Nutritional advice

Objectives:
With the increasing incidence of osteoporosis, vitamin K and calcium have been linked to bone mineral density (BMD) and undercarboxylated osteocalcin (UcOC) in many studies, but the results of studies of the combined effect of vitamin K and calcium on BMD and UcOC in humans have been inconsistent. Therefore, this review article has been conducted.

Do vitamin K and calcium supplements used in combination increase bone mineral density and decrease undercarboxylated osteocalcin level?

Study design:
This review article included 10 randomized controlled trials (RCTs) with a total of 1,346 patients.

Results and conclusions:
The investigators found that the combination of vitamin K and calcium supplements was significantly associated with a higher lumbar spine bone mineral density [SMD = 0.20, 95% CI = 0.07 to 0.32, I2 = 46.9%, p = 0.049].
However, after applying trim and fill method (where correction was made for publication bias), the results were not statistically significant [estimate = 0.067, 95% CI = -0.044 to 0.178].

The investigators found that vitamin K and calcium supplementation led to a significant decrease in undercarboxylated osteocalcin [SMD = -1.71, 95% CI = - 2.45 to -0.96, I2 = 95.7%, p  0.01].
The results did not change after correcting publication bias [estimate = - 0.947, 95% CI = -1.211 to - 0.687].
The SMD in the sensitivity analysis was -0.82 [95% CI = - 1.10 to -0.55, I2 = 65.4%, p  0.01].

The investigators found in subgroup analysis that the combination of vitamin K2 and calcium supplements was significantly associated with a higher lumbar spine bone mineral density [SMD = 0.30, 95% CI = 0.10 to 0.51, I2 = 0%].

The investigators found in subgroup analysis that the combination of vitamin K and  ≤ 1000 mg/d calcium supplements was significantly associated with a higher lumbar spine bone mineral density [SMD = 0.19, 95% CI = 0.05 to 0.32, I2 = 62.3%].

The investigators found in subgroup analysis that the combination of  ≤100 µg/d vitamin K and calcium supplements was significantly associated with a higher lumbar spine bone mineral density [SMD = 0.40, 95% CI = 0.20 to 0.61, I2 = 49.9%].

The investigators found in subgroup analysis that the combination of vitamin K and calcium supplements during ≤1 year was significantly associated with a higher lumbar spine bone mineral density [SMD = 0.38, 95% CI = 0.19 to 0.57, I2 = 40%].

The investigators concluded that ≤100 µg/d vitamin K2 and ≤1000 mg/d calcium supplements used in combination are associated with a higher lumbar spine bone mineral density and a lower undercarboxylated osteocalcin level.

Original title:
The combined effect of vitamin K and calcium on bone mineral density in humans: a meta-analysis of randomized controlled trials by Hu L, Ji J, [...], Yu B.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515712/

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Objectives:
Whether mushroom consumption, which is a rich source of potent antioxidants ergothioneine and glutathione, vitamins and minerals (e.g., selenium & copper), is associated with a lower mortality risk is not well understood. Therefore, this review article (meta-analysis) has been conducted.

Does mushroom consumption reduce all-cause mortality?

Study design:
This review article included 5 prospective cohort studies with a total of 50,787 cases of deaths accrued in 601,893 men and women.

Results and conclusions:
The investigators found in a meta-analysis that mushroom consumption was significantly associated with an 6% decrease of the risk of all-cause mortality [pooled risk ratio = 0.94, 95% CI = 0.91 to 0.98].  

The investigators concluded that a meta-analysis of prospective cohort studies shows mushroom consumption reduces all-cause mortality. These findings can be used to support public health recommendations and increase awareness about the health-promoting effects of mushrooms. Large prospective cohort studies with repeated dietary data measurements are needed to replicate these findings and clarify the potential protective role of mushrooms against premature mortality.

Original title:
Prospective study of dietary mushroom intake and risk of mortality: results from continuous National Health and Nutrition Examination Survey (NHANES) 2003-2014 and a meta-analysis by Ba DM, Gao X, [...], Richie Jr JP.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8454070/

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Objectives:
Does fruits and vegetables (FVs) consumption reduce risk of frailty?

