Resemblance in dietary habits and calcaneal ultrasound attenuation in malay mother-daughter pairs

The relationship between dietary habits and bone health status was evaluated in 61 pairs of premenopausal mothers and their biological daughters aged 10-19 years. Subjects were volunteers living in Kuala Lumpur. Bone status of the calcaneus was assessed using Quantitative Ultrasound (QUS) which measured the Broadband Ultrasound Attenuation (BUA; in units of dB/MHz) of the bone. Daily nutrient intake of all subjects was evaluated using a 3-day dietary record. Reproductive history, food intake habits, and physical activity level were assessed using questionnaires. Bone health status of mothers (mean BUA of 98.0 ± 15.8 dB/MHz) was significantly higher (p<0.001) compared to their daughters (mean BUA of 86.4 ± 17.0 dB/MHz). BUA (r=0.30, p<0.05), weight (r=0.30, p<0.05) and BMI (r=0.32, p<0.05) were significantly correlated within mother-daughter pairs. Lifestyle characteristics such as calcium intake and physical activity were not correlated. However, other dietary habits (energy intake, milk intake and frequency of skipping meals) in daughters were significantly correlated with their mothers. This study suggests that mothers play an important role in influencing the dietary habits of their daughters, which in turn may affect their bone health status.     

Dietary acid load is not associated with lower bone mineral density except in older men

High dietary acid load may be detrimental to bone mineral density (BMD), although sufficient calcium intake might neutralize this effect. In observational studies, the association between BMD and dietary acid load, estimated by net endogenous acid production (NEAP) and potential renal acid load (PRAL), has been inconsistent, and the potential modifying effect of calcium intake has not been assessed. We therefore examined the cross-sectional associations of estimated NEAP and PRAL with BMD in the Framingham Osteoporosis Study. We hypothesized that higher estimated NEAP and PRAL would be associated with lower BMD, but only among those with total calcium intake < 800 mg/d. BMD of the femoral neck and lumbar spine was measured, and estimated NEAP and PRAL were calculated via FFQ among 1069 Framingham Original (1988-1989, 1992-1993; 62% women, mean age 76 y) and 2919 Offspring (1996-2001; 56% women, mean age 60 y) cohort participants. Cohort- and sex-specific ANCOVA was used to calculate multivariable-adjusted mean BMD for estimated NEAP and PRAL quartiles. Assuming no uncontrolled confounding, estimated NEAP, but not PRAL, was inversely associated with femoral neck BMD (P-trend = 0.04) in Original cohort men, whereas neither was associated with lumbar spine BMD. Estimated NEAP and PRAL were not associated with BMD at any site among Original cohort women or Offspring cohort men and women. There were no significant interactions between either estimated NEAP or PRAL and total calcium intake. These results suggest that, with a possible exception of older men, dietary acid load does not have a measureable negative effect on bone health, regardless of total calcium intake.     

Acid-base status affects renal magnesium losses in healthy, elderly persons

Magnesium and calcium deficiency in humans is related to a number of pathological phenomena such as arrhythmia, osteoporosis, migraine, and fatal myocardial infarction. Clinically established metabolic acidosis induces renal losses of calcium. In normal subjects, even moderate increases in net endogenous acid production (NEAP) impair renal calcium reabsorption but no information is available whether this also influences renal magnesium handling. The aim of the study was to examine the relation between NEAP and renal magnesium excretion in healthy, free-living, elderly subjects. The subjects (age 64 +/- 4.7 y, n = 85) were randomly selected from the population register in Gothenburg (Sweden). Magnesium, calcium, and potassium were measured in 24-h urine samples and NEAP was quantified as renal net acid excretion (NAE). NAE was positively correlated with excretions of magnesium (R(2) = 0.27, P < 0.0001) and calcium (R(2) = 0.30, P < 0.0001) but not potassium. When 24-h urinary magnesium excretion was adjusted for 24-h urinary potassium excretion, a biomarker for dietary potassium intake, the association between magnesium excretion and NAE remained significant (R(2) = 0.21, P < 0.0001). The significant association between potassium-adjusted magnesiuria and NAE suggests that the acid-base status affects renal magnesium losses, irrespectively of magnesium intake. Magnesium deficiency could thus, apart from an insufficient intake, partly be caused by the acid load in the body.     

