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Eating Behavior Traits, Weight Loss Attempts, and Vertebral Dimensions Among the General Northern Finnish Population

Oura, Petteri MD, PhD∗,†,‡; Niinimäki, Jaakko MD, PhD∗,†,‡; Karppinen, Jaro MD, PhD∗,‡,§; Nurkkala, Marjukka MSc (nutrition)∗,‡,¶

doi: 10.1097/BRS.0000000000003123

Study Design. A population-based birth cohort study.

Objective. To evaluate the associations of eating behavior traits and weight loss attempts with vertebral size among the general Northern Finnish population.

Summary of Background Data. Vertebral fragility fractures are a typical manifestation of osteoporosis, and small vertebral dimensions are a well-established risk factor for vertebral fracturing. Previous studies have associated cognitive eating restraint and diet-induced weight loss with deteriorated bone quality at various skeletal sites, but data on vertebral geometry are lacking.

Methods. This study of 1338 middle-aged Northern Finns evaluated the associations of eating behavior traits (flexible and rigid cognitive restraint of eating, uncontrolled eating, emotional eating; assessed by the Three-Factor Eating Questionnaire-18) and weight loss attempts (assessed by a separate questionnaire item) with magnetic resonance imaging-derived vertebral cross-sectional area (CSA). Sex-stratified linear regression models were used to analyze the data, taking body mass index, leisure-time physical activity, general diet, smoking, and socioeconomic status as potential confounders.

Results. Women with rigid or rigid-and-flexible cognitive eating restraints had 3.2% to 3.4% smaller vertebral CSA than those with no cognitive restraint (P ≤ 0.05). Similarly, the women who reported multiple weight loss attempts in adulthood and midlife had 3.5% smaller vertebral size than those who did not (P = 0.03). Other consistent findings were not obtained from either sex.

Conclusion. Rigid cognitive eating restraint and multiple weight loss attempts predict small vertebral size and thus decreased spinal health among middle-aged women, but not among men. Future longitudinal studies should confirm these findings.

Level of Evidence: 3

In a birth cohort sample of 1338 Northern Finns, the women who reported multiple weight loss attempts or rigid (or rigid-and-flexible) cognitive eating restraint had smaller vertebral size than those who did not. These means of eating and dieting seem to predict decreased spinal health among middle-aged women.

Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland

Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland

Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland

§Finnish Institute of Occupational Health, Finland

Department of Sports and Exercise Medicine, Oulu Deaconess Institute, Oulu, Finland.

Address correspondence and reprint requests to Petteri Oura, MD, PhD, Center for Life Course Health Research, Faculty of Medicine, FI-90014 University of Oulu, PO Box 5000, Oulu, Finland; E-mail:

Received 15 January, 2019

Revised 21 March, 2019

Accepted 16 May, 2019

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

NFBC1966 received financial support from the University of Oulu (Grant no. 65354, 24000692), the Oulu University Hospital (Grant no. 2/97, 8/97, 24301140), the Finnish Ministry of Health and Social Affairs (Grant no. 23/251/97, 160/97, 190/97), the Finnish National Institute for Health and Welfare (Grant no. 54121), Regional Institute of Occupational Health, Oulu, Finland (Grant no. 50621, 54231), and the European Regional Development Fund (Grant no. 539/2010 A31592).

Relevant financial activities outside the submitted work: board membership, payment for lecture.

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