We investigated the effect of feeding a skin barrier function-augmenting diet early in dogs' lives on the appearance of clinical signs associated with canine atopic dermatitis. Pregnant bitches (starting 5 weeks after mating) and their subsequent litters (up to 1 year of age) were fed either supplemented or unsupplemented diets. Nutrients supplemented were nicotinamide, pantothenate, histidine, inositol and choline. Circulating IgE levels to dust mute allergens Der f and Der p were measured when the puppies were 6 and 12 months old. Two owner questionnaires were used to assess the occurrence of typical signs associated with atopic dermatitis when dogs were between the ages of 22 and 36, and 34 and 48 months. Using linear mixed models we observed higher levels of circulating anti-Der f (P = 0·021) and -Der p IgE (P = 0·01) during the first year in the dogs fed the unsupplemented than in those fed the supplemented diet. The owner-assessed incidence of atopic dermatitis signs amongst the dogs was significantly greater in the unsupplemented group at the time of the second follow-up questionnaire (10/33 dogs v. 2/24 dogs). These outcomes suggest that a nutritionally derived improvement to barrier function early in life may reduce the frequency of signs associated with atopic dermatitis. The effect is possibly the result of making the epidermis, now thought to be a major route of environmental allergen exposure, more resistant to penetration.

A previous analysis of the Alpha-Tocopherol Beta-Carotene (ATBC) Study on male smokers found that β-carotene supplementation increased the risk of pneumonia 4-fold in those who started smoking at the age of ≥21 years and smoked ≥21 cigarettes/d (a subgroup of 7 % of the study population). The present study hypothesised that β-carotene increases mortality in the same subgroup. The ATBC Study (1985–1993) recruited 29 133 Finnish male smokers (≥5 cigarettes/d) aged 50–69 years. Cox regression models were constructed to estimate the effect of β-carotene supplementation in subgroups. β-Carotene increased mortality (risk ratio 1·56; 95 % CI 1·06, 2·3) in those who started to smoke at ≥21 years and smoked ≥21 cigarettes/d. Within this subgroup, there was strong evidence of further heterogeneity. The effect of β-carotene supplementation was further modified by dietary vitamin C intake, fruit and vegetable intake (P = 0·0004), and by vitamin E supplementation (P = 0·011). Thus, harm from β-carotene was not uniform within the study population. Interactions between β-carotene and vitamins C and E were seen only within a subgroup of 7 % of the ATBC participants, and therefore should not be extrapolated to the general population. Heterogeneity of the β-carotene effect on mortality challenges the validity of previous meta-analyses that have pooled many diverse antioxidants for one single estimate of effect using the assumption that a single estimate equally applies to all antioxidants and all people. Trial registration: ClinicalTrials.gov NCT00342992.

Although the intake of specific flavonoid-rich foods may reduce C-reactive protein (CRP) levels, the association between dietary flavonoid intakes and CRP is inconsistent. We aim to describe dietary flavonoid intakes in a Taiwanese nationally representative sample and to investigate the association between flavonoid intakes and CRP. We conducted a cross-sectional study based on 2592 adults from the Nutrition and Health Survey in Taiwan 2005–8. Flavonoid intakes were estimated by linking the 24-h dietary recall with the U.S. Department of Agriculture flavonoid database and divided into quartiles. Adjusted estimates of the flavonoid intakes for the continuous and binary (elevated CRP: >0⋅3 mg/dl) variables were performed by using general linear and logistic regression. We found that tea, orange, tofu and sweet potato leaves/water spinach constituted the major food items of the total flavonoid intake. The total flavonoid intake was lower among women and elderly. Compared with the lowest total flavonoid intake quartile, participants in higher quartiles were associated with a lower CRP status (adjusted odds ratio (OR): 0⋅61, 95 % confidence interval (CI): 0⋅44–0⋅86 for the highest quartiles). The trends were similar for flavonol and flavan-3-ol intakes. Compared with non-consumers, tea consumers were likely to have a lower CRP status (adjusted OR: 0⋅74, 95 % CI: 0⋅57–0⋅97). In brief, a higher total flavonoid intake and tea consumption were inversely associated with CRP levels, indicating that a high-flavonoid diet may contribute to anti-inflammatory effects. A Taiwanese flavonoid content table is necessary for conducting further studies related to flavonoids in Taiwan.