Lower estimates of net endogenous non-carbonic acid production are positively associated with indexes of bone health in premenopausal and perimenopausal women

BACKGROUND: The link between acid-base homeostasis and skeletal integrity has gained increasing prominence in the literature. Estimation of the net rate of endogenous non-carbonic acid production (NEAP) from dietary protein and potassium content enables exploration of the effects of dietary acidity or alkalinity on bone. OBJECTIVE: The study aimed to ascertain whether lower dietary acidity (lower dietary protein intake but higher potassium intake-ie, low estimate of NEAP) was associated with greater axial and peripheral bone mass and less bone turnover, independent of key confounding factors. DESIGN: Baseline (cross-sectional) results of a population-based study were examined further. The database includes spine and hip bone mineral density (BMD) in 1056 premenopausal or perimenopausal women aged 45-54 y and forearm bone mass and the urinary markers of bone resorption in 62 women. A validated food-frequency questionnaire was used to measure dietary intakes. RESULTS: Lower estimates of energy-adjusted NEAP were correlated with greater spine and hip BMD and greater forearm bone mass (P < 0.02 to P < 0.05). Hip and forearm bone mass decreased significantly across increasing quartiles of energy-adjusted NEAP (P < 0.02 to P < 0.03), and trends at the spine were similar (P < 0.09). Differences remained significant after adjustment for age, weight, height, and menstrual status. Lower estimates of energy-adjusted NEAP were also correlated with lower excretion of deoxypyridinoline and were significant predictors of spine and forearm bone mass. CONCLUSIONS: These novel findings provide evidence of a positive link between a ratio of lower protein to higher potassium dietary intake (ie, less dietary acid) and skeletal integrity.     

Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women

BACKGROUND: The Western diet may be a risk factor for osteoporosis. Excess acid generated from high protein intakes increases calcium excretion and bone resorption. Fruit and vegetable intake could balance this excess acidity by providing alkaline salts of potassium. Algorithms based on dietary intakes of key nutrients can be used to approximate net endogenous acid production (NEAP) and to explore the association between dietary acidity and bone health. OBJECTIVE: We investigated the relation between dietary potassium and protein, NEAP (with an algorithm including the ratio of protein to potassium intake), and potential renal acid load (with an algorithm including dietary protein, phosphorous, potassium, magnesium, and calcium) and markers of bone health. DESIGN: Measurements of bone mineral density (BMD) (n = 3226) and urinary bone resorption markers (n = 2929) at the lumbar spine and femoral neck were performed in perimenopausal and early postmenopausal women aged 54.9 +/- 2.2 y (x +/- SD) in 1997-1999. BMD (g/cm(2)), free pyridinoline (fPYD), and free deoxypyridinoline (fDPD) were expressed relative to creatinine. Dietary intake was assessed with a food-frequency questionnaire. RESULTS: Comparison of the highest with the lowest quartile of potassium intake or the lowest with the highest NEAP showed a 6-8% increase in fPYD/creatinine and fDPD/creatinine. A difference of 8% in BMD was observed between the highest and lowest quartiles of potassium intake in the premenopausal group (n = 337). CONCLUSIONS: Dietary potassium, an indicator of NEAP and fruit and vegetable intake, may exert a modest influence on markers of bone health, which over a lifetime may contribute to a decreased risk of osteoporosis.     

