台灣中年女性代謝體、飲食型態與骨質密度之關聯研究

Abstract

背景: 隨著年齡的增長，骨質疏鬆症成為導致不同部位骨折（髖部、脊椎、肩部與其他部位）風險的疾病。不同於少數或單一營養素或食物的探討，飲食型態可全面了解各種營養素或食物對於骨質密度的關係。代謝體可以反映出生物體對於環境刺激（像是飲食、生活型態等）產生之交互作用及最終反應。飲食型態與代謝體對於骨質密度息息相關，但過去少有研究探討它們之間的關係。故本研究旨在探討代謝體、飲食型態與骨質密度之間的關係。由於停經狀態是骨質密度的重要危險因子，因此本研究對於以上的關係依停經狀態進行分層分析。 方法: 本篇研究為一橫斷性研究，於2009到2010年間，招募772位在臺北美兆健康檢查診所參與健康檢查的40至55歲臺灣女性。腰椎骨質密度使用雙能量放射線儀測量。所有的代謝物圖譜分析是利用500兆赫的核磁共振儀進行分析。飲食型態的資料乃以25題自填的半定量飲食問卷進行收集。因素分析用來挑選出飲食型態與代謝體型態，再利用典型相關分析找出飲食與代謝體型態之間的相關性。最後透過多變項邏輯斯迴歸分析模型來探討飲食與代謝體型態與骨質密度的關聯。 結果: 本研究發現停經婦女中，每增加一單位濃度之乳酸（調整後勝算比 = 0.42）、丙酮（調整後勝算比 = 0.41）、極低密度脂蛋白（調整後勝算比 = 0.36）和脂質（調整後勝算比 = 0.02）對於骨質密度也具有保護效果。相反地，每增加一單位濃度之穀氨醯胺（調整後勝算比 = 13.60）、乙酸鹽（調整後勝算比 = 5.48）或葡萄糖（調整後勝算比 = 1.26）則增加低骨質密度之風險。「海鮮以及乳製品」之攝取量達最高三分位數者（T3）比起最低三分位數者(T1) 之低骨質密度風險較低，（T3 vs. T1，調整後勝算比 = 0.12）。此外，停經後婦女代謝體中的乳酸 (調整後勝算比= 0.05)、丙酮 (調整後勝算比= 0.07) 及極低密度脂蛋白 (調整後勝算比= 0.06) 達最高三分位數者（T3）比起最低三分位數者(T1)對於低骨質密度具有保護的效果。然而，中三分位數（T2）以及最高三分位數（T3）的穀氨醯胺（T2，調整後勝算比 = 8.22；T3，調整後勝算比 = 10.04）與葡萄糖（T2，調整後勝算比 = 36.57；T3，調整後勝算比 = 8.99）則會增加低骨質密度的風險。對於低骨質密度的風險，飲食與代謝體型態並無交互作用。然而，分層分析中發現，在低攝取量（低與中三分位數）的「炸物、醃製類與主餐」飲食型態中，每增加一單位濃度的乳酸（調整後勝算比 = 0.35）、丙酮（調整後勝算比 = 0.41）、與極低密度脂蛋白（調整後勝算比 = 0.30）對於骨質密度是具有保護效果的。然而，每增加一單位濃度的穀氨醯胺（調整後勝算比 = 15.81）與葡萄糖（調整後勝算比 = 1.53）則會增加低骨質密度的風險。 結論: 高濃度的「海鮮與乳製品」攝取量與代謝體中之乳酸、丙酮以及極低密度脂蛋白，對於低骨質密度具有保護效果，但穀氨醯胺與葡萄糖濃度高時則會增加低骨質密度風險。「炸物、醃製與主餐類」飲食型態與代謝體之間有顯著相關。上述的飲食型態與代謝體可以用來早期偵測停經後婦女低骨質密度之風險並給予飲食建議。未來需要大型的前瞻性研究來驗證我們的發現。

Background: As population aging, osteoporosis is an important human disease that leads to increase the risk of fractures in hip, spine, shoulder, and other site. Unlike few or individual nutrients or food items, dietary pattern provide the overview of various foods or nutrients in relation to bone mineral density (BMD). The metabolome reflects the interactions and the ultimate responses of organism’s systems to environmental stimuli (e.g., diet, and life style). Both dietary pattern and metabolome are closely related to BMD, but few studies discussed about the association between these factors. Therefore, this study aimed to explore the association between metabolome, dietary pattern and BMD. Because postmenopausal status is an important risk factor for BMD, this study assessed the above association by menopausal status. Methods: This cross-sectional study recruited 772 Taiwanese women aged 40 to 55 years old from MJ Health Management Institution, Taipei, Taiwan (2009 – 2010). BMD (g/cm2) was measured at the lumbar spine by dual-energy X-ray absorptiometry (DXA, GE Lunar Health Care, DPX-L, USA). All plasma NMR spectra were acquired at 500.13 MHz using an Avance-500 spectrometer (Bruker, Fremont, CA , USA) at the 1H frequency. Dietary intake was collected by a 25-question, self-reported semi-quantitative food frequency questionnaire. Principal component analysis and partial least-squares discriminant analysis was used for identifying metabolome Factor analysis was utilized to identify dietary pattern. Multivariable logistic regression models were used to explore the association of metabolome, dietary pattern and low BMD. Results: Among postmenopausal women, the highest tertile (T3) of “seafood and dairy” pattern protected against low BMD (adjusted odds ratio [AOR] = 0.12). In addition, elevated levels of lactate (AOR = 0.42), acetone (AOR = 0.41), lipid (AOR = 0.02), and very low-density lipoprotein (VLDL, AOR = 0.36) levels protected against low BMD. In contrast, elevated glutamine (AOR = 13.60), acetate (AOR = 5.48), and glucose (AOR = 1.26) levels increased the risk of low BMD. Compared with the lowest tertile (T1), the T3 of lactate (AOR = 0.05), acetone (AOR = 0.07), and VLDL (AOR = 0.06) protected against low BMD. However, the higher tertiles (T2 and T3) of glutamine (T2 vs. T1: AOR = 8.22; T3 vs. T1: AOR = 10.04) and glucose (T2 vs. T1: AOR = 36.57; T3 vs. T1: AOR = 8.99) increased the risk of low BMD. No interaction was observed between dietary pattern groups and metabolome, and the risk of low BMD. After stratification of unhealthy patterns (T1 plus T2), elevated lactate (AOR = 0.35), acetone (AOR = 0.41), and VLDL (AOR = 0.30) levels protected against low BMD. In contrast, elevated glutamine (AOR = 15.81), and glucose (AOR = 1.53) levels increased the risk of low BMD. Conclusions: High intake of “seafood and dairy” dietary pattern, and high level of lactate, acetone, VLDL, and lipid protected against low BMD. In contrast, high glutamine, acetate, and glucose increased the risk of low BMD. “Fried, salted food and staples”dietary pattern was significantly correlated with metabolome. Dietary patterns and metabolome identified in this study may be useful for early detection of low BMD and dietary suggestions among postmenopausal women. Future large prospective studies are needed to confirm our findings.