The Associations of Dietary Inflammatory Potential with Musculoskeletal Health in Chinese Community-Dwelling Older People

The Mr. OS and Ms. OS (Hong Kong) Cohort Study


Sarcopenia and osteoporosis are two prevalent age-related disorders that frequently coexist. These serious conditions of impaired mobility, which predisposes individuals to increased risk of falls, hospitalizations, and mortality. Understanding of the biological determinants of musculoskeletal diseases is essential to developing novel interventions for prevention and treatment. Inflammation as a key contributor to developing frailty aging and disease states are often paired with elevated levels of inflammation. Consequently, the accumulation of inflammatory cytokines can promote muscle degradation. Proinflammatory diet are known to be associated with higher inflammation and a higher risk of age-related diseases while some healthy dietary changes may be helpful in lowering chronic inflammation for better musculoskeletal health in the elderly. The Dietary Inflammatory Index (DII) was created to offer a quantitative method for evaluating the impact of diet on health outcomes, including chronic diseases and blood levels of inflammatory cytokines.

In a new research paper published in Journal of Bone and Mineral Research, Dr. Yi Su, Suey Yeung, Professor Yu-Ming Chen, Professor Jason Leung and Professor Timothy Kwok from The Chinese University of Hong Kong evaluated the relationships between musculoskeletal parameters and outcomes of associated diseases in 3995 community-dwelling Chinese men and women aged 65 years in Hong Kong. The authors created a food frequency questionnaire to assess the DII score at the baseline. The research team looked at different motor function criteria such as measurements of hand grip strength, gait speed at different timelines (baseline, year 4, and year 14). They also measured the muscle mass by dual-energy X-ray absorption (DXA), bone mineral density (BMD), and muscle mass. Using a general linear model, a multinomial logistic regression model, and a Cox proportional hazards regression model, respectively, the relationships between the DII score and the longitudinal changes of musculoskeletal parameters, as well as the incidence of osteoporosis, sarcopenia, and fractures, were examined.

According to the authors, a higher DII score—which denotes a more pro-inflammatory diet—was linked to a faster loss of muscle strength and physical performance in the first four years and a likely elevated risk of sarcopenia in older adults males. Even after controlling for the concurrent risk of death, older men had higher 10-year fracture risk and were more likely to have osteoporosis or lower baseline BMD. The longitudinal decrease in musculoskeletal measures or the 10-year fracture risk were not significantly correlated with dietary inflammatory potential in older women, with the exception that a more pro-inflammatory diet was linked to a higher risk of osteoporosis at year 14. Further investigation revealed that men who were deemed sarcopenic by AWGS (2019) criteria but not by AWGS (2014) criteria consumed more pro-inflammatory diets at baseline and experienced a significantly greater loss in muscle strength at year four compared to men who were deemed normal by both of these criteria. This revealed that those with borderline sarcopenic status would be more negatively affected by a pro-inflammatory diet than healthy individuals in terms of muscular strength. Interestingly, despite men’s average serum hs-CRP concentrations being lower than women’s, a pro-inflammatory diet was substantially related with higher serum hs-CRP concentrations in men but not in women.

Even after controlling for competing mortality risk, the significance of the link between higher DII and a higher 10-year fracture risk remained. Interestingly, the risk of any fracture was much more correlated with DII than the risk of a large osteoporotic fracture. Long-term osteoporosis incidence was substantially correlated with DII in older women.

In conclusion, the new study clearly shows that older Chinese men who consume pro-inflammatory diets experience greater loss of muscular strength and function as well as a higher risk of fractures. However, aside from an increased risk of osteoporosis in older Chinese women, higher DII was not substantially linked to musculoskeletal outcomes. Thus, dietary strategies to reduce proinflammatory foods and increase anti-inflammatory foods may have a significant role in prevention of sarcopenia and fractures in older men.


Su Y, Yeung SS, Chen YM, Leung JC, Kwok TC. The Associations of Dietary Inflammatory Potential With Musculoskeletal Health in Chinese CommunityDwelling Older People: The Mr. OS and Ms. OS (Hong Kong) Cohort Study. Journal of Bone and Mineral Research. 2022 Apr 13.

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