Fruit and vegetable intake and bone health in women aged 45 years and over: a systematic review

Summary High fruit and vegetable intake may be associated with improved bone status among women aged .45 years. This is the first systematic review that specifically assessed this association and identified research gaps. The benefits of fruit and vegetables (F&V) on bone health remain unclear. Further studies are needed. Introduction F&V have several components that are beneficial to bones. Some studies report that high F&V intake is associated with improved bone status in middle aged and aged women; however, findings are inconsistent. The objective was to systematically review observational and interventional studies that investigated the effects of F&Vintake on incidence of osteoporotic fractures, bone mineral density (BMD), and bone turnovermarkers (BTM) in women aged .45 years and to identify potential research gaps. Methods Electronic databases were searched, and peerreviewed manuscripts published in English, with F&V intake as a main dietary exposure, were included. Data selection, extraction, and evaluation of risk of bias were performed independently by two reviewers. Results Eight studies were included. One cohort study reported cross-sectional as well as longitudinal data. There was significant between-study heterogeneity in design, definition, and amount of F&V intake, outcomes, analyses, and reporting of results. Two studies had low, two had moderate, and four had high risk of bias. Among reports with low or moderate risk of bias, two cross-sectional analyses reported positive associations between F&V intake and BMD of the forearm, lumbar spine, or total hip, whereas one randomized controlled trial and two prospective cohort analyses reported no effects. One trial reported no associations between F&Vand BTM. Conclusions Based on limited evidence, the benefits of F&V on bone health remain unclear for women aged .45 years. Further studies with low risk of bias are needed.