Adherence to a Mediterranean diet and risk of fractures in French older persons Authors

word count: 250 Text word count: 4,417 Number of tables: 5 Revised version OI-2013-01-0032, Féart et al. 2 Number of references: 44 Summary Prevention of fractures is a considerable public health challenge . In a population-based cohort of French elderly people, a diet closer to a Mediterranean-type had a borderline significant deleterious effect on the risk of fractures, in part linked to a low consumption of dairy product s and a high consumption of fruits. Revised version OI-2013-01-0032, Féart et al. 3 ABSTRACT 1 2 Purpose: Higher adherence to the Mediterranean diet (MeDi) is linked to a lower risk of several 3 chronic diseases, but its association with the risk of fractures is unclear. Our aim was to investigate the 4 association between MeDi adherence and the risk of fracture s in older persons. 5 Methods: The sample consisted of 1,482 individuals aged 67yrs +, from Bordeaux, France, included 6 in the Three-City Study in 2001-2002. Occurrences of hip, vertebral and wrist fractures were sel f7 reported every two years over 8 years and 155 incident fractures were recorded. Adherence to the 8 MeDi was evaluated at baseline by a MeDi score, on a10-point scale based on a food frequency 9 questionnaire and a 24h recall. Multivariate Cox regression were performed to estimate risk of 10 fractures according to MeDi adherence. 11 Results: Higher MeDi adherence was associated with a non-significant increased risk of fractures t 12 any site (HR per 1-point increase of MeDi score=1.10, P=0.08) in fully adjusted model. Among MeDi 13 components, high er fruits consumption (>2 servings/day) was significantly associated with an 14 increased risk of hip fractures (HR=1.95, P=0.04), while low intake of dairy products w as associated 15 with a doubled risk of wrist fractures (HR=2.03, P=0.007). An inverse U-shaped association betw een 16 alcohol intake and risk of total fracture was observed (HR high vs moderate=0.61, P for trend 0.03). 17 Conclusions: Greater MeDi adherence was not associated with a decreased risk of fractures in French 18 older persons. The widely recognized beneficial effects of the MeDi do not seem to apply to bone 19 health in these people. 20 Revised version OI-2013-01-0032, Féart et al. 4 TEXT 2