Ultrasound measurement of calcaneus: a promising method for prediction of osteoporotic fractures]

When carrying out quantitative ultrasound (QUS) measurements of the calcaneus, broadband ultrasound attenuation (BUA, in dB/MHz) and speed of sound (SOS, in m/s) are assessed. From in vitro studies it is known that the mechanical properties of trabecular bone (stiffness and strength) can be better predicted with QUS than with dual energy X-ray absorptiometry (DEXA). Bone mineral density (BMD) measurements with DEXA are currently used for the diagnosis of osteoporosis according to the WHO criteria. There is no consensus regarding the diagnosis of osteoporosis with QUS measurements of the calcaneus. In prospective studies in women of 65 years and older it has been shown that fracture risk assessment with QUS measurements is feasible. The value of QUS measurements for the follow-up of patients with skeletal disorders is not yet known. At present there are important differences between ultrasound devices and there is no standardisation. The development of quality standards for and cross-calibrations of QUS scanners is necessary, so that results from different devices can be compared. Although QUS of the calcaneus is a promising method for the prediction of osteoporotic fractures, its routine use in clinical practice cannot yet be recommended.     

More acidic dietary acid-base load is associated with reduced calcaneal broadband ultrasound attenuation in women but not in men: results from the EPIC-Norfolk cohort study

BACKGROUND: Dietary patterns that promote mild metabolic acidosis may have a negative effect on bone density. OBJECTIVE: We investigated the relation between a measure of dietary acid-base load, potential renal acid load (PRAL), and calcaneal broadband ultrasound attenuation (BUA) after adjustment for confounders and also compared the results with different estimates of acid-base load. DESIGN: A cross-sectional study was conducted in 14 563 men and women aged 42-82 y living in Norfolk, United Kingdom, in which measures of calcaneal BUA and dietary PRAL were estimated by using the European Prospective Investigation into Cancer and Nutrition Norfolk (EPIC-Norfolk) food-frequency questionnaire. RESULTS: A more acidic dietary intake (high PRAL) was significantly associated with lower calcaneal BUA in women but not in men; there was a difference of approximately 2% in BUA between the highest and lowest quintiles of PRAL, independent of age, body mass index, smoking habit, physical activity, diagnosed osteoporosis, and history of fracture, and (in women) hormone replacement therapy. No relation was observed between history of fracture or incident fracture and PRAL. Those with the greatest PRAL had higher intakes of meat, fish, eggs, and cereal and cereal products and lower intakes of fruit and vegetables, tea, and coffee. CONCLUSION: PRAL was inversely associated with bone ultrasound measures in women, but the magnitude of the association was relatively small compared with other known risk factors. Further longitudinal studies are required to establish whether, in the long term, these small effects are important in overall fracture risk in populations.     

Estimates of daily net endogenous acid production in the elderly UK population: analysis of the National Diet and Nutrition Survey (NDNS) of British adults aged 65 years and over

Dietary intake has been shown to influence acid-base balance in human subjects under tightly controlled conditions. However, the net effect of food groups on alkali/acid loading in population groups is unclear. The aims of the present study were to: (1) quantify estimates of daily net endogenous acid production (NEAP) (mEq/d) in a representative group of British elderly aged 65 years and older; (2) compare and characterise NEAP by specific nutrients and food groups likely to influence dietary acid loading; (3) determine whether geographical location influenced NEAP. The National Diet and Nutrition Survey dataset, consisting of a 4 d weighed record and anthropometric data, was used to estimate dietary acidity. Dietary under-reporters were excluded by analysing only subjects with energy intakes >/= 1.2 x BMR. NEAP was estimated as the dietary potential renal acid load+organic acid excretion, the latter as a multiple of estimated body surface area. NEAP was lower in women compared with men (P < 0.001), and lower than values reported in a Swedish elderly cohort. Lower dietary acidity was significantly associated with higher consumption of fruit and potatoes and lower consumption of meat, bread and eggs (P < 0.02 to P < 0.001). Lower intakes of fish and cheese were associated with lower NEAP in men only (P < 0.01 to P < 0.001). There were regional differences for NEAP, with higher intakes in Scotland/Northern regions compared with Central/South-Western and London/South-Eastern regions (P = 0.01). These data provide an insight into the acid-generating potential of the diet in the British elderly population, which may have important consequences in this vulnerable group.     

Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women

Malnutrition, a risk factor for osteoporotic fractures, is frequent in elderly people and, is underdiagnosed and undertreated. There are only few studies on the nutritional status of elderly people in Europe. The Mini Nutritional Assessment (MNA) is a non invasive and validated questionnaire to evaluate nutritional status in elderly people, classified in three groups: 1 degree score < 17: malnourished, 2 degrees score >17 and < 24: at risk of malnutrition, 3 degrees score >24: well-nourished, with a maximum of 30 points. Quantitative ultrasound of bone (QUS) is a method for assessing quality of bone which can be easily performed in nursing homes. Therefore, these two tests allowed to study the relationships between nutritional status and ultrasonic parameters of bone in 78 institutionalized women aged 86 +/- 6 years, living in 11 nursing homes around Lausanne (Switzerland). All were assessed by the MNA, had a measurement of the tricipital skin fold and of the grip strength. Functional status was evaluated by the scale "Activity of Daily Living" (ADL), and serum albumin level was measured when permitted. All had QUS of the calcaneus (with an Achilles, GE Lunar). The measured parameters are the Broadband Ultrasound Attenuation (BUA), attenuation of a band of ultrasonic frequencies through the medium, expressed in dB/MHz, and the Speed of Sound (SOS), speed of the ultrasounds through the medium, expressed in m/s. A third parameter, the stiffness index (SI), expressed as a percentage of the values obtained by the manufacturer in a young population and derived from BUA and SOS, was calculated automatically : SI = (0.67xBUA) + (0.28xSOS) - 420, expressed in percent compared to a young adult population (%YA). Fifteen percent of the women were undernourished and 58% were at risk of malnutrition. As expected, compared with the well-nourished minority, undernourished subjects had significant lower body mass index (BMI), tricipital skin fold (TSF), ADL score and albumin level (p < 0,01). The subjects "at risk of malnutrition" had significant lower BMI, ADL score (p < 0.01), tricipital skin fold and serum albumin (p < 0.05). Ultrasound parameters were low independently of the nutritional status. MNA score correlated significantly with tricipital skin fold (r = 0.508, p < 0.01), ADL (r = 0.538, p < 0.01) and albumin serum level (r = 0.409, p = 0.01). There was a trend for a correlation between the MNA and the ultrasound parameter BUA (r = 0.207, p = 0.07), whereas no correlation was found with SOS and SI. A multivariate analysis showed that tricipital skin fold and ADL explained 61% of the variance of the MNA. In conclusion, using simple and non invasive methods, this study showed that malnutrition and osteoporosis are frequent in institutionalized elderly persons in our country, and the ultrasound parameters are influenced by many others factors in addition to nutrition, especially at this age and in elderly residents of nursing homes.     

Higher dietary acid load is weakly associated with higher adiposity measures and blood pressure in Japanese adults: The National Health and Nutrition Survey

Epidemiologic evidence on the associations between dietary acid load and metabolic risk factors is limited and inconsistent. We investigated the hypothesis that dietary acid load is associated with adverse profiles of metabolic risk factors in Japanese adults. This cross-sectional study included 15 618 Japanese adults aged ≥20 years from the 2012 National Health and Nutrition Survey, Japan. Dietary acid load was characterized as potential renal acid load (PRAL) and net endogenous acid production (NEAP) based on information on nutrient intake, which was derived from a 1-day semi-weighed dietary record. After adjustment for potential confounding factors, both PRAL and NEAP were positively associated with body mass index (BMI) and waist circumference in both sexes (P for trend ≤.01). PRAL and NEAP also showed positive associations with systolic and diastolic blood pressure in men, independently of BMI (P for trend ≤.005), while they showed positive associations with systolic (but not diastolic) blood pressure in women (P for trend ≤.03). For other metabolic risk factors, there were positive associations between PRAL and NEAP and total cholesterol and LDL-cholesterol concentrations only in men (P for trend ≤.04). After excluding participants taking medication for hypertension, dyslipidemia, and diabetes, similar associations were observed for adiposity measures and blood pressure (P for trend ≤.01), with there being positive associations between NEAP and HDL-cholesterol and between PRAL and NEAP and glycated hemoglobin in men (P for trend ≤.04). In conclusion, higher dietary acid load was significantly but weakly associated with higher adiposity measures and blood pressure in Japanese adults.     

