膳食模式对妊娠期糖尿病发生风险的系统评价

目的评估不同膳食模式对妊娠期糖尿病发生风险的影响,为妊娠期糖尿病的预防提供依据。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库、维普中文期刊数据库、中国生物医学文献数据库中关于膳食模式与妊娠期糖尿病相关性的研究,采用定性系统评价的方法对纳入文献进行分析。结果最终纳入英文文献7篇,均为前瞻性队列研究,样本量总数为23 085例,妊娠期糖尿病1 896例。结果显示以蔬菜、鱼类和豆类为主的精明膳食模式对妊娠期糖尿病具有保护作用;而以肉类、加工肉类、甜点、饮料类为主的西方膳食模式可增加妊娠期糖尿病发生风险。结论不同膳食模式对妊娠期糖尿病发生风险的影响有较大的差异,建议妊娠期糖尿病高危孕妇采取合理、健康的膳食模式,早期改善膳食习惯,以达到预防妊娠期糖尿病的作用。     

膳食营养在骨质疏松发生中的作用——病例对照研究及14年饮食营养改变

探讨膳食营养在骨质疏松（ＯＰ）发病风险中的作用；了解目前膳食营养中存在的问题。方法采用广州市中老年知识分子的病例对照研究及十四年来膳食营养比较。结果体重指数（ＢＭＩ）与ＯＰ关系密切，ＢＭＩ越低，ＯＰ危险性越大（ＢＭＩＭ—１９—２２，ＯＲ＝１．６５；ＢＭＩ＜１９，ＯＲ＝４．９）；膳食营养中，蛋白质、钙、锰、磷等的摄入量不足均增加ＯＰ发病风险（ＯＲ值分别为２．６８，５．９８，２．２４和１．８０），其中以钙和锰的作用较为重要；比较近十四年来的膳食营养情况，尽管膳食营养明显改善，但人均每日钙摄入量仍普遍偏低，约５００毫克。结论膳食营养与骨质疏松的发生、发展关系密切，钙及微量元素摄入不足是目前饮食主要问题，应加强膳食中钙及微量元素的补充。     

骨质疏松及其预防

随着世界人口老龄化,骨质疏松(OP)越来越受到临床重视,现代社会不健康生活习惯增多使这一传统老年疾病日益呈现低龄化趋势.作为一种进行性又不可逆转的病理过程,OP一旦发生很难恢复正常结构,因此正确认识OP并加以预防尤为重要.该文就近年相关研究文献中OP及其预防方面的认识作一综述.     

自制膳食卡在糖尿病饮食治疗中的应用

目的合理指导糖尿病患者的饮食治疗，提高其饮食治疗依从性。方法将200例糖尿病患者随机分为对照组和观察组各100例，对照组按糖尿病饮食常规进行饮食治疗，观察组采用自制膳食卡进行饮食治疗，治疗后3个月，比较两组饮食治疗依从性、对糖尿病饮食治疗的知晓情况。结果观察组患者饮食治疗依从性及对饮食知识的知晓情况显著高于对照组，且血糖控制较平稳（P〈0．05，P〈0．01）。结论膳食卡便于糖尿病患者获得正规饮食治疗。     

原癌基因c-fos与骨质疏松

c-fos基因是原癌基因的重要成员.其表达受多种细胞活性物质的影响,通过其表达产物c-fos蛋白参与转录激活蛋白1的组成发挥生物学作用,并可以反过来对细胞因子进行调节,从而参与细胞的生长、增殖、分化途径上环节的调控.本文着重就诱导c-fos基因在骨组织中表达的影响因素及其与骨质疏松的相关性进行了探讨.     

