負重運動與飲食行為對中年婦女骨骼健全之影響

Effects of weight-bearing exercise and dietary behavior on the bone health of middle-aged females

施嘉美(Chia-Mei Shih)

指導教授 ： 湯馥君

國立臺灣師範大學/教育學院/人類發展與家庭學系/碩士(2007年)

摘要

本研究目的是探討負重運動與飲食行為對中年婦女骨骼健全間之相關性。研究對象為40~65歲之中年婦女，依運動習慣及停經與否分為四組：行經運動組21人 (47.8 ± 3.6歲)、停經運動組21人 (55.8 ± 1.9歲)、行經靜態組21人 (47.6 ± 3.6歲) 以及停經靜態組25人 (57.0 ± 3.4歲)；分別進行「飲食、運動與生活習慣問卷」、飲食態度問卷調查、身體組成、跟骨廣頻超音波衰減率及雙能量X光吸收值之測量、血清雌二醇與骨鹼性磷酸?之濃度分析，及尿液羥基脯胺酸、3-甲基組胺酸、鈣與脫氧??二酚胺等濃度及酸鹼值檢測。
結果發現，四組受試者對於自我體型認知上皆呈現不滿意，但並未影響其飲食態度。就飲食攝取而言，四組受試者每日熱量攝取皆未達建議量，而部分受試者卻對自我食量有高估的認知。蛋、豆、魚、肉類和水果類的攝取份數、乳製品之鈣攝取量、總蛋白質與動物性蛋白等食物攝取及三正餐熱量攝取之差異，源自於規律負重運動之從事與否 (p＜.05)。就身體組成而言，四組受試者之體脂重百分比、除脂體重百分比受規律負重運動之影響，同體重下，運動組有較高之除脂體重，靜態組則體脂重較高；腰臀比則受停經與否之影響，以停經組顯著高於行經組 (p＜.01)。就生化分析而言，受試者之血清雌二醇濃度以停經組顯著低於行經組 (p＜.0001)、血清骨鹼性磷酸?濃度則以停經組顯著高於行經組 (p＜.01)。尿液中之羥基脯胺酸濃度以停經組顯著高於行經組 (p＜.05)、尿液中之脫氧??二酚胺濃度則以運動組顯著低於靜態組 (p＜.05)。尿液中之3-甲基組胺酸、尿鈣等濃度及酸鹼值在各組間則無差異。就骨骼生理而言，受試者慣用腳 (r = .276, p＜.01) 、非慣用腳 (r = .386, p＜.001) 之跟骨廣頻超音波衰減率及雙能量X光吸收值 (r = .338, p＜.01) 與每週負重運動時間呈顯著正相關。但不論運動習慣為何，行經組雙腳之跟骨廣頻超音波衰減率及雙能量X光吸收值皆顯著高於停經組者 (p＜.0001)。停經運動組非慣用腳之跟骨廣頻超音波衰減率及雙能量X光吸收值皆分別顯著高於停經靜態組者 (p＜.05)，顯示規律的負重運動對骨骼具正面益處，特別是已停經者。停經組之每日熱量 (r = .355, p＜.05) 及植物性蛋白質攝取 (r = .300, p＜.05) 均與非慣用腳之跟骨廣頻超音波衰減率呈現正相關，且停經組之每日熱量 (r = .409, p＜.01) 及植物性蛋白質攝取 (r = .327, p＜.05) 亦與雙能量X光吸收值呈現正相關。靜態組之慣用腳 (r = .518, p＜.01)、非慣用腳 (r = .397, p＜.01) 之跟骨廣頻超音波衰減率及雙能量X光吸收值 (r = .443, p＜.01) 均與血清雌二醇呈顯著正相關。年齡與每週負重運動時間對雙能量X光吸收值具有35.0% (R2 = .350, p＜.0001 ) 之解釋力。
本研究受試中年婦女之體型意識並不影響其飲食態度。而從事規律負重運動之受試中年婦女，無論停經與否，其在飲食攝取、生理結構與營養代謝指標等皆優於靜態生活之中年婦女。而於停經婦女中，在缺乏雌二醇的保護下，規律負重運動及飲食攝取對於其骨骼健全之維護，則更是扮演著極其重要的角色。

