Alicja and Michaëlsson, Karl and Byberg, Liisa}},
issn = {{1464-3685}},
language = {{eng}},
number = {{1}},
pages = {{234--244}},
publisher = {{Oxford University Press}},
series = {{International Journal of Epidemiology}},
title = {{Is the Effect of Mediterranean Diet on Hip Fracture Mediated through Type 2 Diabetes and Body Mass Index?}},
url = {{http://dx.doi.org/10.1093/ije/dyaa239}},
doi = {{10.1093/ije/dyaa239}},
volume = {{50}},
year = {{2021}},
}