肥胖与骨质疏松

肥胖与骨质疏松症这两种复杂遗传病,从发病机制而言,两者可能共享某些环境因素和遗传因素。有研究显示,体重增加对预防骨质疏松症发生有保护性作用,降低骨折风险。肥胖形成过程中,与体重相关的许多激素与骨量变化有关,如:脂肪组织分泌的瘦素、雌激素、脂联素;消化道分泌的胃饥饿素;胰腺分泌胰岛素、胰淀素。然而,近年来也有一些不同的研究发现,过度脂肪组织增加并不能预防骨折的发生。可见肥胖和骨质疏松之间内因与外因的相互作用错综复杂,导致不同人群出现不同的研究结果。推测可能在不同体脂比例条件下,体脂与骨量形成呈现不同的关联。     

端粒酶与骨质疏松

端粒、端粒酶是当今生物学、医学研究的热点之一，端粒是一种封闭了真核染色体末端的脱氧核糖核酸。它与端粒结合蛋白结合在一起，对染色体起到了保护的作用。端粒酶是一种特异的染色体末端转移酶，它的存在解决了染色体末端复制引缩问题。为了探讨端粒酶与骨质疏松之间的关系，笔者通过检索有关端粒、端粒酶的结构、功能及活性与骨质疏松的相关文献并进行综述。文章阐明了端粒酶激活机制在骨质疏松的发生发展中起着重要作用，而利用分子生物学技术改变端粒酶尤其是hTERT的基因表达水平，将在防治骨质疏松方面具有广泛的应用前景及实际意义。     

骨质疏松与骨折的关系

骨质疏松症主要危险是脊椎压缩性骨折、髋部骨折和桡骨远端骨折。这种骨质疏松性骨折可加重原发性骨质疏松，易发生再骨折。创伤性骨折，治疗过程中多发生局部或全身性骨质疏松。预防和治疗骨质疏松、骨质疏松性骨折、骨折后骨质疏松及再骨折具有重要意义。本文对骨质疏松与骨折相互影响、病理机理、诊断及预防和治疗作一综述。     

社区骨质疏松患者饮食行为及健康管理策略

目的分析社区骨质疏松患者饮食行为及影响因素,提出有针对性的健康管理策略。方法 2016年5月在解放军第309医院医联体所属的8个社区随机选择160例(每社区20例)电子健康档案登记患有骨质疏松症的患者,采用现场发放问卷的方式进行调查。项目包括骨质疏松患者饮食行为、骨质疏松患者独立生活能力、骨质疏松患者家庭关怀度、健康饮食知晓程度、社会支持度。采用多元回归方法进行统计学处理,P0.05为差异有统计学意义。结果回收有效问卷131份,有效回收率81.88%。多元回归结果显示,工具性日常生活能力、家庭关怀度、社会支持度、健康饮食知晓率偏回归系数差异有统计学意义(P0.05)。食物选择主要考虑"便利原则""是否新鲜";食物制作存在食用"剩饭剩菜""过保质期食物"现象;饮食偏好"豆制品""深色蔬菜",较少食用"奶制品""海鲜"。结论骨质疏松患者的饮食行为依从性并不乐观。需要根据社区居民的饮食习惯,制定可操作性的、个体化的健康食谱和直观的饮食指导卡片。建立符合骨质疏松患者活动能力和饮食需求的社区副食供应网络。开展骨质疏松社区健康指导,定期进行家庭关怀度评估,提供延伸服务,保证骨质疏松患者饮食均衡。     

Dietary recommendations in the prevention and treatment of osteoporosis

IntroductionThis article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie – SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d’Informations sur les Ostéoporoses – GRIO) on the role of diet in the prevention and treatment of osteoporosis.MethodsThe recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to “daily practices” were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies.ResultsA Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and “high quality” protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics.ConclusionsThese are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines.     

Dietary calcium and physical activity — Implications for osteoporosis

Summary and Conclusions This review has focused on two of the most important etiologic factors relating to bone health, specifically dietary calcium and physical activity. In general, these two lifestyle variables have been shown to influence, each in a positive way, skeletal development during childhood and adolescence and peak bone mass optimization during premenopausal adulthood. If females can maximize bone mass prior to themenopause, they are likely to track at a higher level of bone mass during the inexorable postmenopausal period of bone loss, perhaps almost independently of the rate of bone loss. The greater bone mass of women entering the menopause should help to delay, or possibly, to prevent entirely hip fractures. The promotion of good bone health, especially for the purpose of preventing hip fractures, should become national goals built into school and public health programs at federal and local levels.     

Dietary protein deficiency induces osteoporosis in aged male rats.