Study design:
This review article included 10 cohort studies and 4 cross-sectional studies with 18,616 subjects with frailty and 101,969 controls (persons without frailty).

Based on the NutriGrade score, the quality of evidence for a protective effect of fruits and vegetables consumption on frailty was "moderate".

Results and conclusions:
The investigators found in 7 cohort studies for the highest versus lowest category of fruits and vegetables consumption a significantly reduced risk of 35% for frailty [RR = 0.65, 95% CI = 0.50 to 0.84, I2 = 81%].

The investigators found that every 200g per day increment in fruits and vegetables consumption was significantly associated with a 14% lower risk of frailty.
The risk of frailty decreased linearly up to fruits and vegetables consumption of 700 g/d, with flattening the curve at higher intake.

The investigators found that pooled analysis regarding fruits and vegetables separately did not indicate a significant association with the risk of frailty.

The investigators concluded that 200-700 g/d fruits and vegetables consumption decreases risk of frailty. Further large-scale prospective cohort studies are needed to reach more confident conclusions.

Original title:
Fruit and vegetable intake and risk of frailty: A systematic review and dose response meta-analysis by Ghoreishy SM, Asoudeh F, […], Mohammadi H.

Link:
https://pubmed.ncbi.nlm.nih.gov/34534684/

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Objectives:
Findings on the link between dietary intakes of monounsaturated fatty acids (MUFA) and risk of mortality are conflicting. Therefore, this review article has been conducted.

Does monounsaturated fatty acids dietary intake reduce risk of mortality?

Study design:
This review article included 17 prospective cohort studies with a total of 1022,321 participants aged ≥ 20 years, of which 191,283 all-cause deaths, 55,437 cardiovascular diseases (CVD) deaths and 64,448 cancer deaths.

Results and conclusions:
The investigators found combining 15 effect sizes from 11 studies, monounsaturated fatty acids dietary intake was significantly associated with a reduced risk of 6% for all-cause mortality [RR = 0.94, 95% CI = 0.90 to 0.98, I2 = 55.5%, p = 0.005].
Significantly because RR of 1 was not found in the 95% CI of 0.90 to 0.98. RR of 1 means no risk/association.

The investigators found based on 17 effect sizes from 11 studies, no significant association between monounsaturated fatty acids dietary intake and risk of cardiovascular diseases mortality [RR = 0.95, 95% CI = 0.89 to 1.01, I2 =37.0%, p = 0.06].
No significant means that there is no association with a 95% confidence.

The investigators found when combining 10 effect sizes from 6 studies, monounsaturated fatty acids dietary intake was not significantly associated with cancer mortality [RR = 0.99, 95% CI = 0.96 to 1.03, I2 = 13.3%, p = 0.32].  
Not significantly because RR of 1 was found in the 95% CI of 0.96 to 1.03. RR of 1 means no risk/association.

The investigators found an additional 5% of energy (5 En%) from monounsaturated fatty acids was significantly associated with a 3% reduced risk of all-cause mortality [RR = 0.97, 95% CI = 0.96 to 0.98], but not with cardiovascular diseases [RR = 0.98, 95% CI = 0.95 to 1.01] and cancer mortality [RR = 0.99, 95% CI = 0.97 to 1.01].

The investigators concluded that monounsaturated fatty acids dietary intake reduces risk of all-cause mortality.

Original title:
Dietary intakes of monounsaturated fatty acids and risk of mortality from all causes, cardiovascular disease and cancer: A systematic review and dose-response meta-analysis of prospective cohort studies by Lotfi K, Salari-Moghaddam A, […], Esmaillzadeh A.

Link:
https://pubmed.ncbi.nlm.nih.gov/34560281/

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Find more information/studies on fatty acids, cardiovascular disease and elderly right here.

Objectives:
Despite growing evidence that type 2 diabetes is associated with dementia, the question of whether intensive glucose control can prevent or arrest cognitive decline remains unanswered. Therefore, this review articles (meta-analysis) has been conducted.

Does intensive glucose control slow down cognitive decline in persons with type 2 diabetes?

