Association between dietary patterns and bone health among children and adolescents: a cross-sectional study

Abstract Bone mass accumulation in childhood and adolescence forms the foundation for lifelong bone health, and vitamin D deficiency remains prevalent. This study aims to investigate the association between dietary patterns in children and adolescents and bone health. This study population comprised 3,299 children and adolescents aged 6 to 18 from Shenzhen, China. Dietary intake data were collected using a validated semi-quantitative food frequency questionnaire (FFQ). Bone health was assessed by measuring the speed of sound (SOS) in the calcaneus using quantitative ultrasound (QUS). The SOS reflects bone density and microstructure, with a higher value indicating better bone quality. Dietary patterns were extracted from 18 food groups using principal component analysis (PCA) and reduced-rank regression (RRR). The 25-hydroxyvitamin D (25(OH)D) level was chosen as the response variable for RRR, quantified by liquid chromatography-mass spectrometry. The association between dietary patterns and SOS by means of generalized linear models (GLM) and restricted cubic splines models (RCS). Five dietary patterns were identified via PCA, namely the ultra-processed, seafood-egg-soup, plant-based, meat-based, and nut-dairy-fruit dietary patterns. RRR identified a vitamin D-related dietary pattern characterized by high consumption of fish and other seafood, dairy, fruits, and eggs, and low consumption of snack foods and fried foods. Both the nut-dairy-fruit (β = 3.50, 95% CI: 0.15–6.85, P = 0.041) and the vitamin D-related dietary pattern (β = 4.97, 95% CI: 1.34–8.61, P = 0.007) were positively associated with SOS. Higher dairy intake was also linked to increased SOS (β = 0.01, 95% CI: 0.00–0.01, P = 0.003), whereas refined grains showed a negative association (β = − 0.02, 95% CI: − 0.04– − 0.01, P = 0.002). Notably, the association between the vitamin D-related dietary pattern and SOS was nonlinear (P-overall < 0.001, P-nonlinear < 0.001). This study suggests that increasing the intake of dairy, fruits, eggs, aquatic products, and nuts, while reducing the intake of snack foods, fried foods, and refined grains, could help maintain adequate vitamin D levels and promote bone development among children and adolescents. Graphical Abstract