台灣女性之飲食型態與骨質密度關聯性研究

Abstract

背景 飲食與骨質疏鬆症有密不可分的關係，過去探索飲食型態與骨質密度的研究相當稀少且結果並不一致。由於停經對於骨質密度的影響甚鉅，但以往並無研究同時探討及比較停經狀態對於不同飲食型態與骨質密度關係的影響。同時，飲食型態和其他風險或保護因子之交互作用對於骨質密度的影響並不清楚。 方法 此研究為橫斷性設計，於2009 至2010 年間，招募了1,567 位年齡介於40及55 歲至台北美兆健康檢查中心參加健康檢查的台灣女性。腰椎骨質密度使用雙能量放射線儀測量;飲食型態的資料則使美兆健檢的自填25 題半定量飲食問卷收集，再利用因素分析找出對於骨質密度解釋力最強的幾種飲食型態。接著依總人數將因素分數切為三組(高、中、低)，依此分數來比較不同攝取量與骨質密度的相關。 此外，本研究亦進行分層分析，以探討停經狀態與其他風險或保護因子如何影響飲食型態與骨質密度之關係。 結果 本研究發現，女性之「蔬菜與水果」攝取為中等量時，有保護骨質密度過低的風險(調整後勝算比= 0.66, 95%信賴區間= 0.46-0.94)。分層分析發現，以上的關係在停經前(調整後勝算比= 0.58, 95%信賴區間= 0.39-0.86)、正常身體質量指數(大於18.5 到小於24 kg/m2：調整後勝算比= 0.62, 95%信賴區間= 0.41-0.93)、不喝酒(調整後勝算比= 0.64, 95%信賴區間= 0.44-0.92)、不抽菸(調整後勝算比= 0.67,95%信賴區間= 0.47-0.97)或無規則運動習慣的女性(小於每次30 分鐘且每週少於3 次：調整後勝算比= 0.43, 95%信賴區間= 0.26-0.71)依舊存在。除此之外，若女性抽菸且攝取中等量的「醃製醬菜與泡麵」，其低骨質密度風險顯著上升(調整後勝算比= 8.74, 95%信賴區間= 1.43-53.43)。 結論 中等「蔬菜與水果」形態的攝取能保護骨質密度過低，此關係在尚未停經、正常身體質量指數、不喝酒、不抽菸或無規則運動的女性依然存在。然而，攝取中等量之「醃製醬菜與泡麵」型態的吸菸女性，低骨質密度的風險則會升高。

Background Diet has been closely associated with osteoporosis. Few studies have explored the associated between dietary pattern and bone mineral density (BMD) and results were inconsistent. It is well known that menopausal status has a great impact on BMD, however, no study include both pre- and postmenopausal women and compare how menopausal status affect the association between dietary pattern and BMD. Meanwhile, it is unclear how some risk or protective factors modify the association above. Material and Methods This is a cross-sectional study. A total of 1,567 women aged 40 to 55 were recruited from MJ Health Management Institution in Taipei, Taiwan (2009-2010).Bone mineral density (BMD, g/cm2) was measured at lumbar spine by using dual-energy X-ray absorptiometry. Based on a 25-question semi-quantitative food frequency questionnaire, factor analysis was performed to identify dietary patterns that can well explain the variation of BMD. Factor score of each food item was tertiled (high, medium, low) to explore the association between factor score and BMD. In addition, stratified analyses were performed to explore how menopausal status, other risk or protective factors affect the association between dietary patterns and BMD. Results Medium “vegetables and fruits” pattern protects against low BMD in women [adjusted OR (AOR) = 0.66, 95% confidence interval (CI) = 0.46-0.94]. After stratification, the association above remains significant among premenopausal women (AOR = 0.58, 95% CI = 0.39-0.86), women with normal BMI (18.5 to < 24 kg/m2:AOR = 0.62, 95% CI = 0.41-0.93), women who are non-drinkers (AOR = 0.64, 95% CI = 0.44-0.92), never-smokers (AOR = 0.67, 95% CI = 0.47-0.97) or lack of regular exercise (< 30 minutes/time and < 3 days/week, AOR = 0.43, 95% CI = 0.26-0.71). In contrast, medium “salted pickles and instant noodles” pattern is associated with low BMD among smoking women (AOR = 8.74, 95% CI = 1.43-53.43). Conclusions Medium “vegetables and fruits pattern” protects against low BMD. This association remains in premenopausal women, women with normal BMI, or women who are non-drinkers, never smokers, or lack of regular exercise. In contrast, medium “salted pickles and instant noodles” pattern is associated with low BMD among smoking women.