Effect of Mediterranean diet adherence on all-cause and cause-specific mortality of vertebral compression fractures: results from the NHANES database cohort study

Abstract Background: Vertebral compression fractures (VCFs) is a common fragility fracture with high mortality worldwide. The management and prevention of VCFs start with a proper nutrition. The Mediterranean diet (MD) is rich in balanced nutrients and has been shown to be beneficial for several chronic diseases. However, the association of adherence to Mediterranean diet (aMED) and outcome of VCFs patients remains unclear. This study aims to explore the association between adherence to Mediterranean diet (aMED) and all-cause and Cardiovascular diseases-cause (CVD-cause) mortality in VCFs patients. Methods: In present study, patients aged ≥40 years old and with the VCFs measurement were extracted from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) was used to diagnose VCFs. The weighted univariable and multivariable COX proportional hazards regression models were utilized to explore the moderating effect of aMED and the risk of mortality in VCFs patients, and were described as hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on different complications were further assessed the association. Results: A total of 2,730 patients were included. Until 12 December 2019, 218 (7.99%) deaths were documented. VCFs was related to the high risk of all-cause mortality (HR= 1.75, 95%CI: 1.13-2.73) and CVD-cause mortality (HR=2.35, 95%CI: 1.12-4.91). Compared to the patients without VCFs and with aMED score ≥6, patients with VCFs and aMED score <6 has a higher risk of all-cause (HR=2.27, 95%CI: 1.25-4.13) and CVD-cause mortality (HR=4.25, 95%CI: 1.64-11.06). Our study also suggested that there was a moderating effect of aMED on the mortality of VCFs patients (all-cause mortality: HR: 1.36, 95%CI: 0.71-2.61; CVD-mortality: HR: 1.53, 95%CI: 0.46-5.12), especially in patients with dyslipidemia (HR: 2.49, 95%CI: 1.29-4.80), CVD (HR: 3.48, 95%CI: 1.56-7.74) and Chronic kidney disease(CKD) (HR: 3.64, 95%CI: 1.50-8.78). Conclusion: Greater adherence to the MD may have a moderating effect on the risk of all-cause and CVD-cause mortality in VCFs patients. Our research further supports the importance of the MD as a potentially healthy eating pattern.