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Background <p>Evidence on the relationship between dietary fat intake and bone mineral density (BMD) remains inconsistent, particularly regarding sex- and site-specific differences in femoral bone health among older adults.</p> Methods <p>This cross-sectional study analyzed data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) to explore associations between dietary fat intake and femoral BMD in U.S. adults aged ≥ 50 years. Femoral BMD at four anatomical sites (total femur, neck, trochanter, intertrochanteric region) was measured using dual-energy X-ray absorptiometry (DXA). A high-fat diet was defined as &gt; 35% of total energy intake from fat (%E). Sex-stratified, survey-weighted multivariable logistic regression models were applied to examine associations with osteopenia/osteoporosis after adjustment for relevant covariates.</p> Results <p>Among 1,127 adults aged ≥ 50 years (612 men; 515 women), high-fat diet consumption was more prevalent in men (59.5%) than in women (54.0%). Women showed a higher baseline prevalence of osteopenia/osteoporosis, approximately 1.7–2.0 times that of men across femoral sites. After multivariable adjustment, a high-fat diet was associated with lower odds of femoral neck osteopenia/osteoporosis in men (OR = 0.45, <i>p</i> = 0.03) and women (OR = 0.43, <i>p</i> = 0.04), with no significant associations observed at other sites. Sensitivity and substitution analyses yielded directionally similar results, suggesting a modest, potentially protective association when carbohydrates were replaced with dietary fat. Restricted cubic spline and exploratory dose–response analyses demonstrated a protective effect of moderate fat intake in both sexes, with distinct sex-specific patterns: a nonlinear trend in women—with maximal protection observed at 40–45%E (OR = 0.22, <i>p</i> = 0.02)—and a linear inverse association in men, with the lowest risk at 35–40%E (OR = 0.35, <i>p</i> = 0.01).</p> Conclusions <p>These findings suggest a modest, sex- and site-specific association between dietary fat intake and femoral bone health in older adults. The observed relationships should be interpreted as exploratory and hypothesis-generating, emphasizing the need for longitudinal studies to confirm causality. Maintaining balanced macronutrient intake, rather than strict fat restriction, may be a reasonable dietary strategy for preserving bone health in aging populations.</p>

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Association of high-fat diet with bone mineral density in older U.S. adults: a cross-sectional study of NHANES 2017–2018

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  • 发表日期：

    2025年12月31日

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  • Na Li,
  • Qing He,
  • Yuan Cheng,
  • Tao Jin

摘要

Background

Evidence on the relationship between dietary fat intake and bone mineral density (BMD) remains inconsistent, particularly regarding sex- and site-specific differences in femoral bone health among older adults.

Methods

This cross-sectional study analyzed data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) to explore associations between dietary fat intake and femoral BMD in U.S. adults aged ≥ 50 years. Femoral BMD at four anatomical sites (total femur, neck, trochanter, intertrochanteric region) was measured using dual-energy X-ray absorptiometry (DXA). A high-fat diet was defined as > 35% of total energy intake from fat (%E). Sex-stratified, survey-weighted multivariable logistic regression models were applied to examine associations with osteopenia/osteoporosis after adjustment for relevant covariates.

Results

Among 1,127 adults aged ≥ 50 years (612 men; 515 women), high-fat diet consumption was more prevalent in men (59.5%) than in women (54.0%). Women showed a higher baseline prevalence of osteopenia/osteoporosis, approximately 1.7–2.0 times that of men across femoral sites. After multivariable adjustment, a high-fat diet was associated with lower odds of femoral neck osteopenia/osteoporosis in men (OR = 0.45, p = 0.03) and women (OR = 0.43, p = 0.04), with no significant associations observed at other sites. Sensitivity and substitution analyses yielded directionally similar results, suggesting a modest, potentially protective association when carbohydrates were replaced with dietary fat. Restricted cubic spline and exploratory dose–response analyses demonstrated a protective effect of moderate fat intake in both sexes, with distinct sex-specific patterns: a nonlinear trend in women—with maximal protection observed at 40–45%E (OR = 0.22, p = 0.02)—and a linear inverse association in men, with the lowest risk at 35–40%E (OR = 0.35, p = 0.01).

Conclusions

These findings suggest a modest, sex- and site-specific association between dietary fat intake and femoral bone health in older adults. The observed relationships should be interpreted as exploratory and hypothesis-generating, emphasizing the need for longitudinal studies to confirm causality. Maintaining balanced macronutrient intake, rather than strict fat restriction, may be a reasonable dietary strategy for preserving bone health in aging populations.