Bone health status of the elderly in Taiwan by quantitative ultrasound

Bone density of the elderly in Taiwan was assessed by quantitative ultrasound bone densitometry of the heel in the Elderly Nutrition and Health Survey in Taiwan (1999-2000). Broadband ultrasound attenuation (BUA) was measured, and the corresponding Z-score was calculated. Physical examination data of 1123 males and 1034 females were included in the current analysis, and data of 752 males and 721 females who also had complete questionnaire information were used for analysis of relationships between several risk factors and BUA status. The results show that in elderly Taiwanese males, higher BMI and intake of dietary calcium is positively associated with a higher BUA Z-score. Advancing age and living in the second stratum in the southern areas appeared to be negatively associated with BUA Z-score in elderly females. BMI, height, years of education, and intake of dietary calcium were positive predictors of BUA Z-score. Further analysis was performed by grouping subjects according to the gender-specific medians of intake levels of dietary calcium, protein, and sodium. The results revealed that for both genders, those in the "high calcium/high protein" group had a higher mean BUA Z-score. The results of the current analysis show that in Taiwan, BMI and dietary calcium intake are positive predictors of BUA Z-score in elderly males, whereas BMI, height, years of education, and dietary calcium intake are positively associated with BUA Z-score in elderly females. The effects of dietary calcium intake may be influenced by the intake of other nutrients such as sodium and protein.     

绝经后女性2型糖尿病患者发生骨质疏松性骨折的危险因素分析

目的探讨绝经后女性2型糖尿病(T2DM)患者发生骨质疏松性骨折的危险因素。方法采用回顾性研究方法,选取绝经后女性T2DM骨质疏松患者220例,根据有无骨折分为骨折组(n=100)和无骨折组(n=120),记录患者的一般资料,收集其空腹血样本用于血糖、血脂、尿酸、HbA_1c等检测。结果骨折组BMI、TG、FBG、HbA_1c水平高于无骨折组(P <0.05);Logistic回归分析提示,BMI、TG、FBG和HbA_1c是绝经后女性T2DM骨质疏松患者发生骨折的独立危险因素;分别根据BMI、TG、FBG和HbA_1c三分位数将绝经后女性T2DM骨质疏松患者分成3组,结果提示随着BMI、TG、FBG和HbA_1c水平的升高,骨折的发生率逐渐升高。结论在绝经后女性T2DM骨质疏松患者中,BMI、TG、FBG和HbA_1c是其发生骨折的独立危险因素。     

Genome-wide linkage scan for quantitative trait loci underlying normal variation in heel bone ultrasound measures

Quantitative ultrasound (QUS) traits are correlated with bone mineral density (BMD), but predict risk for future fracture independent of BMD. Only a few studies, however, have sought to identify specific genes influencing calcaneal QUS measures. The aim of this study was to conduct a genome-wide linkage scan to identify quantitative trait loci (QTL) influencing normal variation in QUS traits. QUS measures were collected from a total of 719 individuals (336 males and 383 females) from the Fels Longitudinal Study who have been genotyped and have at least one set of QUS measurements. Participants ranged in age from 18.0 to 96.6 years and were distributed across 110 nuclear and extended families. Using the Sahara ? bone sonometer, broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI) were collected from the right heel. Variance components based linkage analysis was performed on the three traits using 400 polymorphic short tandem repeat (STR) markers spaced approximately 10 cM apart across the autosomes to identify QTL influencing the QUS traits. Age, sex, and other significant covariates were simultaneously adjusted. Heritability estimates (h2) for the QUS traits ranged from 0.42 to 0.57. Significant evidence for a QTL influencing BUA was found on chromosome 11p15 near marker D11S902 (LOD = 3.11). Our results provide additional evidence for a QTL on chromosome 11p that harbors a potential candidate gene(s) related to BUA and bone metabolism.     

