{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T23:54:28Z","timestamp":1789430068005,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T00:00:00Z","timestamp":1716768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009800","name":"Wenzhou Medical University","doi-asserted-by":"publisher","award":["89219029"],"award-info":[{"award-number":["89219029"]}],"id":[{"id":"10.13039\/100009800","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>With the global aging population, addressing prevalent age-related conditions such as osteoporosis and sarcopenia is crucial. Traditional nutritional strategies focusing on single nutrients like calcium, vitamin D, or protein have limitations, prompting a nuanced exploration of the relationship between aging, nutrition, and musculoskeletal health. This cross-sectional study examines the complex interplay between dietary intake of macronutrients, common micronutrients, and water, as well as their association with musculoskeletal health in adults aged 50 to 80 years, using U.S. National Health and Nutrition Examination Survey data (NHANES). Employing multiple linear regression, restricted cubic splines, weighted quantile sum (WQS), and quantile-based g-computation (QGC) regression models, our initial analysis using the WQS model revealed that a one-quartile increase in mixed macronutrient intake was associated with a significant 0.009 unit increase in bone mineral density (BMD) and a 0.670 unit increase in grip strength, while a similar increase in mixed micronutrient intake showed a 0.007 unit increase in BMD and a 0.442 unit increase in grip strength. Our findings highlight the importance of a balanced dietary approach in promoting musculoskeletal health in the elderly, offering holistic strategies for overall well-being.<\/jats:p>","DOI":"10.3390\/nu16111640","type":"journal-article","created":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T08:36:22Z","timestamp":1716798982000},"page":"1640","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Synergistic Effects of Nutrients on Musculoskeletal Health in Gerontology: Understanding the Combined Impact of Macronutrients and Micronutrients"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8652-1987","authenticated-orcid":false,"given":"Yupeng","family":"Liu","sequence":"first","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyu","family":"Qian","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Shi","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqi","family":"Jing","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hangqian","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiling","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dapeng","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuran","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Wenzhou Medical University, Wenzhou 325035, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/jcsm.12238","article-title":"Skeletal Muscle Performance and Ageing","volume":"9","author":"Tieland","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1111\/jgs.17043","article-title":"The Prevention of Osteoporosis and Sarcopenia in Older Adults","volume":"69","author":"Coll","year":"2021","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/S0140-6736(18)32112-3","article-title":"Osteoporosis","volume":"393","author":"Compston","year":"2019","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1093\/qjmed\/94.2.53","article-title":"Nutrition and Bone: Is There More to It than Just Calcium and Vitamin D?","volume":"94","author":"Reid","year":"2001","journal-title":"QJM"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e79002","DOI":"10.7554\/eLife.79002","article-title":"The Effect of Calcium Supplementation in People under 35 Years Old: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"11","author":"Liu","year":"2022","journal-title":"eLife"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European Consensus on Definition and Diagnosis: Report of the European Working Group on Sarcopenia in Older People","volume":"39","author":"Baeyens","year":"2010","journal-title":"Age Ageing"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1152\/japplphysiol.00246.2003","article-title":"Age-Associated Changes in Skeletal Muscles and Their Effect on Mobility: An Operational Diagnosis of Sarcopenia","volume":"95","author":"Lauretani","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/jcsm.12394","article-title":"Protein Supplementation Improves Lean Body Mass in Physically Active Older Adults: A Randomized Placebo-controlled Trial","volume":"10","author":"Eijsvogels","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.jamda.2019.09.006","article-title":"Effect of Protein Supplementation on Physical Performance in Older People With Sarcopenia\u2014A Randomized Controlled Trial","volume":"21","author":"Suominen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.clnu.2020.08.017","article-title":"Effects of Adequate Dietary Protein with Whey Protein, Leucine, and Vitamin D Supplementation on Sarcopenia in Older Adults: An Open-Label, Parallel-Group Study","volume":"40","author":"Lin","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz-Garach, A., Garc\u00eda-Fontana, B., and Mu\u00f1oz-Torres, M. (2020). Nutrients and Dietary Patterns Related to Osteoporosis. Nutrients, 12.","DOI":"10.3390\/nu12071986"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.clnu.2017.08.016","article-title":"Does Nutrition Play a Role in the Prevention and Management of Sarcopenia?","volume":"37","author":"Robinson","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.mcna.2022.04.008","article-title":"Nutritional Aspects of Healthy Aging","volume":"106","author":"Panda","year":"2022","journal-title":"Med. Clin. N. Am."