Study design:
This review article included 5 cohort studies with 16,584 participants.
The mean follow-up duration ranged from 3.5 to 10 years.
The mean age of participants in the studies included in the current meta-analysis was 65.6 years at the initiation of the studies and the proportion of women was 40.8%.
All quality assessment scores fell in the range of 8 or 9, indicating high quality.
There was no publication bias.

Results and conclusions:
The investigators found a significantly poorer decline in cognitive function in the intensive glucose control group [β = -0.03, 95% CI = -0.05 to -0.02] than in the conventional glucose control group.

The investigators found, subgroup analysis showed a significant difference in the change in cognitive performance in composite cognitive function [β = -0.03, 95% CI = -0.05 to -0.01] and memory [β = -0.13, 95% CI = -0.25 to -0.02].

The investigators concluded that intensive glucose control in persons with type 2 diabetes slows down cognitive decline, especially the decline in composite and memory function. The impact of intensive glucose control on the brain structural abnormalities and risk of dementia needs further rigorously designed studies to validate these findings. Also, replicating and validating these findings is warranted.

Original title:
Impact of Intensive Glucose Control on Brain Health: Meta-Analysis of Cumulative Data from 16,584 Patients with Type 2 Diabetes Mellitus by Tang X, Cardoso MA, […], Simó R.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947088/

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Objectives:
Magnesium supplementation is often purported to improve sleep; however, as both an over-the-counter sleep aid and a complementary and alternative medicine, there is limited evidence to support this assertion. Therefore, this review article (meta-analysis) has been conducted.

Does magnesium supplementation improve sleep in older adults with insomnia?

Study design:
This review article included 3 randomized control trials (RCTs), comparing oral magnesium to placebo in 151 older adults in 3 countries.

All 3 RCTs were at moderate-to-high risk of bias and outcomes were supported by low to very low quality of evidence.

Daily elemental magnesium intake ranged from 320 mg to 729 mg taken 2 to 3 times per day using 2 formulations (magnesium oxide and magnesium citrate tablets).
Duration of follow-up for outcome assessment ranged from 20 days to 8 weeks.

Results and conclusions:
The investigators found pooled analysis showed that post-intervention sleep onset latency time was significantly 17.36 min less [95% CI = -27.27 to -7.44, p = 0.0006] after magnesium supplementation compared to placebo.
Significantly because the calculated p-value of = 0.0006 was less than the p-value of 0.05.

The investigators found pooled analysis showed that total sleep time improved by 16.06 min in the magnesium supplementation group but was statistically insignificant [95% CI = - 5.99 to 38.12, p = 0.15].
Insignificant because the calculated p-value of 0.15 was larger than the p-value of 0.05.

The investigators concluded that RCT evidence may support oral magnesium supplements (less than 1 g quantities given up to 3 times a day) for insomnia symptoms in older adults. May support because all 3 RCTs are at moderate-to-high risk of bias and outcomes are supported by low to very low quality of evidence.

Original title:
Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis by Mah J and Pitre T.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053283/

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Magnesium oxide contains 60% elemental magnesium and magnesium citrate contains 16% elemental magnesium.
So if you want to get 320 mg elemental magnesium from magnesium supplements, you have to take 534 mg magnesium oxide supplements or 2000 mg magnesium citrate.

Objectives:
Lifestyle interventions are an important and viable approach for preventing cognitive deficits. However, the results of studies on alcohol, coffee and tea consumption in relation to cognitive decline have been divergent, likely due to confounds from dose-response effects. Therefore, this review article (meta-analysis) has been conducted.

Does alcohol, coffee or tea consumption reduce the risk of cognitive deficits (such as dementia or Alzheimer's disease)?

Study design:
This review article included 29 prospective cohort studies from America, Japan, China and some European countries (131,777 participants for alcohol, 333,843 participants for coffee and 20,411 participants for tea).

The NOS score was 8.

Results and conclusions:
The investigators found dose-response relationships showed that compared to non-drinkers, low consumption (11 g/day) of alcohol significantly reduced the risk of cognitive deficits or only dementias, but there was no significant effect of heavier drinking (>11 g/day).

