北京市中老年女性月经及身体成分与骨密度的相关性研究

目的调查北京市中老年女性年龄、月经和身体成分特征,分析其与骨密度的关系以及对骨密度的影响。方法招募45～80岁女性384名,调查受试者月经状况,包括初潮年龄、绝经年龄和绝经年限;测试受试者腰椎、左股骨颈、左髋以及全身骨密度,并测试全身脂肪和肌肉含量,由此计算脂肪含量指数(fat mass index,FMI)、肌肉含量指数(lean mass index,LMI)和四肢骨骼质量指数(appendicular skeletal muscle mass index,ASMI)。采用Pearson相关和多元逐步回归模型分析各因素与骨密度的关系。结果相关性结果显示,年龄、绝经年限、初潮年龄与骨密度呈显著负相关,绝经年龄、LMI、FMI和ASMI与骨密度呈显著正相关。多元逐步回归分析结果显示,绝经年限与各部位骨密度均呈显著负相关,ASMI与各部位骨密度均呈显著正相关,FMI仅与全髋和全身骨密度具有显著相关性,初潮年龄和绝经年龄仅与腰椎和全身骨密度具有显著相关性。结论绝经年限是中老年女性骨密度的独立危险因素,而ASMI则为独立保护因素,绝经年龄、初潮年龄以及FMI对中老年女性骨密度的影响存在部位差异性。     

身体成分对绝经后女性骨密度和骨骼肌量的影响

目的 基于双能X线骨密度仪测量的身体成分分析,探讨影响绝经后女性骨密度和骨骼肌量的共同因素,为绝经后骨质疏松和肌少症的协同防治提供思路。方法 纳入2015年1月至2020年10月在中山大学附属第一医院进行身体成分分析的171例绝经后女性,根据全身骨密度和相对骨骼肌肉指数(relative skeletal muscle index,RSMI)分为正常组(T值≥-1且RSMI＞5.45 kg/m2)、肌少组(T值≥-1且RSMI≤5.45 kg/m2)、骨量异常组(T值＜-1且RSMI＞5.45 kg/m2)和肌少/骨量异常组(T值＜-1且RSMI≤5.45 kg/m2)。采用单因素方差分析比较4组一般资料和身体成分差异,Pearson相关分析研究身体成分与骨密度和RSMI的相关性,多元线性回归分析探索影响骨密度和RSMI的共同因素。结果 4组在体脂率(percent body fat,PBF)、脂肪量(fat mass,FM)、脂肪指数(fat mass index,FMI)、瘦组织(lean mass,LM)、瘦组织指数(lean mass index,LMI)、骨矿盐含量(bone mineral content,BMC)、Android/Gynoid区域脂肪比率和休止代谢率(resting metabolic rate,RMR)的整体比较中差异均有统计学意义(P＜0.05)。调整混杂因素后,PBF、FM、FMI与骨密度和RSMI呈不同程度负相关,LM、LMI、BMC、RMR与骨密度和RSMI呈正相关。多元线性回归显示高PBF、低LM和低BMC是骨密度和RSMI的共同危险因素。结论 绝经后女性骨密度与骨骼肌量变化密切相关,针对影响二者的共同危险因素采取干预措施可能有利于绝经后骨质疏松和肌少症的协同防治。     

