Adherence to the Mediterranean diet regulates the association between osteopenia and the risk of all-cause mortality in general population

BACKGROUND: This study aimed to explore the association of adherence to the Mediterranean diet (MD), osteopenia and the risk of all-cause mortality in general population. METHODS: This retrospective cohort study included 5452 participants ≥ 50 years from the National Health and Nutrition Examination Survey (NHANES). The associations of osteopenia and adherence to the MD with all-cause mortality, as well as the interaction and moderating effects between the osteopenia and adherence to the MD on the all-cause mortality, were explored via univariate and multivariable Cox proportional hazards models. RESULTS: The follow-up was from October 1, 2006, to December 31, 2019. The median survival time of patients was 81 months. In total, 4724 people were survived and 728 were dead. Osteopenia was associated with increased risk of all-cause mortality in people [hazards ratio (HR) = 1.57, 95% confidence interval (CI) 1.23–1.99]. No significant risk of all-cause mortality was found in people with high adherence to the MD compared with those with low adherence to the MD (P > 0.05). Compared to subjects with no osteopenia who had high adherence to the MD, osteopenia people who had high adherence to the MD (HR = 1.52, 95% CI 1.17–1.98) or low adherence to the MD (HR = 1.81, 95% CI 1.23–2.66) were at increased risk of all-cause mortality after adjusting for confounding factors. The relationship between osteopenia and the risk of all-cause mortality was decreased in those with high adherence to the MD (HR = 1.57, 95% CI 1.17–2.11) compared with those with low adherence to the MD (HR = 1.62, 95% CI 1.08–2.41) after adjusting for confounding factors. CONCLUSION: The adherence to the MD regulated the association between osteopenia and the risk of all-cause mortality, which suggested the importance of adherence to the MD in those with osteopenia, and the MD could be advocated in general people. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41043-023-00447-6.