Dietary fat is normally in TAG form, but diacylglycerol (DAG) is a natural component of edible oils. Studies have shown that consumption of DAG results in metabolic characteristics that are distinct from those of TAG, which may be beneficial in preventing and managing obesity. The objective of the present study was to investigate if food items in which part of the TAG oil is replaced with DAG oil combined with high α-linolenic acid (ALA) content would influence metabolic markers. A 12-week double-blinded randomised controlled parallel-design study was conducted. The participants (n 23) were healthy, overweight men and women, aged 37–67 years, BMI 27–35 kg/m2, with waist circumference >94 cm (men) and >88 cm (women). The two groups received 20 g margarine, 11 g mayonnaise and 12 g oil per d, containing either high ALA and sn-1,3-DAG or high ALA and TAG. Substitution of TAG oil with DAG oil in food items for 12 weeks led to an improvement of the predicted 10 years cardiovascular risk score in overweight subjects by non-significantly improving markers of health such as total body fat percentage, trunk fat mass, alanine aminotransferase, systolic blood pressure, γ-glutamyl transferase, alkaline phosphatase and total fat-free mass. This may suggest that replacing TAG oil with DAG oil in healthy, overweight individuals may have beneficial metabolic effects.

Insufficient vitamin D during pregnancy increases risk of adverse outcomes, with known differences by race/ethnicity. We sought to determine whether predictors of vitamin D insufficiency vary by race/ethnicity in an ethnically diverse pregnancy cohort. Plasma 25-hydroxyvitamin D concentrations and patient characteristics were measured at first prenatal visit to prenatal clinics in south-eastern USA between 2009 and 2011 (n 504). Prevalence ratios (PR) and 95 % CI were estimated using multivariable regression to quantify predictors of vitamin D insufficiency, overall and by race/ethnicity. In race/ethnicity-stratified models, season was most associated with vitamin D insufficiency among non-Hispanic white women; PR for winter v. summer were 3·58 (95 % CI 1·64, 7·81) for non-Hispanic white, 1·52 (95 % CI 1·18, 1·95) for Hispanic and 1·14 (95 % CI 0·99, 1·30) for non-Hispanic black women. Although women with darker skin tones are most vulnerable to prenatal vitamin D insufficiency, season may be more strongly associated with insufficiency among women with lighter skin tones.

The objective of the present study was to evaluate the contribution of voluntary fortified foods and supplements to reducing micronutrient shortfalls in the UK population. A secondary analysis of the UK National Diet and Nutrition Survey was conducted (2012/13–2013/14, N 2546, 1·5–95 years). Micronutrient intakes were derived from food consumption intake data and food composition data and calculated as the proportion below or above the Dietary Reference Values for males and females of different age groups, for those on a base diet only, users of fortified foods but no supplements and users of fortified foods and supplements. Of the population consuming a base diet only, 21–45 % and 5–29 % fell below the Estimated Average Requirement (EAR) for minerals and vitamins, respectively. About 3–13 % fewer consumers of fortified foods fell below the EAR for vitamins and minerals. Supplements barely reduced the prevalence of intakes below the EAR. Among supplement non-users and users, 99 and 96 % failed to meet the reference intakes for vitamin D. More women than men were at risk of inadequacies of micronutrient intakes. The prevalence of inadequacies declined with increasing age. Voluntary fortified foods but not supplements made a meaningful contribution to intakes of vitamin and minerals, without risk of unacceptably high intakes. These insights may help the UK to define approaches to address micronutrients of concern in vulnerable groups.

Fetal exposure to maternal undernutrition has lifelong consequences for physiological and metabolic function. Maternal low-protein diet is associated with an age-related phenotype in rats, characterised by a period of resistance to development of obesity in early adulthood, giving way to an obesity-prone, insulin-resistant state in later adulthood. Offspring of rats fed a control (18 % casein) or low-protein (9 % casein; LP) diet in pregnancy were challenged with a high-fat diet at 9 months of age. To assess whether other maternal factors modulated the programming effects of nutrition, offspring were studied from young (2–4 months old) and older (6–9 months old) mothers. Weight gain with a high-fat diet was attenuated in male offspring of older mothers fed LP (interaction of maternal age and diet; P = 0·011) and adipose tissue deposition was lower with LP feeding in both males and females (P < 0·05). Although the resistance to weight gain and adiposity was partially explained by lower energy intake in offspring of LP mothers (P < 0·001 males only), it was apparent that energy expenditure must be influenced by maternal diet and age. Assessment of locomotor activity indicated that energy expenditure associated with physical activity was unlikely to explain resistance to weight gain, but showed that offspring of older mothers were more anxious than those of younger mothers, with more rearing observed in a novel environment and on the elevated plus-maze. The data showed that in addition to maternal undernutrition, greater maternal age may influence development and long-term body composition in the rat.