老年女性相对骨骼肌质量指数与骨密度及脂肪含量的相关性

目的分析老年女性相对骨骼肌质量指数(relative appendicular skeletal muscle,RASM)与骨密度及脂肪含量的相关性。方法选取2018年10月至2020年8月就诊于兰州大学第一医院年龄≥60岁的女性受试者127例,其中低RASM组46例,正常组81例。分析两组的年龄、体质量指数(body mass index,BMI)、骨密度(bone mineral density,BMD)、总脂肪含量(TFM)、总组织含量及总肌肉含量(TLM)。结果60岁的老年女性中低RASM者检出率为36.2%,骨质疏松者检出率为44.1%;低RASM组的年龄、BMI、全身BMD、TFM、总组织含量及TLM明显低于正常组,差异均有统计学意义(P<0.05);RASM与L_1~4 BMD及年龄的相关系数为0.188与-0.176(P<0.05),RASM与全身BMD、TFM、BMI的相关系数为0.369、0.375及0.620(P<0.01),TFM与全身BMD、L_1~4 BMD的相关系数为0.442与0.407(P<0.01)。结论老年女性的肌肉质量、骨密度、脂肪含量之间存在显著正相关,适当的运动和营养支持可增加肌肉质量、改善骨密度、促进脂肪组织的正向作用,有利于预防老年人发生跌倒、骨折及致残的风险,改善老年人生活质量。     

肌肉含量指标对绝经后女性骨质疏松症发生风险的预测价值分析

目的 评价肌肉含量指标与骨密度(bone mineral density, BMD)的关联性,筛选预测绝经后女性骨质疏松(osteoporosis, OP)发生风险的最佳部位肌肉指标及其截止点。方法 选取2018年1月至2021年10月贵州医科大学附院健康管理中心的1366名绝经后女性,采用DXA和BIA测量BMD和四肢骨骼肌含量(ASM),以ASM算出各肌肉含量指标：ASMI、ASM_BMI及SMI。应用ROC曲线及Logistic回归分析验证肌肉指标对OP风险的预测能力及评估关联强度。结果 OP组的肌肉含量低于非OP组,除腰椎BMD间的SMI和股骨颈、腰椎BMD间的内脏脂肪面积及大粗隆、全髋BMD间的ASM_BMI差异无统计学意义(P>0.05),各部位不同BMD间脂肪、肌肉含量指标差异均有统计学意义(P<0.05)。Pearson分析显示,各部位BMD与SMI呈负相关(r=-0.095、-0.122、-0.195、-0.177);与ASM、ASM、ASM_BMI呈正相关(r=0.369、0.298、0.085...     

脂肪质量指数对全膝关节置换术后早期功能康复的影响

目的探讨脂肪质量指数(fat mass index, FMI)对全膝关节置换(total knee arthroplasty, TKA)术后早期康复的影响。方法回顾性分析2020年7月至2021年7月于西安市红会医院关节外科接受初次单侧TKA的患者, 采用双能X线吸收测定法测量患者术前的体成分并计算FMI。根据FMI大小将患者分为正常组(男:3.0～6.0 kg/m2;女:5.0～9.0 kg/m2)、超重组(男:6.1～9.0 kg/m2;女:9.1～13.0 kg/m2)、肥胖组(男:>9 kg/m2;女:>13 kg/m2), 并收集患者的手术时间、出血量、术后并发症的发生率等指标。使用广义线性模型进行FMI对TKA术后早期康复影响的多因素分析。绘制FMI和体质指数(body mass index, BMI)对术后西大略和麦克马斯特大学(Western Ontario and McMaster Universities, WOMAC)骨关节炎指数评分和美国膝关节协会评分(Knee Society Score, KSS)预测效果的受试者工作特征(receiver ope...     

肌肉含量指标预测社区人群骨质疏松症风险研究

目的 评价肌肉含量指标与骨质疏松症(osteoporosis,OP)的关联性,筛选预测社区人群OP风险的良好肌肉含量指标.方法 选取来自甘肃省四个市、县的3151名社区居民,用超声骨密度仪测量研究对象的骨强度、T值,运用生物电阻抗体成分分析仪分别测量四肢肌肉量,并计算四肢骨骼肌量(appendicular skelet...     