Anthropometrics provide a better estimate of urinary organic acid anion excretion than a dietary mineral intake-based estimate in children, adolescents, and young adults

The role of elevated net endogenous acid production (NEAP) in the causation of osteoporosis, muscle wasting, and kidney stones is currently under discussion. The aim of this study was to examine whether urinary organic acid anion excretion, a major component of NEAP, is predicted primarily by anthropometric- (OA(anthro)) or diet- (OA(diet)) based estimates. Dietary intakes, anthropometric data, and 24-h urinary excretion rates of organic acids (24h-OA(urine)) were determined cross sectionally in healthy children (6-7 y; n = 217), adolescents (13-14 y; n = 91), and young adults (18-22 y; n = 82). OA(anthro) was computed from body surface area and OA(diet) calculated using a published algorithm based on dietary intakes of mineral anions and cations. There was a significant increase (P < 0.0001) in 24h-OA(urine) across the age groups that was no longer discernible after correction for body surface area. In almost all sex-stratified subsamples, OA(anthro) had a higher correlation with 24h-OA(urine) than OA(diet). Multiple regression analyses, using energy-corrected diet variables, revealed that OA(anthro) was consistently the primary predictor of 24h-OA(urine) (R(2) varying from 0.15 to 0.39) and dietary fat and protein were sporadic predictors. In accordance with the observed age independency of 24h-OA(urine) after body surface area correction, our findings indicate that OA(anthro) is a better estimate of 24h-OA(urine) in healthy children, adolescents, and young adults than OA(diet). This further confirms that the (principally diet-dependent) NEAP comprises a component, i.e., organic acid anions, that is reasonably predictable by anthropometrics. Consequently, the other component, i.e., the potential renal acid load, appears to be the primary parameter that characterizes the diet-induced acid load.     

A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group

BACKGROUND: Different sources of dietary protein may have different effects on bone metabolism. Animal foods provide predominantly acid precursors, whereas protein in vegetable foods is accompanied by base precursors not found in animal foods. Imbalance between dietary acid and base precursors leads to a chronic net dietary acid load that may have adverse consequences on bone. OBJECTIVE: We wanted to test the hypothesis that a high dietary ratio of animal to vegetable foods, quantified by protein content, increases bone loss and the risk of fracture. DESIGN: This was a prospective cohort study with a mean (+/-SD) of 7.0+/-1.5 y of follow-up of 1035 community-dwelling white women aged >65 y. Protein intake was measured by using a food-frequency questionnaire and bone mineral density was measured by dual-energy X-ray absorptiometry. RESULTS: Bone mineral density was not significantly associated with the ratio of animal to vegetable protein intake. Women with a high ratio had a higher rate of bone loss at the femoral neck than did those with a low ratio (P = 0.02) and a greater risk of hip fracture (relative risk = 3.7, P = 0.04). These associations were unaffected by adjustment for age, weight, estrogen use, tobacco use, exercise, total calcium intake, and total protein intake. CONCLUSIONS: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial.     

