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Reply to JB Lavine

Department of Nutrition and Food Sciences Utah State University Logan, UT 84322-8700 E-mail: bihmi{at}interasia.com.ph

Dear Sir:

We agree with Lavine that dietary intake of carbohydrate and other nutrients may be involved in osteoporosis. We emphasized the possible role of protein intake in our report (1) because it was the nutrient with the strongest dose-response relation to risk of hip fracture and because a good deal of other evidence has accumulated suggesting that protein intake is important in bone health.

In our report we stated that "analyses based on single nutrients derived from dietary questionnaires must be interpreted with caution because of the collinearity of nutrient intakes." The relation between carbohydrate and protein intakes is a good example of this problem. In our study, intake of animal protein was negatively correlated with carbohydrate intake (r = -0.56 , P < 0.0001). Carbohydrate intake was positively associated with risk of hip fracture, but this finding was diminished in multivariate analyses with nonnutrient variables and fell below the threshold of statistical significance. Because of our relatively small number of hip fracture cases and the collinearity of protein and carbohydrate intakes, multivariate models with simultaneous inclusion of these 2 nutrient variables were not interpretable. A clearer picture may emerge in subsequent analyses with larger sample sizes. A better understanding of the possible role of carbohydrate intake in the risk of osteoporotic fractures is important because of current dietary trends in which fat and protein are replaced with carbohydrates.

REFERENCES

1. Munger RG, Cerhan JR, Chiu BC-H. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr 1999;69:147–52.[Abstract/Free Full Text]

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