正常女性的身体组成成份与骨密度的关系

目的 研究体内的体脂含量(fat mass)和非脂质含量(lean mass)对正常女性骨密度的影响程度.方法 414例绝经前和1020例绝经后妇女参加本研究,采用美国Hologic Delphi A 双能X线骨密度仪测定腰椎、左股骨骨密度和全身骨密度以及fat mass和lean mass.结果 ①各部位脂肪含量和肌肉含量呈显著负相关;②在青年女性和绝经前妇女中,Lean mass是决定腰椎、股骨近端各部位和全身骨密度的主要因素;③在绝经后妇女中,fat mass起主要作用.结论 Fat mass和lean mass对骨密度起不同的作用.     

正常女性的身体组成成份与骨密度的关系

目的 研究体内的体脂含量(fat mass)和非脂质含量(lean mass)对正常女性骨密度的影响程度.方法 414例绝经前和1020例绝经后妇女参加本研究,采用美国Hologic Delphi A 双能X线骨密度仪测定腰椎、左股骨骨密度和全身骨密度以及fat mass和lean mass.结果 ①各部位脂肪含量和肌肉含量呈显著负相关;②在青年女性和绝经前妇女中,Lean mass是决定腰椎、股骨近端各部位和全身骨密度的主要因素;③在绝经后妇女中,fat mass起主要作用.结论 Fat mass和lean mass对骨密度起不同的作用.     

老年人骨骼健康与肌少型肥胖症的关系

目的探讨与老年人骨骼健康和平衡相关的肌少型肥胖症的特征性指标。方法收集168名50岁以上的社区老年人,通过双能X线骨密度仪测定全身骨骼面积骨密度(areal bone mineral density,aBMD)、总体脂和四肢瘦组织量(appendicular lean mass,ALM)。通过外周定量计算机断层扫描评估小腿肌肉密度、体积骨密度(volumetric bone mineral density,vBMD)、面积、厚度和强度应变指数(strength-strain index,SSI)等,并测量手握力和平衡路径长度,通过Pearson、多元线性回归等比较各项身体成分与胫骨参数的相关性。结果较高的小腿肌肉密度与男性(r=-0.36,P=0.008)和女性(r=-0.40,P=0.003)较低的平衡路径长度有关。受试者体质量指数(body mass index,BMI)≥30 kg/m~2即为肥胖人群,其全身aBMD、胫骨近端骨皮质面积、厚度和SSI均高于BMI正常的受试者。在多元回归分析中,肥胖受试者的小腿肌肉密度与胫骨近端骨皮质vBMD(β=2.91,95%CI:0.02～5.80,P=0.004)和面积(β=2.70,95%CI:0.06～5.33,P=0.001)呈正相关。结论在各项身体成分中,较高的ALM是反映骨骼健康状况的较好指标,低肌肉密度可严重影响老年人的骨质健康与平衡。     

BMI和SMI在类风湿关节炎继发骨质疏松中的临床研究

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者的体质量指数(body mass index,BMI)、脂肪质量指数(fat mass index,FMI)和骨骼肌质量指数(skeletal muscle mass index,SMI)与RA患者继发骨质疏松(osteoporosis,OP)的相关性。方法选择RA患者418例,同时选择同期健康体检的158名正常人作为对照组。采用双能X线骨密度仪测量研究对象股骨颈(Neck)、大转子(G.T)、总髋部(Hip)、腰椎1～4(L1、L2、L3、L4)部位的骨密度(bone mineral density,BMD)并参照OP诊断标准进行分级,采用直接节段多频率生物电阻抗测试法测定研究对象的骨骼肌含量、体脂肪、矿物质含量,并计算BMI、FMI和SMI。结果①RA患者各测定部位的BMD均明显低于正常对照组(P0.0001),其OP发生率(42.6%)明显高于对照组(13.9%)(χ~2=41.551,P0.0001)。②RA患者肌少症发生率(54.5%)明显高于对照组(9.0%)(χ~2=96.747,P0.0001)。③不同BMI组RA患者间各部位的BMD、SMI、FMI、矿物质含量、体脂百分比和骨骼肌含量是明显不同的(P0.0001),且随着BMI的增高,上述各指标均呈线性增高趋势(P0.0001)。④在BMI为消瘦的RA患者中,肌少症组中OP发生率与无肌少症组中相近(48.1%vs 45.5%,χ~2=0.027,P=0.870),在BMI为正常、超重或肥胖组中,肌少症组中OP发生率均明显高于无肌少症组(56.6%vs 33.0%,χ~2=12.238,P0.0001;52.6%vs 22.7%,χ~2=10.953,P=0.001)。在有或无肌少症的RA患者中,不同BMI组间RA患者OP发生率无明显差别(P=0.563、0.148)。⑤线性相关分析显示,SMI与各部位的BMD和BMI均呈正直线相关(P0.0001),而与体脂百分比呈负直线相关(P0.0001)。⑥多元Logistic回归分析显示,SMI(OR=0.696,P=0.001,95%CI:0.565～0.857)为RA患者发生OP的保护因素,年龄(OR=1.091,P0.0001,95%CI:1.065～1.117)和性别(OR=5.259,P0.0001,95%CI:2.543～10.876)均为RA患者发生OP的危险因素。结论 BMI、SMI和FMI均与RA患者OP的发生有关,但SMI是RA患者发生OP最重要的保护因素。     

