Dietary carbohydrate intake and risk of bone fracture: a systematic review and meta-analysis of observational studies

Objective: Despite growing evidence for the association between other dietary macronutrients and bone health, limited and inconsistent knowledge is available regarding carbohydrate intake. In this systematic review and meta- analysis, we purposed to clarify and synthesize the knowledge about the relation between carbohydrate intake and the risk of fracture. Study design: Systematic review and meta-analysis of observational studies. Methods: In this study, PubMed and Scopus were used to conduct a comprehensive search for articles published up to September 2018. The screening was done independently by two authors. Pooled effect sizes were calculated using fixed and random effect models for the highest versus lowest intake categories. The dose-response nature of the relationship was also investigated. Results: No association was observed between carbohydrate intake and the risk of fracture in high versus low intake meta-analysis (overall relative risk [RR]: 1.24; 95% confidence interval [95% CI]: 0.84-1.84; P = 0.27) with moderate heterogeneity (I-2 = 57.7%, P (heterogeneity) = 0.05). Moreover, there was no relationship between carbohydrate intake and the risk of fracture in both linear (overall RR: 1.00; 95% CI: 0.94-1.05; P = 0.88) (I-2 = 68.1%, P (heterogeneity) = 0.48) and nonlinear (Pnon-linearity = 0.14) models. Conclusion: No association was observed between carbohydrate intake and the risk of fracture. (c) 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.