Association of the Alternative Healthy Eating Index with osteoporosis and muscle mass among U.S. adults aged 50 years and older

Objective: this study aimed to explore the association between the Alternative Healthy Eating Index (AHEI) and both osteoporosis and muscle mass among U.S. adults aged 50 years and older, using data from the National Health and Nutrition Examination Survey (NHANES). Methods: data from 9,466 participants were analyzed to examine the association between AHEI and osteoporosis, defined as a bone mineral density (BMD) T-score ≤ -2.5. Another 2,233 participants were included to evaluate the association between AHEI and muscle mass, measured by appendicular lean mass index (ALMI). Weighted multivariable logistic and linear regression analyses, restricted cubic spline (RCS) models, and subgroup analyses were conducted to investigate the relationships of AHEI with both outcomes. Results: compared with the lowest AHEI tertile (Q1), the highest tertile (Q3) was significantly associated with both a lower prevalence of osteoporosis (OR = 0.55, 95 % CI: 0.38-0.80; p = 0.002) and a reduced ALMI (β = -0.18, 95 % CI: -0.34 to -0.01; p = 0.039). The RCS analysis observed no significant nonlinear association, and subgroup analyses showed consistency across different population groups. Conclusion: a higher AHEI is significantly associated with a lower prevalence of osteoporosis and a lower ALMI among middle-aged and older U.S. adults, underscoring the necessity of developing more precise and personalized dietary interventions aimed at delaying age-related decline in both skeletal and muscular systems.