Positive associations of dietary intake and plasma concentrations of vitamin E with skeletal muscle mass, heel bone ultrasound attenuation and fracture risk in the EPIC–Norfolk cohort

Angela Mulligan, Richard Hayhoe, Robert Luben, Ailsa Welch

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The prevalence of sarcopenia, frailty and fractures is increasing. Prevention options are limited, but dietary factors including vitamin E have the potential to confer some protection. This study investigated cross-sectional associations between dietary and plasma concentrations of vitamin E with indices of skeletal muscle mass (SMM) (n = 14,179 and 4283, respectively) and bone density (n = 14,694 and 4457, respectively) and longitudinal fracture risk (n = 25,223 and 7291, re-spectively) in European Prospective Investigation Into Cancer and Nutrition (EPIC)-Norfolk participants, aged 39–79 years at baseline. Participants completed a health and lifestyle questionnaire, a 7-day diet diary (7dDD) and had anthropometric measurements taken. Fat-free mass (as a SMM proxy) was measured using bioimpedance and bone density was measured using calcaneal broad-band ultrasound attenuation (BUA) and incident fractures over 18.5 years of follow-up. Associations between indices of SMM, BUA and fracture risk were investigated by quintiles of dietary vitamin E intake or plasma concentrations. Positive trends in SMM indices and BUA were apparent across dietary quintiles for both sexes, with interquintile differences of 0.88%–1.91% (p < 0.001), and protective trends for total and hip fracture risk. Circulating plasma α-and γ-tocopherol results matched the overall dietary findings. Dietary vitamin E may be important for musculoskeletal health but further investigation is required to fully understand the relationships of plasma tocoph-erols.

Original languageEnglish
Article number159
Issue number2
Early online date22 Jan 2021
Publication statusPublished - Feb 2021


  • sarcopenia
  • frailty
  • skeletal muscle
  • bone density status
  • fracture risk
  • vitamin E
  • Sarcopenia
  • Vitamin E
  • Bone density status
  • Frailty
  • Fracture risk
  • Skeletal muscle

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