素食和骨質疏鬆相關性探討

Abstract

背景： 由於健康、文化和社會的考量，素食於全球與台灣皆逐漸成為飲食趨勢。然而有關素食飲食與較低骨密度（BMD）以及骨質疏鬆症風險之相關性仍需更多實研究探討。 研究目標： 本研究旨在評估素食主義與骨質疏鬆之間的相關性，並確定此相關性是否受到吸菸、牛奶飲用習慣及咖啡飲用習慣等其他因子所修飾。 方法： 本研究運用台灣苗栗縣竹南鎮社區醫院於竹南進行的社區篩檢，共招募611位社區居民。參與者被分為素食者和非素食者兩組，分別代表暴露組和未暴露組。主要結果為運用骨質密度（Bone marrow density，BMD）量測之骨質疏鬆。飲食習慣與相關干擾因子及交互作用則以問卷調查及健康檢查檢驗數據收集。BMD以雙能X光吸收測量法（DEXA）和定量超聲波量測。使用邏輯迴歸和隨機森林機器學習演算法評估素食與骨質疏鬆之間的相關性及修飾因子交互作用。 結果： 在611名參與者中，17.8%（100人）診斷為骨質疏鬆。素食者的骨質疏鬆風險（25.9%）高於非素食者（15.8%），女性（20.39%）高於男性（13.17%），70歲及以上的人群（34.9%）高於其他年齡組(包括60-69歲（20.9%），50-59歲（9.3%）和50歲以下（4.4%）)，初中或以下學歷者（27.1%）高於高中學歷者（11.7%）和大學或以上學歷者（8.9%）。調整骨質疏鬆相關影響因素後，素食者仍具有顯著較高的骨質疏鬆風險（調整後的勝算比[aOR]：2.57，95%信賴區間[CI]：1.33-4.99）。 本研究進一步探討素食與骨質疏鬆風險相關的修飾因子之間的交互作用影響。結果顯示素食對於骨質疏鬆之影響與牛奶攝取（P = 0.0292）、咖啡飲用（P = 0.0343）和吸菸（P = 0.0233）之間具有顯著交互作用。在吸菸者中，素食者的骨質疏鬆風險高於非素食者（未調整勝算比[cOR] = 7.88； aOR = 58.27，95% CI：7.36-461.25）。在非吸菸者中，此相關性較為減弱（cOR = 1.59，95% CI：0.88-2.86； aOR = 2.70，95% CI：1.19-6.12）。未有喝牛奶習慣的素食者其骨質疏鬆風險顯著增加（cOR = 4.50，95% CI：1.54-13.19； aOR = 28.1，95% CI：5.81-135.99）。具有喝牛奶習慣的素食者雖然骨質疏鬆風險較低但仍顯著高於非素食者（cOR = 1.49，95% CI：0.76-2.92； aOR = 5.59，95% CI：1.82-17.19）。未具有喝咖啡習慣的素食者具有較高的骨質疏鬆風險（cOR = 3.11，95% CI：1.45-6.65； aOR = 28.94，95% CI：6.97-120.12）。具喝咖啡習慣的素食者雖然骨質疏鬆風險較低但仍顯著高於非素食者（cOR = 1.04，95% CI：0.43-2.51； aOR = 5.42，95% CI：1.53-19.26）。 結論： 本研究證實了素食與骨質疏鬆之相關性。素食對於骨骨質疏鬆之影響程度受到吸菸、牛奶攝取與咖啡飲用習慣所修飾。

Background: Due to health, cultural, and social considerations, an increasing number of people in Taiwan are choosing a vegetarian diet. Evidence on the association between vegetarian diets and lower bone mineral density (BMD) related to osteoporosis risk has not been fully elucidated. Objectives: The study aimed to evaluate the association between vegetarianism and osteoporosis, and also to determine whether such association was modified by other related factors including smoking, milk intake, and coffee consumption. Material and Methods: A total of 611 community residents were enrolled in the study through a community-based screening service provided by a community hospital in Zhunan Township, Miaoli County, Taiwan. Participants were categorized into two groups: vegetarians and non-vegetarians, representing those exposed and not exposed to vegetarianism. The outcome of interest is osteoporosis measured by BMD. Data on dietary habits, confounding factors, and effect modifiers were collected through questionnaires and health examinations. BMD was measured using dual-energy X-ray absorptiometry (DEXA) and quantitative ultrasound. Logistic regression model and random forest machine learning algorithms were used to evaluate the associations between vegetarianism and osteoporosis and also interaction attributed to effect modifiers. Results: Among 611 participants 17.8% (100 individuals) were ascertained as osteoporosis. The risk of osteoporosis was higher in vegetarians (25.9%) compared to non-vegetarians (15.8%), females (20.39%) compared to males (13.17%), individuals aged >=70 years (34.9%) compared to other age group, including 60-69 years (20.9%), 50-59 years (9.3%), and <50 years (4.4%), and those with a junior high school education or below (27.1%) compared to those with a high school education (11.7%) and university education or above (8.9%). After adjusting for confounders, vegetarianism showed a statistically higher risk of osteoporosis compared to non-vegetarianism (adjusted odds ratio [aOR]: 2.57, 95% confidence interval [CI]: 1.33-4.99). The study further explored the interaction between vegetarianism and effect modifiers associated with the risk of osteoporosis. Significant interactions were found between vegetarianism and milk intake (P = 0.0292), coffee consumption (P = 0.0343), and smoking (P = 0.0233). Among smokers, vegetarians had a higher risk of osteoporosis than non-vegetarians (unadjusted odds ratio [cOR] = 7.88; aOR = 58.27, 95% CI: 7.36-461.25). However, this association was attenuated among non-smoker (cOR = 1.59, 95% CI: 0.88-2.86; aOR=2.70, 95% CI: 1.19-6.12). Non-milk-drinking vegetarians had a significantly increased risk of osteoporosis (cOR = 4.50, 95% CI: 1.54-13.19; aOR = 28.1, 95% CI: 5.81-135.99), while milk-drinking vegetarians had a lower but still significantly higher risk compared to non-vegetarians (cOR=1.49, 95% CI: 0.76-2.92; aOR=5.59, 95% CI: 1.82-17.19). Non-coffee-drinking vegetarians also showed a higher risk of osteoporosis (cOR = 3.11, 95% CI=1.45-6.65; aOR=28.94, 95% CI: 6.97-120.12), while coffee-drinking vegetarians had a lower but still significantly higher risk compared to non-vegetarians (cOR=1.04, 95% CI=0.43-2.51; aOR=5.42, 95% CI: 1.53-19.26). Conclusion: The study demonstrated positive associations between vegetarianism and osteoporosis, which were further modified by smoking, milk intake, and coffee consumption.