Low dietary intake is common in elderly males with low femoral neck areal bone mineral density (BMD). To evaluate the selective influence of a low-protein diet in the pathogenesis of osteoporosis in males and to uncover early and late adaptation of bone cells to protein deficiency, 8-month-old male rats were pair-fed a control (15% casein) or isocaloric low-protein (2.5% casein) diet for 1 or 7 months. BMD, bone ultimate strength, stiffness, and absorbed energy were measured in tibia proximal metaphysis and diaphysis. After double-labeling, histomorphometric analysis was performed at the same sites. Serum osteocalcin, insulin-like growth factor I (IGF-I), and urinary deoxypyridinoline excretion were measured. In proximal tibia, isocaloric low-protein diet significantly decreases BMD (12%), cancellous bone mass (71%), and trabecular thickness (Tb.Th; 30%), resulting in a significant reduction in ultimate strength (27%). In cortical middiaphysis, a low-protein diet decreases BMD (9%) and enlarges the medullary cavity (36%), leading to cortical thinning and lower mechanical strength (20%). In cancellous bone, protein deficiency transiently depresses the bone formation rate (BFR; 60%), osteoid seam thickness (15%), and mineral apposition rate (MAR; 20%), indicating a decrease in osteoblast recruitment and activity. Cortical loss (15%) results from an imbalance between endosteal modeling drifts with impaired BFR (70%). From the first week of protein deficiency, osteocalcin and IGF-I levels drop significantly. Bone resorption activity and urinary deoxypyridinoline remain unchanged throughout the experiment. Protein deficiency in aged male rats induces cortical and trabecular thinning, and decreases bone strength, in association with a remodeling imbalance with a bone formation impairment and a decrease in IGF-I levels.     

鼻咽癌患者同步放化疗期间膳食结构及其影响因素研究

目的了解鼻咽癌患者同步放化疗期间膳食结构及影响因素,为针对性干预提供参考。方法采用一般资料调查表、膳食调查及结构测评工具、中国居民膳食营养与健康调查问卷对99例鼻咽癌同步放化疗患者进行膳食结构及影响因素调查。结果患者中国膳食宝塔10类食物总分为22.21±3.01;能量及三大产热营养素充足比为44.4%～105.4%;患者膳食营养与健康知识行为总分为112.53±15.63,其中膳食营养得分90.88±12.58,健康知识行为得分21.65±4.18;肿瘤分期、膳食营养与健康知识行为是患者膳食结构的影响因素(均P0.05)。结论鼻咽癌患者放化疗期间膳食结构欠合理,受肿瘤分期及相关知识行为影响。医护人员应针对影响因素给予有效干预,以提高膳食结构合理化水平。     

Vertebral shape, trabecular pattern, and spinal bone mineral density in osteoporosis

Vertebral morphometry and trabecular pattern were correlated to the bone mineral density (BMD) of the corresponding vertebra in 82 patients with osteoporosis. With lateral roentgenograms of the lumbar spine, the anterior, middle, and posterior vertebral heights of L2, L3, and L4 were measured, and the wedge index, concavity index, lumbar spine score, and relative central compression were calculated. The trabecular pattern was graded from normal to a disappearance of trabeculae. The BMD of the corresponding vertebrae was measured by dual photon absorptiometry. There were positive correlations between the BMD and the following measurements of biconcavity: the middle height (r=0.182, p=0.0086), concavity index (r=0.202, p=0.0034), lumbar spine score (r=0.147, p=0.0343), and relative central compression (r=0.179, p=0.0099). The trabecular pattern showed a negative correlation with the BMD (r=−0.141, p=0.0428). Although these correlations were statistically significant, the correlation coefficients and the coefficients of determination were small. Therefore, we may be able to use the degree of biconcavity and the trabecular pattern to differentiate severe osteoporosis from mild one, but these parameters are of limited value in the precise assessment of bone loss.     