Polyphenols have been suggested as protective factors for a range of chronic diseases. However, studying the impact of individual polyphenols on health is hindered by the intrinsic inter-correlations among polyphenols. Alternatively, studying foods rich in specific polyphenols fails to grasp the ubiquity of these components. Studying overall dietary patterns would allow for a more comprehensive description of polyphenol intakes in the population. Our objective was to identify clusters of dietary polyphenol intakes in a French middle-aged population (35–64 years old). Participants from the primary prevention trial SUpplementation en VItamines et Minéraux AntioXydants (SU.VI.MAX) study were included in the present cross-sectional study (n 6092; 57·8 % females; mean age 48·7 (sd 6·4) years). The fifty most consumed individual dietary polyphenols were divided into energy-adjusted tertiles and introduced in a multiple correspondence analysis (MCA), leading to comprehensive factors of dietary polyphenol intakes. The identified factors discriminating polyphenol intakes were used in a hierarchical clustering procedure. Four clusters were identified, corresponding broadly to clustered preferences for their respective food sources. Cluster 1 was characterised by high intakes of tea polyphenols. Cluster 2 was characterised by high intakes of wine polyphenols. Cluster 3 was characterised by high intakes of flavanones and flavones, corresponding to high consumption of fruit and vegetables, and more broadly to a healthier diet. Cluster 4 was characterised by high intakes of hydroxycinnamic acids, but was also associated with alcohol consumption and smoking. Profiles of polyphenol intakes allowed for the identification of meaningful combinations of polyphenol intakes in the diet.

Resistant maltodextrin (RMD) from various sources of starch has been extensively studied. However, studies which reported the effects of tapioca RMD (TRM) on glucose and insulin response are lacking. This study investigated the effect of TRM on postprandial plasma glucose and serum insulin in healthy subjects. Additionally, satiety and gastrointestinal tolerability were also evaluated. Sixteen healthy participants received five different treatments on five separate days. Participants received 50 g of either: glucose (GL), tapioca maltodextrin (TM), TRM, MIX15% (7⋅5 g TRM + 42⋅5 g TM) or MIX50% (25 g TRM + 25 g TM). Plasma glucose, serum insulin and subjective appetite responses were measured postprandially over 180 min. Gastrointestinal symptoms were evaluated by questionnaire before and after each test day. Results showed that at 30 min after treatment drinks, plasma glucose after TRM was significantly lowest (104⋅60 (sem 2⋅63 mg/dl) than after GL (135⋅87 (sem 4⋅88) mg/dl; P <0⋅001), TM (127⋅93 (sem 4⋅05) mg/dl; P = 0⋅001), MIX15% (124⋅67 (sem 5⋅73) mg/dl; P = 0⋅039) and MIX50% (129⋅33 (sem 5⋅23) mg/dl; P = 0⋅003) (1 mg/dl = 0⋅0555 mmol/l). In addition, TRM also significantly reduced serum insulin (13⋅01 (sem 2⋅12) μIU/ml) compared with GL (47⋅90 (sem 11⋅93) μIU/ml; P = 0⋅013), TM (52⋅96 (sem 17⋅68) μIU/ml; P = 0⋅002) and MIX50% (33⋅16 (sem 4⋅99) μIU/ml; P = 0⋅008). However, there were no significant differences in subjective appetite between treatments (P > 0⋅05). A single high dose of TRM (50 g) caused flatulence (P < 0⋅05). Tapioca resistant maltodextrin has low digestibility in the small intestine and, therefore, reduced incremental plasma glucose and serum insulin, without affecting satiety in healthy subjects over 180 min. Gastrointestinal tolerability of TRM should be considered when consumed in high doses.

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6–23 months in Ethiopia. We included 2960 children aged 6–23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6–23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6–23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9–11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12–17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18–23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