Body fat mass and lean mass as predictors of survival in hemodialysis patients

A higher body mass index (BMI) is a predictor of better survival in hemodialysis patients, although the relative importance of body fat and lean mass has not been examined in the dialysis population. We performed an observational cohort study in 808 patients with end-stage renal disease on maintenance hemodialysis. At baseline, fat mass was measured by dual-energy X-ray absorptiometry and expressed as fat mass index (FMI; kg/m2). Lean mass index (LMI) was defined as BMI minus FMI. During the mean follow-up period of 53 months, 147 deaths, including 62 cardiovascular (CV) and 85 non-CV fatal events, were recorded. In univariate analysis, LMI was not significantly associated with CV or non-CV death, whereas a higher FMI was predictive of lower risk for non-CV death. Analyses with multivariate Cox models, which took other confounding variables as covariates, indicated the independent associations between a higher LMI and a lower risk of CV death, as well as between a higher FMI and a lower risk of non-CV death. These results indicate that increased fat mass and lean mass were both conditions associated with better outcomes in the dialysis population.     

Prior loss of body mass index,low body mass index,and central obesity independently contribute to higher rates of fractures in elderly women and men

We aimed to comprehensively evaluate the association of body composition with fracture risk using longitudinal data from a Swedish cohort of 44,366 women and men (mean age of 70 years) and a subcohort of 5022 women. We estimated hazard ratios (HRs) of fracture for baseline body mass index (BMI), BMI change during the prior 12 and 18 years, baseline waist-to-height ratio, total and regional distribution of fat and lean mass, with and without areal bone mineral density (BMD) adjustment. During follow-up (median 8.7 years), 7290 individuals sustained a fracture, including 4279 fragility fractures, of which 1813 were hip fractures. Higher baseline BMI and prior gain in BMI were inversely associated with all types of fracture. Lower fracture rate with higher baseline BMI was seen within every category of prior BMI change, whereas higher prior BMI gain conferred a lower rate of fracture within those with normal baseline BMI. Each standard deviation (SD) higher baseline waist-to-height ratio, after adjustment for BMI, was associated with higher rates of hip fracture in both women and men (HR 1.12; 95% CI, 1.05–1.19). In the subcohort (median follow-up 10 years), higher baseline fat mass index (FMI) and appendicular lean mass index (LMI) showed fracture-protective effects. After BMD adjustment, higher baseline BMI, total LMI, FMI, and higher prior BMI gain were associated with higher fracture rate. Baseline fat distribution also was associated with fracture rate; a 1-SD higher android to gynoid fat mass ratio in prior BMI gainers was associated with BMD-adjusted HRs of 1.16 (95% CI, 1.05–1.28) for any fracture and 1.48 (95% CI, 1.16–1.89) for hip fracture. This pattern was not observed among prior BMI losers. These findings indicate that for optimal fracture prevention, low baseline BMI, prior BMI loss and high baseline central obesity should be avoided in both women and men. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Lean mass and fat mass have differing associations with bone microarchitecture assessed by high resolution peripheral quantitative computed tomography in men and women from the Hertfordshire Cohort Study