Serum retinyl esters are not elevated in postmenopausal women with and without osteoporosis whose preformed vitamin A intakes are high

BACKGROUND: Recent observational studies suggest that preformed vitamin A (VA) intakes of 1500-2000 microg/d may increase the risk of osteoporosis and hip fracture. However, few studies have examined associations between biologic indicators of VA and osteoporosis. OBJECTIVE: This study characterized VA intake, serum VA, and bone turnover markers in postmenopausal women with and without osteoporosis. DESIGN: Bone density was measured by dual-energy X-ray absorptiometry. Subjects were separated into those with osteoporosis (n = 30) and those with normal bone density (n = 29). Women with osteopenia were excluded. Complete blood chemistries were obtained. Serum was analyzed for retinol, retinyl esters, and metabolites. Assays for 3 bone turnover markers were performed by using commercially available kits. Diet records were quantified. Logistic regression was used to test for an association between dietary and serum variables and osteoporosis. RESULTS: Dietary VA did not differ significantly between the groups but was nearly twice the Recommended Dietary Allowance in both groups. Body mass index (BMI) and serum triacylglycerols were significantly lower in the osteoporosis group. Retinyl esters were not elevated in either group, but a trend existed for the association of serum retinyl esters as a percentage of total VA with osteoporosis (P = 0.070) after adjustment for BMI and triacylglycerols in the statistical model. Milk, fruit, and vegetable intakes were below the current recommendations. CONCLUSIONS: Serum retinyl esters were not elevated in these postmenopausal women despite intakes of total VA that were nearly two-fold the Recommended Dietary Allowance. However, retinyl ester concentration (percentage of total VA) was marginally associated with osteoporosis and should be further investigated.     

三江侗族成年女性年龄、体重指数对骨量的影响

[目的]探讨广西三江侗族成年女性年龄、体重指数对骨量的影响。[方法]选择侗族成年女性406例,应用定量超声骨密度仪测定其右侧跟骨BUA,测量身高、体重、足长,计算体重指数(BMI),并分别按BMI及年龄分组。[结果]低BMI组、55岁年龄组及65岁年龄组的跟骨BUA值比其他组低,差异有统计学意义(P﹤0.05),骨量减少检出率高于其他组。[结论]高龄、低体重指数者的骨量较低,骨量减少检出率增高。     

Genetically defined adult-type hypolactasia and self-reported lactose intolerance as risk factors of osteoporosis in Finnish postmenopausal women

OBJECTIVE: To study the relationships of molecularly defined lactose malabsorption (LM) and self-reported lactose intolerance (LI) to bone mineral density (BMD) and fractures among Finnish postmenopausal women. DESIGN: A cross-sectional study of two cohorts. SETTING: Helsinki University Central Hospital. SUBJECTS: One cohort was population-based and comprised 453 women, aged 62-78 (mean 69) y. Another comprised 52 women, aged 69-85 (mean 75) y, with osteoporotic fractures and 59 control women, aged 69-83 (mean 74) y, without osteoporosis. METHODS: A single nucleotide polymorphism of the lactase (LCT) gene at chromosome 2q21-22 was studied. It shows complete association with intestinal disaccharidase activity, with the genotype CC(-13 910) meaning adult-type hypolactasia (primary LM) and the genotypes CT(-13 910) and TT(-13 910) lactose absorption. BMD of the heel was measured by dual-energy X-ray absorptiometry (DXA). RESULTS: In the population-based cohort, 16.0% of women had self-reported LI but only 15.3% of them had the CC(-13 910) genotype. Calcium intake from dairy products (P = 0.10) and BMD, adjusted for age, weight, height, exercise, smoking, and estrogen use (P = 0.71) were similar for the genotypes. Women with self-reported LI had reduced calcium intake from dairy products (P < 0.0001) but they were more frequent users of calcium supplements than lactose-tolerants (P < 0.0001). Adjusted BMD was similar for lactose intolerant and tolerant women (P = 0.60). Of 104 women with previous fracture in the population-based cohort, 13.5% had the CC(-13 910) genotype, which did not differ from the prevalence of 19.3% among 347 women without fractures (P = 0.29). The frequency of the CC(-13 910) genotype (23.1%) for 52 women with established osteoporosis was similar as for 59 control women (15.3%) (P = 0.19). CONCLUSION: Molecularly defined LM and self-reported LI are not risk factors for osteoporosis, if calcium intake from diet and/or supplements remains sufficient. Our study confirms the poor correlation between self-reported LI and LM established by different techniques.     