The investigators found dose-response relationships showed that compared to non-drinkers, low consumption of coffee significantly reduced the risk of any cognitive deficit (2.8 cups/day) or dementia (2.3 cups/day).
However, coffee drinking was not a significant protective factor for cognitive deficits in groups of average age 60 years.

The investigators found dose-response relationships showed that compared to non-drinkers, every cup of green tea per day significantly reduced risk of cognitive deficits with 6% [relative risk = 0.94, 95% CI = 0.92 to 0.97].  

The investigators concluded that light consumption of alcohol (11 g/day) and coffee (2.8 cups/day) reduces risk of cognitive deficits. Cognitive benefits of green tea consumption increases with the daily consumption.

Original title:
Alcohol, coffee and tea intake and the risk of cognitive deficits: a dose-response meta-analysis by Ran LS, Liu WH, […], Wang W.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061189/

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Objectives:
Do magnesium intakes reduce risk of all-cause, cancer and cardiovascular disease (CVD) mortality?

Study design:
This review article included 19 prospective cohort studies with a total of 1,168,756 participants (52,378 deaths from all causes (all-cause mortality), 23,478 from cardiovascular disease (CVD) and 11,408 from cancer).
The follow-up period was 3.5 to 32 years.

Results and conclusions:
The investigators found dietary magnesium intake was significantly associated with a lower risk of 13% for all-cause mortality [pooled effect size (ES) = 0.87, 95% CI = 0.79 to 0.97, p = 0.009, I2 = 70.7%, p 0.001].

The investigators found dietary magnesium intake was significantly associated with a lower risk of 20% for cancer mortality [pooled ES = 0.80, 95% CI = 0.67 to 0.97, p = 0.023, I2 = 55.7%, p = 0.027].

The investigators found for supplemental and total magnesium intakes, no significant associations with risks of all-cause, cardiovascular disease and cancer mortality.

The investigators found, however, linear dose-response meta-analysis indicated that each additional intake of 100 mg/d of dietary magnesium was significantly associated with a 6% and 5% reduced risk of all-cause and cancer mortality, respectively.

The investigators concluded that higher intake of dietary magnesium (at least 100 mg/d of dietary magnesium) is associated with a reduced risk of all-cause and cancer mortality, but not cardiovascular disease mortality. Supplemental and total magnesium intakes are not associated with the risk of all-cause, cardiovascular disease and cancer mortality. These findings indicate that consumption of magnesium from dietary sources may be beneficial in reducing all-cause and cancer mortality and thus have practical importance for public health.  

Original title:
Total, Dietary, and Supplemental Magnesium Intakes and Risk of All-Cause, Cardiovascular, and Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies by Bagheri A, Naghshi S, […], Esmaillzadeh A.

Link:
https://pubmed.ncbi.nlm.nih.gov/33684200/

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Objectives:
Previous population studies on the associations between dietary fatty acids (FAs), plasma FAs levels and the risk of age-related macular degeneration (AMD) have yielded inconclusive results. Therefore, this review article (meta-analysis) has been conducted.

Do higher dietary fatty acids (EPA and DHA) intakes or higher plasma fatty acids levels reduce risk of age-related macular degeneration?

Study design:
This review article included 11 prospective cohort studies with 167,581 participants. During the follow-up periods (ranging from 3 to 28 years), 6,318 cases of age-related macular degeneration were recorded.

Results and conclusions:
The investigators found that each 1 g/day increment of dietary intake of docosahexaenoic acid (DHA) and eicosatetraenoic acid (EPA) combined significantly reduced risk of early age-related macular degeneration with 33% [RR = 0.67, 95% CI = 0.51 to 0.88].
Significantly means that there is an association with a 95% confidence.

The investigators found that each 1 g/day increment of dietary intake of docosahexaenoic acid (DHA) significantly reduced risk of early age-related macular degeneration with 50% [RR = 0.50, 95% CI = 0.32 to 0.78].
Significantly means it can be said with a 95% confidence that each 1 g/day increment of dietary intake of docosahexaenoic acid (DHA) really reduces risk of early age-related macular degeneration with 50%.