Understanding the effects of muscle and fat on bone is increasingly important in the optimisation of bone health. We explored relationships between bone microarchitecture and body composition in older men and women from the Hertfordshire Cohort Study. 175 men and 167 women aged 72–81 years were studied. High resolution peripheral quantitative computed tomography (HRpQCT) images (voxel size 82 μm) were acquired from the non-dominant distal radius and tibia with a Scanco XtremeCT scanner. Standard morphological analysis was performed for assessment of macrostructure, densitometry, cortical porosity and trabecular microarchitecture. Body composition was assessed using dual energy X-ray absorptiometry (DXA) (Lunar Prodigy Advanced). Lean mass index (LMI) was calculated as lean mass divided by height squared and fat mass index (FMI) as fat mass divided by height squared. The mean (standard deviation) age in men and women was 76 (3) years. In univariate analyses, tibial cortical area (p < 0.01), cortical thickness (p < 0.05) and trabecular number (p < 0.01) were positively associated with LMI and FMI in both men and women. After mutual adjustment, relationships between cortical area and thickness were only maintained with LMI [tibial cortical area, β (95% confidence interval (CI)): men 6.99 (3.97,10.01), women 3.59 (1.81,5.38)] whereas trabecular number and density were associated with FMI. Interactions by sex were found, including for the relationships of LMI with cortical area and FMI with trabecular area in both the radius and tibia (p < 0.05). In conclusion, LMI and FMI appeared to show independent relationships with bone microarchitecture. Further studies are required to confirm the direction of causality and explore the mechanisms underlying these tissue-specific associations.     

百色壮族中老年人骨密度和体成分的特点及其相关性分析

目的测量并探讨百色壮族中老年人群的骨密度、身体成分的特点以及随年龄变化的规律,为改善少数民族地区老龄人口健康状况提供科学依据。方法随机抽取620名(男性248名,女性372名)百色壮族健康中老年人作为研究对象。测量受试者的右足跟骨密度,以及身高、体重、和身体成分(身体质量指数、腰臀比、去脂体重、肌肉量、脂肪量、体脂肪率)。运用SPSS17.0软件进行统计学处理。结果百色壮族中老年骨密度与身高、体重、腰臀比、去脂体重、肌肉量均随年龄增长逐渐降低,而脂肪量、体脂肪率在各年龄组间之间无显著差异。同年龄组男性的骨密度和身高、体重、去脂体重、肌肉量均明显高于女性,而女性的脂肪量、体脂肪率则明显高于男性。结论百色壮族中老年人的骨密度与年龄呈负相关线性关系,与体重、身高、脂肪量、体脂肪率、去脂体重、肌肉量均呈正相关线性关系。     