關鍵字

負重運動 ； 雌二醇 ； 骨骼代謝指標 ； 跟骨廣頻超音波衰減率 ； 骨質密度

並列摘要

The purpose of this study was to explore the relationship among diet, exercise and the bone health of middle-aged females. Based on exercise habit and menstrual status, the middle-aged subjects (aged 40~65 years) were divided into four groups: premenopause/exercise group (n=21, 47.8 ± 3.6 y/o), postmenopause/exercise group (n=21, 55.8 ± 1.9 y/o), premenopause/sedentary group (n=21, 47.6 ± 3.6 y/o), and postmenopause/sedentary group (n=25, 57.0 ± 3.4 y/o). We examined the dietary behavior and exercise habits, Eating Attitudes Test (EAT-26), body composition, calcaneus broadband ultrasound attenuation (BUA), dual energy X-ray absorptiometry (DXA), serum concentrations of estradiol and bone alkaline phosphatase (BAP), urinary concentrations of hydroxyproline (HP), 3-methylhistidine (3-MH), calcium, deoxypyrodinoline (Dpd), and urinary pH value.
The female subjects were dissatisfied with their body image which did not affect their eating attitudes. Although self-perceived food intake was overestimated, yet, the energy intake was obviously below the recommendation ranges. Among the groups, the differences in the exchanges (Ex) of egg, bean, fish and meat, in the Ex of fruits, dairy calcium consumption, total protein, animal protein, and energy intake from meal were primarily due to the effect of weight-bearing exercise (p＜.05). The percentages of body fat mass and fat-free mass were affected by exercise: within the same body weight range, the fat-free mass of the exercise subjects tended to be higher than that of the sedentary subjects, whereas the fat mass was lower. The waist to hip ratio of the postmenopause subjects was significantly higher than that of the premenopause subjects (p＜.01). The serum estradiol concentration of the postmenopause subjects was lower than that of the premenopause subjects (p＜.0001), whereas serum BAP concentration was higher (p＜.01). The urinary HP concentration of the postmenopause subjects was significantly higher than that of the premenopause subjects (p＜.05), and the Dpd concentration of the exercise subjects was significantly lower than that of the sedentary subjects (p＜.05). There were no differences in the urinary 3-MH, calcium concentrations as well as the pH value among the four groups. There were positive relactionship between BUA of calcaneus of the dominant (r = .276, p＜.01) and non-dominant leg (r = .386, p＜.001), as well as DXA of lumbar spine (r = .338, p＜.01) and the weekly weight-bearing exercise time. The BMD of the premenopause subjects were significantly higher than the postmenopause subjects (p＜.0001), respectively, regardless of their exercise habits. The BUA of calcaneus of the non-dominant leg as well as DXA of lumbar spine in the postmenopause/exercise group were significantly higher than the postmenopause/sedentary group (p＜.05), respectively. It demonstrated that weight-bearing exercise played a protective role on bone quality and bone density, particularly for the postmenopause females. The energy (r = .355, p＜.05) and plant protein (r =.300, p＜.05) consumptions of the postmenopause subjects were positively associated with the BUA of calcaneus of the non-dominant leg. The energy (r = .409, p＜.01) and plant protein (r = .327, p＜.05) consumptions of the postmenopause subjects were also positively associated with their DXA data of lumbar spine. The BUA of calcaneus of the dominant leg (r = .518, p＜.01) and non-dominant leg (r = .397, p＜.01) and DXA of lumbar spine (r = .443, p＜.01) were positively associated with the serum estradiol concentration of the sedentary group, not the exercise group at all. Age and weekly weight-bearing exercise time explained 35.0% (R2 = .350, p＜.0001 ) of the variation on DXA of lumbar spine.
The body image of the middle-aged females did not affect their eating attitudes. Without the protection of estradiol, our results indicate that regular weight-bearing exercise and diet play important roles in the maintenance of bone health of middle-aged females.

並列關鍵字

weight-bearing exercise ； estradiol ； bone turnover markers ； broadband ultrasound attenuation ； bone density

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