老人骨質狀況與代謝症候群危險因子之研究

The Relationship between Bone Status and Metabolic Syndrome Risks in the Elderly

蘇鈺幀(Yu-Chen Su)

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(2006年)

摘要

骨質疏鬆、高血脂、高血壓、高血糖與肥胖均為影響老人健康的慢性疾病。近年來研究結果指出，骨礦物質密度低與心血管疾病之間似乎有其相關性。本研究目的為了解台灣六十五歲以上老人之骨質狀況，與其和代謝症候群危險因子之關係。資料取自「1999-2000台灣地區老人營養健康狀況調查」中包含有問卷及體檢資料之1088位受測者，以可攜式超音波骨密度測量儀評估其腳跟骨質狀況，並調整其他與骨質相關之變項，觀察其與代謝症候群之相關性。
分析結果顯示，老人女性年齡層 (65歲以上小於70歲、70歲以上小於75歲、75歲以上小於80歲及80歲以上)由小至大之BUA z-score值之依序為-0.61 ± 0.07、-0.61 ± 0.11、-0.94 ± 0.12、-1.25 ± 0.12，顯示台灣老人女性之BUA z-score值隨著年齡增加而有降低的情形，骨質狀況隨年齡越大越差；而在男性並未發現此趨勢。此外在骨質與代謝症候群方面則發現，男性在調整年齡、地區層及抽菸等變項後，代謝症候群與骨質間並無顯著相關；而女性在調整體能年齡、地區層、活動量、嚼檳榔、鈣密度及尿磷/肌酸酐比值後發現有代謝異常危險因子一個(β = 0.41, p < 0.01)、兩個 ( β = 0.31, p < 0.05)或代謝症候群者 ( β = 0.53, p < 0.001)，均與BUA z-score有關。進一步探討發現，代謝症候群中危險因子「肥胖」為主要造成骨質與代謝症候群呈現正相關之因素。在調整其他變項後，發現肥胖與BUA z-score在男女性之相關性分別為β = 0.41 (p < 0.0001)與β = 0.32 (p < 0.01)。若將肥胖因子去除後則發現不論是老年男性或女性，代謝症候群與BUA z-score間已無關聯性存在 (p ≧ 0.05)。
本研究結果顯示在老年女性中骨質狀況與代謝症候群間可能有潛在相關性，且肥胖可能為主要影響骨質之因子，故在監測老人的骨質狀況時, 應注意其體重以及是否出現代謝異常的情形。

關鍵字

台灣地區營養健康狀況調查 ； 老人 ； BUA ； z-score ； 代謝症候群

並列摘要

Osteoporosis, dyslipidemia, hypertension, hyperglycemia, and obesity are common health problems among the older population. To investigate the relationship between bone status and metabolic syndrome in Taiwanese elders, data collected through the “Elderly Nutrition and Health Survey in Taiwan 1999-2000” was used. Bone status of the subjects was measured at heel with a portable quantitative ultrasound device, and the parameter BUA as well as corresponding z-score were generated by the software. A total of 1088 elderly men and women with complete questionnaire data and physical examination were included in the current analyses.
The mean BUA z-scores for women by age-group (65-69.9 years, 70-74.9 years, 75-79.9 years, and 80 years and above) were -0.61 ± 0.07, -0.61 ± 0.11, -0.94 ± 0.12, and -1.25 ± 0.12, respectively. It appears that bone density decreased with age in elderly women but not in elderly men. As to the relationship between bone status and metabolic syndrome, no significant relationship between these two health problems was observed in elderly males after the variables age, stratum, and smoking had been adjusted. In females, after adjusted for age, stratum, physical activity level, habit of chewing betel nuts, dietary calcium intake (as nutrient density), and urinary phosphorous (adjusted for creatinine), we found a positive relationship between women with metabolic disorders and BUA z-score (β = 0.41, p < 0.01 for those with any one disorder; β = 0.31, p < 0.05 for those with any two disorders; and β = 0.53, p < 0.001 for those with at least three disorders, respectively). The results of more in-depth analysis suggested that obesity is the major factor contribute to this positive relation; the regression coefficients of obesity on BUA z-score were 0.41 (p < 0.0001) for men and 0.32 (p < 0.01) for women after other variables were adjusted. The significant relationships between bone status and metabolic syndrome were no longer observed if the obese subjects were removed from the subsequent analyses (p≧0.05).
In conclusion, we found that metabolic syndrome and bone status may be related in Taiwanese elderly females, and obesity appears to be the major disorder contribute to this relationship. When bone status of the older population is monitored, more attention may need to be paid to their body weight as well as the symptoms of metabolic disorders.

並列關鍵字

Elderly Nutrition and Health Survey in Taiwan ； elderly ； BUA ； z-score ； metabolic syndrome

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