More than one-third of humans and companion dogs in Western societies are overweight or obese. In people, vitamin D deficiency is widespread and associated with obesity, a now recognised inflammatory state. Low vitamin D status occurs in dogs with inflammatory conditions, but its relationship with obesity has not been investigated. In otherwise healthy privately owned adult dogs of ideal body condition (control, n 7) and dogs with overweight to obese body condition (treatment, n 8), serum 25-hydroxyvitamin D (25(OH)D) concentration and body composition as inferred from 2H-labelled water dilution space were evaluated. Subsequently, the dogs were transitioned to a commercial canine therapeutic weight-loss diet; control dogs were fed to maintain body weight and treatment dogs were energy-restricted to achieve a safe weight-loss rate. Thereafter, serum 25(OH)D concentration was re-evaluated 8 weeks after diet transition, and at the study end, which was 6 months or when ideal body condition was achieved. At study end, body composition analysis was repeated. Initial body condition scores and percentage body fat were positively correlated (ρ = 0·891; P < 0·001). However, percentage body fat and serum 25(OH)D concentration were not significantly correlated. Final serum 25(OH)D concentrations were greater (P < 0·05) than initial concentrations for control and treatment groups, indicating a diet but not weight-loss effect on vitamin D status. These findings suggest that vitamin D status of dogs is not affected by obesity or loss of body fat with therapeutic weight reduction.

Chickens adapt to P and Ca restriction during the very first days of life by improving P utilisation efficiency. The present study was built to identify the mechanisms underlying this adaptive capacity, and to identify the optimal window of application of the restriction (depletion). A total of 1600 Cobb 500TM male broilers were used. During each phase (from age 0 to 4 d, 5 to 8 d, 9 to 18 d and 19 to 33 d), the animals received either a control diet (H) or a restricted diet (L) with reduced levels of non-phytate P (nPP) and Ca (between −14 and −25 % for both) with four dietary sequences: HHHH, HLHL, LHHL and LLHL. None of the feeding strategies affected growth. Tibia ash content at day 4 and 8 was impaired when the L diet was fed from 0 to 4 and 5 to 8 d, respectively (P = 0⋅038 and P = 0⋅005). Whatever the early restriction period or length between 0 and 8 d of age, the mineralisation delay was compensated by day 18. This was accompanied by an increased mRNA expression of the Ca transporter, CALB1, and an increased apparent ileal digestibility of Ca at day 8 (P < 0⋅001). This adaptation was limited to the starter phase in restricted birds. No effect was seen on P transporters mRNA or protein expression. In conclusion, birds adapted to mineral restriction by increasing Ca and nPP utilisation efficiencies. Depletion−repletion strategies are promising in improving the sustainability of broiler production but need to be validated in phytase-supplemented diets.

The objective of the study was to examine whether a nutritional antioxidant supplementation could improve visual function in healthy dogs as measured by electroretinography (ERG) and autorefraction. A total of twelve Beagles, 6 to 8 years of age, with normal eyes upon indirect ophthalmoscopy and slit lamp biomicroscopy, were age and sex matched and randomly assigned to receive a feeding regimen for 6 months with or without a daily antioxidant supplementation. Portable, mini-Ganzfeld ERG and a Welch Allyn hand-held autorefractor were used to test retinal response and refractive error in the dogs at baseline and at the end of the supplementation period. All ERG a-wave amplitudes obtained were increased in the treatment group compared with those of dogs in the control group, with significant improvements in the scotopic high and photopic single flash cone ERG responses (P < 0·05 for both). For the b-wave amplitudes, all responses were similarly increased, with significant improvements in responses for the scotopic high light intensity stimulation (P < 0·05), and for photopic single flash cone and 30 Hz flicker (P < 0·01 for both) recordings. Change in refractive error was significantly less in the treatment group compared with that of the control group during the 6-month study (P < 0·05). Compared with the control group, the antioxidant-supplemented group showed improvement to varying degrees for retinal function and significantly less decline in refractive error. Dogs, like humans, experience retinal and lens functional decline with age. Antioxidant supplementation as demonstrated may be beneficial and effective in the long-term preservation and improvement of various functions of the canine eye.

Lifestyle score approaches combining individual lifestyle factors, e.g. favourable diet, physical activity or normal body weight, showed inverse associations with cardiovascular disease (CVD) risk. However, research mainly focussed on adult behaviour and is scarce for vulnerable time windows for adult health like adolescence. We investigated associations between an adolescent lifestyle score and CVD risk markers in young adulthood. Overall, we analysed 270 participants of the open DONALD cohort study with 1–6 complete measurements of five lifestyle factors (healthy diet, moderate-to-vigorous physical activity, sedentary behaviour, sleep duration and BMI standard deviation score) during adolescence (females: 8⋅5–15⋅5 years and males: 9⋅5–16⋅5 years). Multivariable linear regression models were used to investigate the prospective association between the adolescent lifestyle score (0–5 points) and CVD risk markers in young adulthood (18–30 years). On average, participants obtained a mean adolescent lifestyle score of 2⋅9 (0–5) points. Inverse associations between the adolescent lifestyle score and waist circumference, waist-to-height ratio and percentage of body fat were observed (4⋅1, 4⋅1 and 9⋅2 % decrease per 1 point increase in adolescent lifestyle score, respectively, P < 0⋅05). For the remaining CVD risk markers (glucose, blood lipids, blood pressure and a proinflammatory score), no associations were observed. A healthy adolescent lifestyle is particularly associated with CVD risk-related favourable anthropometric markers in adulthood. A more comprehensive understanding of lifestyle patterns in the life course might enable earlier, targeted preventive measures to assist vulnerable groups in prevention of chronic diseases.