Muscle Strength and Body Composition Are Clinical Indicators of Osteoporosis

We examined the role of muscle strength, lean tissue distribution, and overall body composition as indicators of osteoporosis (OP) in a pooled sample of 979 Finnish postmenopausal women (mean age 68.1 years) from the Kuopio Osteoporosis Risk Factor and Prevention study. Bone mineral density (BMD) at the femoral neck (FN) and total body composition were assessed by dual-energy X-ray absorptiometry scans. The women (n = 979) were divided into three groups according to WHO criteria, based on FN BMD T score: normal (n = 474), osteopenia (n = 468), and OP (n = 37). Soft tissue proportions, fat mass index (FMI, fat/height2), lean mass index (LMI, lean/height2), and appendicular skeletal muscle mass (ASM, (arms + legs)/height2) were calculated. Handgrip and knee extension strength measurements were made. OP subjects had significantly smaller LMI (p = 0.001), ASM (p = 0.001), grip strength (p < 0.0001), and knee extension strength (p < 0.05) but not FMI (p > 0.05) compared to other subjects. Grip and knee extension strength were 19 and 16 % weaker in OP women compared to others, respectively. The area under the receiver operating characteristic curve was 69 % for grip and 71 % for knee extension strength. In tissue proportions only LMI showed predictive power (63 %, p = 0.016). An overall linear association of LMI (R2 = 0.007, p = 0.01) and FMI (R2 = 0.028, p < 0.001) with FN BMD remained significant. In the multivariate model, after adjusting for age, grip strength, leg extension strength, FMI, LMI, number of medications, alcohol consumption, current smoking, dietary calcium intake, and hormone therapy, grip strength (adjusted OR = 0.899, 95 % CI 0.84-0.97, p < 0.01), leg extension strength (OR = 0.998, 95 % CI 0.99-1, p < 0.05), and years of hormone therapy (OR = 0.905, 95 % CI 0.82-1, p < 0.05) remained as significant determinants of OP. Muscle strength tests, especially grip strength, serve as an independent and useful tool for postmenopausal OP risk assessment. In addition, lean mass contributes to OP in this age group. Muscle strength and lean mass should be considered separately since both are independently associated with postmenopausal BMD.     

8周的基础军训对新疆边防部队新兵人体测量指数影响的分层研究

目的:探讨新兵入伍后8周的基础军事训练,对新兵的人体测量指数的影响。方法:随机抽取新疆边防部队2013年度入警的102名男性新兵,其中汉族67名,维吾尔族35名,分别在训练前后测定并记录身高、体重、腰围、臀围,体质指数和腰臀比。结果:经过8周的基础军事训练,对所有参加测试的新兵而言,体质指数变化不大,腰臀比则显著下降。分层研究表明,经过8周的基础军事训练,体重偏轻(体质指数18.5kg/m2)的新兵,体质指数显著增加,腰围变化不大,臀围显著增加,腰臀比不变;对于正常体重(18.5kg/m2≤BMI25 kg/m2)的新兵,体质指数变化不大,腰围显著降低,臀围显著增加,腰臀比显著降低;对于超重(25kg/m2≤BMI30kg/m2)的新兵,体质指数、腰围、臀围及腰臀比均显著降低。结论:新兵8周的基础军事训练,可以重塑体型,减少腹部脂肪的积聚,促进健康。     

住院2型糖尿病患者血尿酸水平与肌量减少的相关性

目的 探讨2型糖尿病患者血清尿酸水平（serum uric acid,SUA）与肌量减少的相关性。方法 采用横断面调查法,选取2017年1月至2019年12月南京医科大学附属常州第二人民医院内分泌科收治的2120例2型糖尿病患者为研究对象,通过生物电阻抗法检测四肢骨骼肌含量并计算四肢骨骼肌质量指数（appendicular skeletal muscle index,ASMI）,据亚洲肌少症工作组诊断标准,将研究对象分为肌量减少组（n=366）与非肌量减少组（n=1754）,收集年龄、性别、糖尿病病程、BMI、SUA等指标,通过t检验比较两组各指标的差异,Pearson相关性分析ASMI与各指标的相关性,多元线性回归和Logistic回归分析SUA对肌量减少的影响。结果 肌量减少组BMI、SUA均显著低于非肌量减少组,年龄高于非肌量减少组;ASMI与SUA、BMI显著正相关,与年龄负相关;多元线性回归分析显示,在分别校正年龄、BMI后,SUA与ASMI仍存在正相关性;二项Logistic回归分析显示,在校正年龄后,SUA每增加1umol/L,肌量减少风险降低0.5%。结论 SUA水平升高可能是2型糖尿病患者肌量减少的保护性因素。