老人骨質健康影響因素之探討─飲食及生活型態對骨骼相關指標之影響

The effects of dietary intake and lifestyle factors in relation to bone markers in the elderly

許雅芳(Ya-Fang Hsu)

指導教授 ： 林以勤

中山醫學大學/健康管理學院/營養學研究所/碩士(2007年)

https://doi.org/10.6834/CSMU.2007.00098

摘要

骨質疏鬆症是老年人健康上的隱形殺手，嚴重影響老年時的生活品質，營養調查顯示國內老人普遍有骨質不足或偏低的情況，一旦發生跌倒意外則容易引起骨折，其後遺症可能影響老年人的健康及生活。國外許多研究指出骨質健康與飲食營養及生活型態之間具有其相關性。本研究以「竹東朴子地區心臟血管疾病長期追蹤研究 (CVDFACTS)」六十五歲以上受試者為研究對象，以可攜式超音波骨密度測量儀評估其腳跟骨質狀況，觀察飲食攝取、生活型態與骨骼相關指標之間是否具有相關性以及影響五年間骨質變化之相關因素。
分析結果顯示，竹東及朴子地區老人體內的維生素D濃度多處於不足或缺乏邊緣。男性日光曝曬的程度及採取防曬措施與體內維生素D濃度多寡有關 (β= 0.03及-4.45, p<0.01)；而女性結果並未達顯著。此外在骨質與飲食及生活型態方面則發現，男性在調整年齡、居住地區、抽煙等變項後，骨代謝指標osteocalcin與BUA有關 (β= -0.90, p<0.01)；而另一項骨代謝指標ICTP則與BUA改變量有關 (β= -0.03, p<0.01)。而女性在調整年齡、居住地區、osteocalcin等變項後發現臀圍、蔬菜攝取及骨代謝指標ICTP與BUA有關 (β= 0.51, 0.19及-2.30, p<0.05)。
本研究結果顯示，居住於竹東及朴子地區的老年女性，蝕骨作用速率失衡為骨質下降的危險因子；而蔬菜類的攝取為骨質的保護因子。男性骨骼再塑作用 (bone remodeling)速率失衡是造成骨質下降及骨質改變的主因。然而並未發現體內維生素D濃度與骨質BUA之間的關係。因此建議老年人若適度的調整飲食習慣及生活型態，或許能改善骨質健康並預防骨質疏鬆。

關鍵字

老人 ； BUA ； 飲食 ； 生活型態 ； 骨骼指標

並列摘要

Osteoporosis in an important health concern in the elderly. The results of some studies have shown that dietary and lifestyle factors may independently influence bone health. The study was conducted to explore the effects of dietary intakes, lifestyle factors, and relate to bone markers on bone health in the elderly. The subjects in the current study were Taiwanese men and women aged 65 or above, residing in Chu-tung and Pu-tze who were originally recruited in 1989 for a cohort study (Cardiovascular Disease Risk Factor Two-township Study, CVDFACTS) and have had bone density measurements by quantitative ultrasound at heel in 1999-2001. Complete questionnaire interview and physical examination were obtained from the subjects, and bone status was measured at heel with a protable quantitative ultrasound device.
The serum 25(OH)D concentration is in general below the recommended level in the subjects. In men, there is a significant relationship between sun exposure and vitamin D concentration (β= 0.03, p<0.01 ), and use of sun-proof devices is negatively related to vitamin D concentration (β= -4.45, p<0.01). In addition, after adjusting for age, residing area, and smoking, negative relationships were observed between the bone turnover marker osteocalcin and BUA (β= -0.90, p<0.01), and between the bone resorption marker ICTP and change in BUA over 5 years (β= -0.03, p<0.01). In females, after adjusting for age, residing areas, and serum osteocalcin, significant positive relationships were observed between BUA and hip circumference (β= 0.51, p<0.01) as well as vegetable intake (β= 0.19, p<0.05). There was also a negative relationship between BUA and ICTP (β= -2.30, p<0.05).
In conclusion, we found that smoking and higher bone turnover rate, as indicated by higher concentration of bone markers, may be risk factors for lower bone density, and vegetable intake may have a positive effect on bone health in elderly females. In males, imbalanced bone turnover may affect bone status. No significant relationship between vitamin D and bone status were observed in these elderly subjects. Modification in dietary intake and lifestyle may benefit bone health in the elderly.

並列關鍵字

Elderly ； BUA ； dietary ； lifestyle factors ； bone markers

參考文獻

bone health and beyond? Nutrition 2006; 22: 845-52.

行政院衛生署 (2002) 國人營養素參考攝取量。

行政院衛生署 (2005) 每日飲食指南。

變遷調查結果 行政院衛生署 pp. 83-109.

American’s bone health: the state of osteoporosis and low bone mass in our nation. A report of the National Osteoporosis Foundation, 2002.