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zhao, F., He, L., Zhao, L., Guo, Q., Yu, D., Ju, L., and Fang, H. (2021). The Status of Dietary Energy and Nutrients Intakes among Chinese Elderly Aged 80 and Above: Data from the CACDNS 2015. Nutrients, 13.","DOI":"10.3390\/nu13051622"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"115253","DOI":"10.1016\/j.ecoenv.2023.115253","article-title":"Association between Brominated Flame Retardants Exposure and Markers of Oxidative Stress in US Adults: An Analysis Based on the National Health and Nutrition Examination Survey 2007\u20132016","volume":"263","author":"Han","year":"2023","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"He, X., Hu, W., Zhang, Y., Chen, M., Ding, Y., Yang, H., He, F., Gu, Q., and Shi, Q. (2023). Cellular Senescence in Skeletal Disease: Mechanisms and Treatment. Cell Mol. Biol. Lett., 28.","DOI":"10.1186\/s11658-023-00501-5"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/jcsm.12870","article-title":"Associations of Osteoporosis and Sarcopenia with Frailty and Multimorbidity among Participants of the Hertfordshire Cohort Study","volume":"13","author":"Laskou","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"482940","DOI":"10.1155\/2015\/482940","article-title":"Sarco-Osteoporosis: Prevalence and Association with Frailty in Chinese Community-Dwelling Older Adults","volume":"2015","author":"Wang","year":"2015","journal-title":"Int. J. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.jamda.2020.07.032","article-title":"Osteosarcopenia Predicts Falls, Fractures, and Mortality in Chilean Community-Dwelling Older Adults","volume":"22","author":"Salech","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E921","DOI":"10.1152\/ajpendo.90536.2008","article-title":"Functional Impact of High Protein Intake on Healthy Elderly People","volume":"295","author":"Walrand","year":"2008","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1359\/jbmr.2000.15.12.2504","article-title":"Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study","volume":"15","author":"Hannan","year":"2000","journal-title":"J. Bone Miner. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zheng, Y., Wang, J., Wang, Y., Xu, K., and Chen, X. (2023). The Hidden Dangers of Plant-Based Diets Affecting Bone Health: A Cross-Sectional Study with U.S. National Health and Nutrition Examination Survey (NHANES) Data from 2005\u20132018. Nutrients, 15.","DOI":"10.3390\/nu15071794"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.mad.2013.11.009","article-title":"Water-Loss Dehydration and Aging","volume":"136\u2013137","author":"Hooper","year":"2014","journal-title":"Mech. Ageing Dev."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lorenzo, I., Serra-Prat, M., and Y\u00e9benes, J.C. (2019). The Role of Water Homeostasis in Muscle Function and Frailty: A Review. Nutrients, 11.","DOI":"10.3390\/nu11081857"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wu, D., Qu, C., Huang, P., Geng, X., Zhang, J., Shen, Y., Rao, Z., and Zhao, J. (2023). Water Intake and Handgrip Strength in US Adults: A Cross-Sectional Study Based on NHANES 2011\u20132014 Data. Nutrients, 15.","DOI":"10.3390\/nu15204477"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1093\/ajcn\/77.2.504","article-title":"Calcium, Vitamin D, Milk Consumption, and Hip Fractures: A Prospective Study among Postmenopausal Women","volume":"77","author":"Feskanich","year":"2003","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s00421-019-04104-x","article-title":"Mechanisms of Vitamin D on Skeletal Muscle Function: Oxidative Stress, Energy Metabolism and Anabolic State","volume":"119","author":"Dzik","year":"2019","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1301831","DOI":"10.3389\/fnut.2024.1301831","article-title":"Associations of Micronutrient Dietary Patterns with Sarcopenia among US Adults: A Population-Based Study","volume":"11","author":"Liu","year":"2024","journal-title":"Front. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.freeradbiomed.2022.08.002","article-title":"Reactive Sulfur and Selenium Species in the Regulation of Bone Homeostasis","volume":"190","author":"Gilbert","year":"2022","journal-title":"Free Radic. Biol. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lee, S.-C., Lee, N.-H., Patel, K.D., Jang, T.-S., Knowles, J.C., Kim, H.-W., Lee, H.-H., and Lee, J.-H. (2021). The Effect of Selenium Nanoparticles on the Osteogenic Differentiation of MC3T3-E1 Cells. Nanomaterials, 11.","DOI":"10.3390\/nano11020557"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.jamda.2023.05.017","article-title":"Minerals and Sarcopenia in Older Adults: An Updated Systematic Review","volume":"24","author":"Fultinga","year":"2023","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s12603-017-0960-x","article-title":"Association between Salivary Hypofunction and Food Consumption in the Elderlies. A Systematic Literature Review","volume":"22","author":"Feron","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Zhang, R., Huang, Q., Su, G., Wei, M., Cui, Y., Zhou, H., Song, W., Di, D., Liu, J., and Wang, Q. (2023). Association between Multiple Vitamins and Bone Mineral Density: A Cross-Sectional and Population-Based Study in the NHANES from 2005 to 2006. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06202-6"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/11\/1640\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:49:26Z","timestamp":1760107766000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/11\/1640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,27]]},"references-count":33,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["nu16111640"],"URL":"https:\/\/doi.org\/10.3390\/nu16111640","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,27]]}}}