The investigators found that each 1 g/day increment of dietary intake of eicosatetraenoic acid (EPA) significantly reduced risk of early age-related macular degeneration with 60% [RR = 0.40, 95% CI = 0.18 to 0.87].
Significantly because RR of 1 was not found in the 95% CI of 0.18 to 0.87. RR of 1 means no risk/association.

The investigators found that higher plasma docosahexaenoic acid (DHA) levels significantly reduced risk of advanced age-related macular degeneration with 28% [RR = 0.72, 95% CI = 0.55 to 0.95].

The investigators found that higher plasma eicosatetraenoic acid (EPA) levels significantly reduced risk of advanced age-related macular degeneration with 43% [RR = 0.57, 95% CI = 0.40 to 0.81].

The investigators concluded that 1 g/day of dietary intake DHA and 1 g/day of dietary intake EPA and higher plasma DHA and EPA levels are associated with a reduced risk of age-related macular degeneration.

Original title:
Dietary fatty acid intake, plasma fatty acid levels, and the risk of age-related macular degeneration (AMD): a dose-response meta-analysis of prospective cohort studies by Zhong Y, Wang K, [...], Yao K.

Link:
https://pubmed.ncbi.nlm.nih.gov/33469697/

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A high plasma EPA and DHA content can be obtained by eating a lot of oily fish and/or by taking EPA and DHA supplements (fish oil supplements).
Oily fish contains more EPA and DHA than non-oily fish.

Early age-related macular degeneration: most people do not experience adverse symptoms or vision loss in the early stage of age-related macular degeneration, but night vision problems are often reported. Though no pigmentary abnormalities are apparent upon examination, medium-sized drusen (>63 μm and ≤125 μm) are present.

Objectives:
Previous studies on the association between alcohol intake and risk of fracture have reached conflicting findings. Therefore, this review article has been conducted.

Does alcohol consumption increase risk of fractures?

Study design:
This review article included 38 prospective cohort studies with a total sample size of 5,053,117 participants and 169,560 cases of fracture.

Results and conclusions:
The investigators found in a random-effects meta-analysis, that alcohol consumption significantly increased risk of total fractures with 35% [RR = 1.35, 95% CI = 1.01 to 1.81] and any fractures with 24% [RR= 1.24, 95% CI = 1.11 to 1.38].
Significant because RR of 1 was not found in the 95% CI of 1.01 to 1.81. RR of 1 means no risk/association.

The investigators found, however, no significant association between alcohol intake and risk of hip fractures [RR = 1.19, 95% CI = 0.96 to 1.48], osteoporotic fractures [RR = 2.01, 95% CI = 0.76 to 5.34], vertebral fractures [RR = 0.98, 95% CI = 0.68 to 1.40] and wrist fractures [RR = 0.99, 95% CI = 0.85 to 1.16].
No significant because RR of 1 was found in the 95% CI of 0.85 to 1.06. RR of 1 means no risk/association.

The investigators concluded that alcohol consumption is positively associated with risk of total fractures and any fractures.

Original title:
A systematic review and meta-analysis of prospective cohort studies on the association between alcohol intake and risk of fracture by Asoudeh F, Salari-Moghaddam A, […], Esmaillzadeh A.

Link:
https://pubmed.ncbi.nlm.nih.gov/33596741/

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Objectives:
Recent evidence suggests that diet can modify the risk of future cognitive impairment and dementia. A biologically plausible rationale and initial clinical data indicate that the antioxidant activities of dietary carotenoids may assist the preservation of cognitive function. Therefore, this review article has been conducted.

Does carotenoid supplementation improve cognitive performance among healthy adults?

Study design:
This review article included 9 RCTs, involving 2,228 subjects in the treated group (group with carotenoid supplementation) and 2,174 subjects in control group (group without carotenoid supplementation).
The age of all participants varied from 45 to 78 years.
The majority of clinical trials assessed the effect of xanthophylls such as lutein, zeaxanthin, and astaxanthin, whereas only 1 study determined the effects of β-carotene.
The duration of carotenoid supplementation ranged from 2 weeks to 12 months.
The dosage of carotenoids administered in the studies ranged from 0.5 mg/d to 50 mg/d.
There was no evidence of publication bias.

