0.79 $4 cups 2,041 202,877 10.1 0.87 0.91 447 211,106 two.1 0.85 0.89 CI: self-assurance interval, HR: hazard ratio. a Covariates included were: intake of total energy, calcium, retinol, vitamin D, potassium, phosphorus, protein, alcohol, physique mass index, height, physical activity , intake of any vitamins, cortisone use, educational level, smoking status, earlier fractures and Charlson’s comorbidity index. doi:10.1371/journal.pone.0097770.t002 of few fractures, that the only exposure thought of was caffeine as a pooled estimate, i.e. the exposure calculation included not just coffee, or that coffee BTZ-043 chemical information consumption was regarded as any vs. no consumption. The present study exceeds by far the total number of hip fractures in preceding cohort research as well as had the possibility to study a big variety of fractures of any variety. Strengths and Limitations Among by far the most essential strengths of our study is the fact that we had the chance to collect information from a big population-based cohort of middle-aged and elderly guys throughout a imply follow-up of 11.3 years. Such a follow-up is sufficiently long to observe an sufficient variety of fractures. Because all fractures have been identified by the usage of registers, we believe that the risk of not obtaining detected guys having a fracture for the duration of follow-up is little. There was considerable variation in consumption of coffee in this cohort having a large quantity of participants consuming high amounts of coffee, which improves the probabilities of detecting associations. Within this context it should be noted that the consumption of decaffeinated coffee is quite low in Sweden . Additionally, we didn’t focus on intake of caffeine, but on consumption of coffee, which might be yet another advantage in that numerous research have indicated that tea could have a optimistic influence on BMD and fracture threat, likely since of the fluoride, phytoestrogen or antioxidant content of tea. Lastly, it should be doable to generalise our outcomes to all males in Sweden simply because the participants nicely represent the supply population. We also acknowledge many possible limitations. Simply because this investigation is based on data from one single FFQ, some degree of error in the exposure measurement can’t be excluded. Attenuation of a correct association is probably in that the potentially resulting misclassification possibly would be non-differential. Fractures linked with high trauma were not excluded simply because a comparable increased danger of both low- and high-trauma fracture with decreasing bone density inside the elderly has been indicated. Nonetheless, there has been discourse as to whether or not inclusion of both high and low impact fractures will result in a reduce danger estimate compared with low trauma fractures only. Despite controlling for known important threat elements for fractures, which includes comorbidity, it is actually still doable that residual confounding could have influenced the results of this study. As an illustration, we couldn’t adjust for vitamin D status or sunlight exposure within the current study. Nevertheless, we have previously shown that the effect of coffee intake on BMD was not get 79983-71-4 stronger among girls with low vitamin D status. The importance with the dietary supply of protein around the association involving coffee consumption and fracture could not be assessed in the present study. There is certainly to date no consensus around the relation involving dietary protein and fracture risk but recent systematic evaluations and meta-analyses recommend that the postulated dietary acidic load exaggerated by protein intak.0.79 $4 cups 2,041 202,877 ten.1 0.87 0.91 447 211,106 2.1 0.85 0.89 CI: self-confidence interval, HR: hazard ratio. a Covariates integrated have been: intake of total power, calcium, retinol, vitamin D, potassium, phosphorus, protein, alcohol, body mass index, height, physical activity , intake of any vitamins, cortisone use, educational level, smoking status, earlier fractures and Charlson’s comorbidity index. doi:10.1371/journal.pone.0097770.t002 of handful of fractures, that the only exposure viewed as was caffeine as a pooled estimate, i.e. the exposure calculation included not just coffee, or that coffee consumption was regarded as any vs. no consumption. The present study exceeds by far the total number of hip fractures in preceding cohort research and also had the possibility to study a sizable variety of fractures of any form. Strengths and Limitations Certainly one of by far the most important strengths of our study is that we had the opportunity to gather information from a big population-based cohort of middle-aged and elderly guys through a mean follow-up of 11.3 years. Such a follow-up is sufficiently lengthy to observe an adequate quantity of fractures. Since all fractures have been identified by the usage of registers, we think that the threat of not having detected males with a fracture during follow-up is modest. There was considerable variation in consumption of coffee within this cohort with a massive variety of participants consuming higher amounts of coffee, which improves the possibilities of detecting associations. Within this context it should really be noted that the consumption of decaffeinated coffee is extremely low in Sweden . Furthermore, we didn’t focus on intake of caffeine, but on consumption of coffee, which might be a different advantage in that various studies have indicated that tea could possess a positive influence on BMD and fracture danger, in all probability mainly because of the fluoride, phytoestrogen or antioxidant content of tea. Ultimately, it ought to be probable to generalise our results to all men in Sweden because the participants nicely represent the supply population. We also acknowledge many potential limitations. Because this investigation is based on information from a single single FFQ, some degree of error in the exposure measurement cannot be excluded. Attenuation of a correct association is likely in that the potentially resulting misclassification almost certainly could be non-differential. Fractures related with higher trauma weren’t excluded for the reason that a comparable enhanced threat of each low- and high-trauma fracture with decreasing bone density inside the elderly has been indicated. Having said that, there has been discourse as to whether or not inclusion of each higher and low impact fractures will lead to a decrease threat estimate compared with low trauma fractures only. Despite controlling for identified main risk things for fractures, like comorbidity, it is nevertheless doable that residual confounding could have influenced the results of this study. For instance, we couldn’t adjust for vitamin D status or sunlight exposure inside the present study. On the other hand, we have previously shown that the effect of coffee intake on BMD was not stronger amongst women with low vitamin D status. The significance of the dietary supply of protein around the association between coffee consumption and fracture couldn’t be assessed inside the present study. There is certainly to date no consensus on the relation between dietary protein and fracture danger but recent systematic critiques and meta-analyses recommend that the postulated dietary acidic load exaggerated by protein intak.
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