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Clinical Cases in mineral and bone metabolism

The Mediterranean diet for bone health in osteoporosis. Children and adolescents

Mini-Review, 19 - 28
doi: 10.11138/ccmbm/2017.15.1.019
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Abstract
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The traditional Mediterranean diet is characterized by a high intake of vegetables, legumes, fruits and nuts, and cereals (that in the past were largely unrefined), a high intake of olive oil but a low intake of saturated lipids, a moderately high intake of fish (depending on the proximity of the sea), a low-to-moderate intake of dairy products (mostly in the form of cheese or yogurt), a low intake of meat and poultry and a regular but moderate intake of ethanol, primarily in the form of wine, generally during meals.
Although genetic factors are the strongest predictors of bone mass, nutrition is an important modifiable factor that affects bone health. It’s known that a 10% increase in peak bone mass (PBM) is estimated to halve the risk of an osteoporotic fracture in adult life and that bone mass accrual occurs with growth and is enhanced during pubertal growth. According to the European
Commission Regulation no. 432/2012 of May 16, 2012, proteins, calcium, phosphorus, magnesium, manganese, zinc, vitamin D and vitamin K are necessary for maintaining healthy bones. Calcium is important for bone health throughout life, as it is a fundamental constituent element of the skeleton, and is now a recognized role in the formation and maintenance of bone mass.
Several studies have shown that the incidence of osteoporosis (OP) and OP-related fractures vary across the European Union countries; the lowest being recorded in those of Mediterranean basin.
Although the Mediterranean diet does not emphasize nutrients that have been suggested to have a beneficial effect on bone health, such as calcium or protein intake, nonetheless, it is recognized that this dietary pattern (and/or some food groups typical of this dietary model) has positive impact on bone status. In effect, even if milk and dairy products are, in terms of quantity and bioavailability, the best dietary source of calcium, an adequate calcium intake requires the consumption of various foods to optimize its retention and reduce its losses.
Recently systematic reviews reported the benefic impact of this pattern on bone health, nevertheless less attention is put on children and adolescents.
In children and adolescent high adherence to a Mediterranean pattern is very important to achieve an optimal PBM. Moreover, many studies regarding MD adherence in children and adolescents show that the adherence to this pattern is directly associated with physical activity increase (and possibly with diet adequacy) and inversely with sedentary behavior contributing to reach an optimal bone growth.
In conclusion Mediterranean diet is a complex of cultural and lifestyle elements, that make it an all ages useful pattern for bone health.

Vol. XV (No. 1) 2018 January - April

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