Results and conclusions:
The investigators found results of the pooled meta-analysis showed a significant effect of carotenoid intervention on cognitive outcomes [Hedge's g = 0.14, 95% CI = 0.08 to 0.20, p 0.0001, I2 = 0.00%].
The sensitivity analysis did not change the overall findings obtained from the primary analysis.

The investigators concluded that these results highlight the potential role of carotenoids (0.5 mg/d to 50 mg/d) in the protection of mental functions even in subjects (healthy participants aged 45-78 years) without cognitive impairment. This is particularly important because the population is aging and preservation of cognitive function is crucial for individual autonomy and quality of life, even in non-demented subjects. Further well-powered and long-term trials are required to determine treatment duration, type of carotenoid and optimal dosage.

Original title:
Carotenoids and Cognitive Outcomes: A Meta-Analysis of Randomized Intervention Trials by Davinelli S, Ali S, […], Corbi G.

Link:
https://www.mdpi.com/2076-3921/10/2/223/htm

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Objectives:
Increasing macular pigment optical density (MPOD) as a result of increased macular concentration of lutein and zeaxanthin may reduce the risk of age-related macular degeneration (AMD). Therefore, this review article has been conducted.

Have daily egg consumption beneficial effects on macular pigment optical density and serum lutein levels?

Study design:
This review article included 5 RCTs with a total of 296 participants.
There was no heterogeneity between studies.

Results and conclusions:
The investigators found that egg consumption significantly increased macular pigment optical density [WMD = +0.037, 95% CI = 0.004 to 0.069, p = 0.027] and serum lutein levels [WMD = +0.150 μmol/L, 95% CI = 0.037 to 0.263, p = 0.009].

The investigators found subgroup analyses showed that egg consumption had a larger effect on macular pigment optical density in studies with a parallel design and increased serum lutein levels to a greater extent in a healthy population.

The investigators concluded daily egg consumption have beneficial effects on macular pigment optical density and serum lutein level is inversely associated with reduced age-related macular degeneration progression. Further clinical trials are required to confirm the results of this review article.

Original title:
A positive effect of egg consumption on macular pigment and healthy vision: a systematic review and meta-analysis of clinical trials by Sikaroudi MK, Saraf-Bank S, […], Soltani S.

Link:
https://pubmed.ncbi.nlm.nih.gov/33491232/

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Objectives:
Does a high dietary intake of β-cryptoxanthin reduce the risk of osteoporosis and hip fracture?

Study design:
This review article included 7 cohort studies, 4 case-control studies and 4 cross-sectional studies with a total of 100,496 individuals.
The methodological qualities of all studies were rated as “fair” to “good”.
The number of populations in each study ranged from 59 to 25,566.

Results and conclusions:
The investigators found that a high dietary intake of β-cryptoxanthin significantly reduced risk of osteoporosis with 24% [OR = 0.76, 95% CI = 0.66 to 0.88, p = 0.0002, I2 = 36%, p = 0.11].

The investigators found in subgroup analysis that a high dietary intake of β-cryptoxanthin significantly reduced risk of osteoporosis with 28% [OR = 0.72, 95% CI = 0.58 to 0.91, p = 0.005, I2 = 59%] among women.

The investigators found in subgroup analysis that a high dietary intake of β-cryptoxanthin significantly reduced risk of osteoporosis with 20% [OR = 0.80, 95% CI = 0.65 to 1.00, p = 0.005, I2 = 11%] among men.

The investigators found that a high dietary intake of β-cryptoxanthin significantly reduced risk of hip fracture with 28% [OR = 0.72, 95% CI = 0.60 to 0.87, p = 0.0008, I2 = 55%].

The investigators found in subgroup analysis that a high dietary intake of β-cryptoxanthin significantly reduced risk of hip fracture with 29% [OR = 0.71, 95% CI = 0.54 to 0.94, p = 0.02, I2 = 71%] among women. 

The investigators concluded that a high dietary intake of β-cryptoxanthin reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.

Original title:
Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies by Kim SJ, Anh NH, […], Kwon SW.

Link:
https://www.mdpi.com/2304-8158/10/2/296/htm

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