Association between multiple vitamins and bone mineral density: a cross-sectional and population-based study in the NHANES from 2005 to 2006

Ruyi Zhang; Qin Huang; Guanhua Su; Muhong Wei; Yuan Cui; Haolong Zhou; Wenjing Song; Dongsheng Di; Junan Liu; Qi Wang

doi:10.1186/s12891-023-06202-6

Association between multiple vitamins and bone mineral density: a cross-sectional and population-based study in the NHANES from 2005 to 2006

BMC Musculoskelet Disord. 2023 Feb 10;24(1):113. doi: 10.1186/s12891-023-06202-6.

Authors

Ruyi Zhang^#¹, Qin Huang^#², Guanhua Su^#³, Muhong Wei¹, Yuan Cui¹, Haolong Zhou¹, Wenjing Song¹, Dongsheng Di¹, Junan Liu⁴, Qi Wang⁵

Affiliations

¹ MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
² Department of Rehabilitation Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
³ Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
⁴ Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
⁵ MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. wangqi_tj@hust.edu.cn.

^# Contributed equally.

Abstract

Background: Bone mineral density (BMD) alterations in response to multivitamin exposure were rarely studied. Our study assessed the association of coexposure to six types of vitamins (i.e., vitamins B12, B9, C, D, A and E) with BMD measurements in adults in the US.

Methods: Data were collected from participants aged ≥ 20 years (n = 2757) in the U.S. National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2006. Multiple linear regression, restricted cubic splines, principal component analysis (PCA) and weighted quantile sum (WQS) regression were performed for statistical analysis.

Results: The circulating levels of vitamins B12 and C were positively associated with BMDs, and an inverted L-shaped exposure relationship was observed between serum vitamin C and BMDs. PCA identified two principal components: one for 'water-soluble vitamins', including vitamins B12, B9 and C, and one for 'fat-soluble vitamins', including vitamins A, D and E. The former was positively associated with total femur (β = 0.009, 95%CI: 0.004, 0.015) and femoral neck (β = 0.007, 95%CI: 0.002, 0.013) BMDs, and the latter was negatively associated with BMDs with non-statistical significance. The WQS index constructed for the six vitamins was significantly related to total femur (β = 0.010, 95%CI: 0.001, 0.018) and femoral neck (β = 0.008, 95%CI: 0.001, 0.015) BMDs, and vitamins B12 and C weighted the most. The WQS index was inversely related to BMDs with non-statistical significance, and vitamins E and A weighted the most.

Conclusion: Our findings suggested a positive association between water-soluble vitamin coexposure and BMD, and the association was mainly driven by vitamins B12 and C. Negative association between fat-soluble vitamin coexposure and BMD was indicated, mainly driven by vitamins E and A. An inverted L-shaped exposure relationship was found between vitamin C and BMD.

Keywords: Bone mineral density; Multiple vitamins co-exposure; Principal components analysis (PCA); Weighted quantile sum (WQS) regression.

MeSH terms

Adult
Ascorbic Acid
Bone Density* / physiology
Cross-Sectional Studies
Humans
Nutrition Surveys
Vitamins*
Water

Substances

Vitamins
Ascorbic Acid
Water