Dietary fatty acids and incident hip fractures in cohorts of women and men. A relative validation and follow-up study

Objectives: Hip fractures are associated with a high burden of morbidity and mortality. Diet is
essential for preventing fragility fractures, but the role of dietary fatty acids on the risk of hip
fracture is uncertain. The aim was to investigate how intake of different dietary fatty acids
relates to the risk of hip fracture. A relative validation of the long-term intake of dietary fatty
acids estimated from food frequency questionnaires (FFQs) was also performed. Design,
settings and participants: We used data collected in two population-based cohorts, the Swedish
Mammography Cohort and the Cohort of Swedish men (n = 83,603, 54% men, aged 45-82
years). Data from the repeated investigations in the cohorts and cross-sectional data from their
clinical sub-cohorts were used. Measurements: Diet data was collected in FFQs. Incident hip
fractures were gathered by individual linkage to national registers. We performed Cox
regression analysis to investigate associations between dietary fatty acids and hip fracture.
Follow-up time was between January 1st, 1998 and December 31st, 2020. The validation was
performed using correlation analyses, comparing fatty acids measured in adipose tissue with
estimated fatty acid intakes from FFQs. Results: During up to 23 years of follow-up (mean 18
years) and 1,538,627 person-years at risk, 7345 participants (2840 men) experienced a hip
fracture. A low linoleic acid (LA) and high intakes of long-chain n-3 fatty acids were associated
with higher hip fracture risk in a non-linear way. In quartile 4 compared to quartile 1 of LA, the
multivariable-adjusted hazard ratio of hip fracture was 0.89 (95% Confidence Interval: 0.81,
0.97). The study confirmed the validity of FFQs to capture the intake of the specific dietary long-
chain n-3 fatty acids. The estimated intake of LA, α-linolenic acid, and myristic acid were also
adequately captured by the FFQs. Validity was confirmed in both women and men.
Conclusion: A low to moderate intake of linoleic acid and a higher intake of long-chain n-3 fatty
acids were associated with a higher risk of hip fractures. The results indicate that attention
should be paid to dietary fatty acid composition for the optimal prevention of fragility fractures.