Longitudinal changes in BMI in older adults are associated with meat consumption differentially, by type of meat consumed

Hypotheses regarding the role of meat consumption in body weight modulation are contradictory. Prospective studies on an association between meat consumption and BMI change are limited. We assessed the association between meat consumption and change in BMI over time in 3902 men and women aged 55-69 y from the Netherlands Cohort Study. Dietary intake was estimated at baseline using a FFQ. BMI was ascertained through baseline self-reported height (1986) and weight (1986, 1992, and 2000). Analyses were based on sex-specific categories of daily total fresh meat, red meat, beef, pork, minced meat, chicken, processed meat, and fish consumption at baseline. Linear mixed effect modeling adjusted for confounders was used to assess longitudinal associations. Significant cross-sectional differences in BMI between quintiles of total meat intake were observed (P-trend < 0.01; both sexes). No association between total fresh meat consumption and prospective BMI change was observed in men (BMI change highest vs. lowest quintile after 14 y: -0.06 kg/m2; P = 0.75) and women (BMI change: 0.26 kg/m2; P = 0.20). Men with the highest intake of beef experienced a significantly lower increase in BMI after 6 and 14 y than those with the lowest intake (BMI change after 14 y 0.60 kg/m2). After 14 y, a significantly higher increase in BMI was associated with higher intakes of pork in women (BMI change highest vs. lowest quintile: 0.47 kg/m2) and chicken in both sexes (BMI change highest vs. lowest category in both men and women: 0.36 kg/m2). The results remained similar when stratifying on median baseline BMI, and age-stratified analyses yielded mixed results. Differential BMI change effects were observed for several subtypes of meat. However, total meat consumption, or factors directly related to total meat intake, was not strongly associated with weight change during the 14-y prospective follow-up in this elderly population.     

老年男性2型糖尿病患者骨质疏松相关因素分析

目的 探讨与老年男性2型糖尿病（type 2 diabetes mellitus,T2DM）骨质疏松（osteoporosis,OP）发生相关的因素。方法 选取老年男性T2DM患者288例,根据OP诊断标准分为骨量正常组（72例）、骨量减少组（118例）和骨质疏松组（98例）。测量身高、体重,计算体质指数（body mass index,BMI）;测定空腹血糖（fasting blood glucose,FBG）、糖化血红蛋白（glycosylated hemoglobinA1c,HbA1c）、甲状旁腺素（parathyroid hormone,PTH）、血清钙（serum calcium,Ca）、血清磷（serum phosphonium,P）、25羟维生素D （serum 25-hydroxyvitamin D,25-OH-VD）及尿白蛋白/肌酐（urinary albumin/creatinine ratio,ACR）,记录患者病程、降糖药物使用和糖尿病慢性并发症情况。结果 与骨量正常组比较,骨质疏松组和骨量减少组病程较长和HbA1c较高,BMI减低,差异均有统计学意义（均有P<0.05）。相关分析显示股骨颈、三角区、大转子、腰椎（lumbar vertebrae,L）2-4节骨密度（bone mineral density,BMD）与BMI均呈正相关（均有P<0.05）,但与HbA1C均呈负相关（均有P<0.05）。骨质疏松组糖尿病肾病、糖尿病视网膜病变发生率均高于骨量正常组、骨量减少组（均有P<0.05）;骨质疏松组糖尿病神经病变发生率高于骨量正常组（χ2=6.168,P=0.013）。Logistic回归分析显示BMI、HbA1c及糖尿病肾病与糖尿病骨质疏松发生相关（均有P<0.05）。结论 低BMI,血糖控制不佳和糖尿病肾病是老年男性T2DM患者OP发生的危险因素。