镁与骨质疏松

镁离子是人体内重要的阳离子,参与多种生理活动。。镁缺乏易导致骨质疏松,适当补充镁可以增强骨密度,改善骨组织形态,缓解骨质疏松等症状。此外,可降解金属镁及其镁合金因其在骨折和骨缺损治疗中的潜在优势,有望在未来的骨外科治疗中得到广泛应用。然而镁离子促进成骨细胞增殖和分化,促进骨骼生长作用机制仍待深入研究。本文综述了镁在骨代谢中的作用及相关分子机制的最新研究进展。     

Impaired bone healing pattern in mice with ovariectomy-induced osteoporosis: A drill-hole defect model

ObjectiveTo establish a drill-hole defect model in osteoporotic mouse femur by comparing temporal cortical bone healing pattern between OVX-induced osteoporotic bone and sham-operated bone.Methods3-month-old female C57BL/6 mice were randomly divided into an ovariectomy group (OVX) and a sham-operated group (Sham). At 6 weeks post-surgery, 7 mice from each group were sacrificed to examine the distal femur and femoral shaft by both micro-CT and mechanical testing for confirming established osteoporosis induced by OVX. In the remaining mice, a cortical bone defect 0.8 mm in diameter was created on the mid-diaphysis of the right femur. The local repair process at days 0, 3, 7, 10, 14 and 21 after creation of the drill-hole was in vivo monitored by high-resolution micro-CT scanning. At each time point, each animal was scanned four times and was removed from the scanner between scans to determine reproducibility. Mice were sacrificed at each time point (n = 12 at days 0, 3, 7, 10 and 14; n = 20 at day 21). Before sacrifice, sera were collected to examine expression of bone formation marker P1NP (procollagen type I N-terminal propeptide) and bone resorption marker CTX (C-terminal telopeptide of type I collagen). After sacrifice, callus samples were collected and subjected to the following analyses: micro-CT-based angiography; histological examination; immunohistochemical staining to determine estrogen receptor expression; quantitative real-time PCR analysis of collagen type I, collagen type II, collagen type X, osteocalcin, tartrate-resistant acid phosphatase, estrogen receptor alpha (ER alpha) and estrogen receptor beta (ER beta) gene expression; and three-point mechanical testing.ResultsAt 6 weeks post-surgery, OVX mice had significantly lower bone mass, impaired bone micro architecture and compromised mechanical properties compared to the Sham mice. In vivo micro-CT analysis revealed that the bone volume fraction in the defect region was significantly lower in the OVX group from day 10 to day 21 post-injury as compared to the Sham group, and was significantly lower in the intra-medulla region in the OVX group from day 7 to day 14 as compared to the Sham group, consistent with the histological data. Analysis of bone biochemical markers indicated that circulating P1NP levels normalized by baseline in the OVX mice were significantly lower than in the Sham mice from day 7 to day 10, and that temporal expression of circulating CTX levels normalized by baseline was also lower in the OVX mice as compared to the Sham mice. These results were consistent with quantitative real-time PCR analysis. ER alpha mRNA expression was significantly lower in the OVX mice, whereas ER beta mRNA expression was significantly higher in the OVX mice as compared to the Sham mice at all time points examined, consistent with immunohistochemical staining. The restoration of femoral mechanical property, determined based on ultimate load and energy-to-failure, was significantly lower in the OVX mice than in the Sham mice. In addition, in vivo micro-CT scanning for quantifying new bone formation in the defect site was highly reproducible in this model.ConclusionThe bone healing of the drill-hole defect was impaired in mice with OVX-induced osteoporosis. The present study provides a model to investigate the functional role of specific gene in osteoporotic bone healing and may facilitate development of novel therapeutic strategies for promoting osteoporotic bone healing.     

Smad与骨质疏松症

骨质疏松症(osteoporosis,OP)是由成骨细胞(osteoblast,OB)负责的骨形成和破骨细胞(osteoclast,OC)负责的骨吸收之间的平衡被打破所致。已有大量研究证实转化生长因子-β(transforming growth factor-β,TGF-β)通路和骨形态发生蛋白(bone morphogenetic proteins,BMPs)通路能调控骨形成与骨吸收的平衡,而Smad蛋白家族(Smad)直接介导TGF-β通路和BMP通路下游的信号转导,在调节骨代谢过程中扮演重要的角色。本文针对OP,主要从Smad影响OB与OC的作用方面进行综述。