The aim of the present study was to determine whether the association between body mass index (BMI) and the intake of macronutrients varies along the BMI distribution of German adults. Based on a sample of 9214 men and women aged 18–80 years from the representative cross-sectional German National Nutrition Survey (NVS) II, quantile regression was used to investigate the association between BMI and the intake of macronutrients independent of energy intake and other predictors. In both sexes, BMI was positively associated with the intake of total protein and animal protein over its entire range and negatively associated with vegetable protein. A negative association between BMI and the intake of polysaccharides was found along the entire range of BMI in men. There was a weak negative association between BMI and the intake of total fat and saturated fatty acids observed in normal-weight-range women only. In conclusion, the association between BMI and the intake of macronutrients varies along the BMI range. Animal protein intake is positively associated with BMI independent of energy intake in both sexes whereas only in men an inverse association of polysaccharide intake with BMI was shown.

The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15–69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.

Past dietary patterns may be more important than recent dietary patterns in the aetiology of chronic diseases because of the long latency in their development. We developed an instrument to recall vegetarian dietary patterns during the lifetime and examined its reliability of recall over 5·3 and 32·6 years on average. The short-term/5-year recall ability study (5-RAS) was done using 24 690 participants from the cohort of the Adventist Health Study-2 (mean age 62·2 years). The long-term/33-year recall ability study (33-RAS) included an overlap population of 1721 individuals who joined the Adventist Health Study-1 and Adventist Health Study-2 (mean age 72·5 years). Spearman correlation coefficients for recall of vegetarian status were 0·78 and 0·72 for the 5-RAS and 33-RAS, respectively, when compared with ‘reference’ data. For both time periods sensitivity and positive predictive values were highest for the lacto-ovo-vegetarian and non-vegetarian patterns (vegans, lacto-ovo-vegetarians, pesco-vegetarians, semi-vegetarians and non-vegetarians). In the 5-RAS analyses, male, non-black, younger, and more educated participants, lifetime Adventists, and those with more stability of consumption of animal products generally showed higher recall ability. Somewhat similar tendencies were shown for the 33-RAS analyses. Our findings show that the instrument has higher reliability for recalled lacto-ovo-vegetarian and non-vegetarian than for vegan, semi- and pesco-vegetarian dietary patterns in both short- and long-term recalls. This is in part because these last dietary patterns were greatly contaminated by recalls that correctly would have belonged in the adjoining category that consumed more animal products.

To investigate the effect of coffee consumption on hip fracture risk, a meta-analysis was conducted. The PubMed database was screened for all published studies about coffee consumption and hip fracture through to November 2011. Reviews, PubMed option ‘related articles’ and references of retrieved papers were also searched for potentially relevant papers. Only studies that contained OR with 95 % CI for the association between coffee consumption and hip fracture risk were included. The summary risk estimates were calculated by fixed- and random-effects models. Subgroup analyses were carried out stratified by study designs and participant characteristics, respectively. A total of six prospective cohort studies and six case–control studies were included in the final analysis. The pooled OR displayed increased risk of hip fracture by 29·7 % (95 % CI 0·960, 1·751; P = 0·09) for the highest compared with the lowest coffee consumption by the random-effects model (P for heterogeneity = 0·000; I2 = 84·0 %), but the result had no statistical significance. Subgroup analyses showed that coffee consumption significantly increased hip fracture risk by 54·7 % (95 % CI 1·152, 2·077; P = 0·004) among women, by 40·1 % (95 % CI 1·015, 1·935; P = 0·040) for elderly participants aged over 70 years, and by 68·3 % for Northern Americans (95 % CI 1·492, 1·899; P = 0·000). Other subgroup analyses according to data published before the year 2000 showed a positive association between coffee and hip fracture risk, and follow-up duration also positively affected hip fracture risk, especially when the follow-up length was less than 13 years. Although our meta-analysis has provided insufficient evidence that coffee consumption significantly increases hip fracture risk, coffee intake may increase hip fracture risk among women, elderly participants and Northern Americans. No dose–response pattern was observed.