Increased intake of vegetables, herbs and fruit : effects on bone in postmenopausal women : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, Massey University, Manawatu, New Zealand

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Dietary approaches to address bone loss at midlife usually involve supplementation or fortification. We aimed to investigate a food based approach to reduce bone turnover in post-menopausal (PM) women in two studies. In the first study, we investigated whether daily inclusion of specific vegetables attributed with bone resorbing inhibiting properties was feasible. We hypothesised increased intake of fruit/vegetables to ≥9 servings/day would lower potential renal acid load (PRAL) significantly (~20mEq/day) and increase urine pH (0.5 pH units) sufficiently to affect bone markers. The results of the first study confirmed the feasibility of daily inclusion of specific vegetables, reduction in renal acid load and increased urine pH. The subsequent Scarborough Fair Study (SF) used a randomised, active comparator design to increase specific vegetable/herb/fruit intake in two groups (A and B) of 50 PM women, from ≤ 5 servings/day to ≥ 9 servings/day for 3 months while a control group consumed their usual diet (n=43). Primary outcome variables were plasma bone markers which were assessed at baseline, six weeks and twelve weeks. Secondary outcome variables were plasma inflammation markers including adiponectin, urinary electrolytes (calcium, magnesium, potassium and sodium) and dietary intake assessed at baseline and 12 weeks and urinary pH assessed twice weekly. Increased intake of vegetables/herbs/fruit reduced P1NP and CTX (osteopenia) in Group B (SF) and urinary calcium loss in both intervention groups A and B (SF) with reduced PRAL. Adiponectin, tumour necrosis factor, interleukin 6 and 10 reduced in all groups. This study showed the SF vegetables/herbs/fruit may influence bone turnover and inflammatory markers. Few human intervention studies demonstrate reduction in plasma bone resorption markers with diet. Even fewer studies demonstrate reduction without supplementation with calcium, vitamin D, alkaline substrates, concentrated extracts or consumption of large quantities of a single functional food. The SF vegetables/herbs/fruit may protect against high bone turnover and subsequent bone loss in women with osteopenia and may have possibilities as an adjuvant to pharmaceutical therapies or a holistic dietary approach to reduce bone turnover and bone loss. Trial registration ACTRN 12611000763943
Osteoporosis in women, Bone density, Bone loss, Nutrition, Vegetables in human nutrition, Fruit in human nutrition, Vegetable intake, Fruit intake, Vegetable intake, Fruit intake, Post-menopausal women, Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Domestic science and nutrition