| Abstract: | 骨質疏鬆是一種無聲無症狀的疾病，其特徵在於骨量與骨強度的損失，導致低能量或脆弱性骨折的易感性增加。世界骨質疏鬆基金會IOF(International Osteoporosis Foundation)指出50歲以上的人群中，多達三分之一的女性和五分之一的男性會因骨質疏鬆的問題容易導致骨折。根據2013-2016年國民營養健康狀況變遷調查，50歲以上國人12.3%有骨質疏鬆症，其中男性為8.6%，女性為15.5%，且盛行率隨年齡而增加。了解影響骨量的因素對於骨質疏鬆的一級預防是很重要的，而飲食營養與骨質疏鬆症密切相關，當飲食中營養素攝取不當
時，會影響骨骼代謝之平衡，而造成骨流失(bone loss)。
研究飲食模式可能有助於確定影響骨密度的整個飲食成分之間潛在加成、協同和拮抗作用。先前研究指出得舒飲食(Dietary Approaches to Stop Hypertension, DASH)和地中海飲食與健康狀況的改善有相關。本研究以19歲以上的成年人為對象，探討DASH飲食和地中海飲食模式遵從度與成年人骨骼健康之相關性。研究對象來自來自2 項橫斷式(cross-sectional)研究;一為研究飲食及生活型態因子與成年人骨質狀況之相關性，另一項則為成年人維生素D營養狀況及其相關影響因素之研究。DASH飲食評分指數選用Millen’s index並納入9種營養素(蛋白質、纖維、鎂、鈣、鉀、總脂肪、飽和脂肪、鈉、膽固醇)。地中海飲食評分是參考MMDS(Modified Mediterranean Diet Score)，針對蔬菜、水果和堅果、豆類、穀物、魚類、肉類和家禽類製品與乳製品等之攝取狀況評分。骨骼健康指標以雙能量X-光吸收儀(dual-energy X-rayabsorptiometry, DXA)掃描包括個案的全身平均(total body, TB)、腰椎骨(lumbar spine, LS)和股骨頸(femoral neck, FN)之骨礦物量(bone mineral content, BMC)和骨密度(bone mineral density, BMD)，並可獲
得體組成。
本研究觀察到隨著年齡的增加男性和女性對DASH 飲食評分遵
從性會越高，可推測隨著年齡的增加會越注重飲食營養和健康。DASH飲食評分與男性瘦體率呈正相關，可推測男性對DASH飲食遵從度較高有助維持其肌肉量。MMDS飲食評分對65歲以上的男性全身、股骨頸BMC與腰椎BMC和BMD可能有益。
Osteoporosis is an asymptomatic disease characterized by low bone mass and microarchitectural deterioration that would consequently increase bone fragility and the risk of fracture. The International Osteoporosis Foundation (IOF) reported that one-third of women and one-fifth of men over the age of 50 are threatened by osteoporotic fractures. According to the results from 2013-2016Nutrition and Health Survey in Taiwan(NAHSIT), the prevalence rates of osteoporosis in those aged 50 years and older were 8.6% in men and 15.5% in women, respectively, and the prevalence increases with age. It is thus important to understand the factors that affect bone mass in order to develop effective strategies for preventing osteoporosis. Previous studies have shown that both DASH(Dietary Approaches to Stop Hypertension)diet and the Mediterranean diet are associated with improved health. We thus hypothesized that adults with higher adherence to these diets would have better bone health status.
The subjects were 189 adults (141 males and 148 females) aged 20 years and older who were originally recruited for two independent observational studies on adult bone health. Adherehce to DASH diet was assessed by calculating the Mellen‘s index based on the intake of 9 nutrients from the 24-h dietary recalls of the subjects, whereas the adherence to the Meditterranean diet was assessed by calculating the MMDS (modified Mediterranean Diet score) according to the intake of 5 beneficial components (vegetables, fruits and nuts, legumes, cereals, and fish) and 2 components presumed to be detrimental (meat and poultry products, and dairy products). These diet scores were then evaluated for the association with bone health measurements, including BMC and BMD at total body, lumbar spine and femoral neck
The results showed that only low to fair adherence to both diets in the subjects though the adherence to DASH diet seemed to increase with age. There were positive correlations, of borderline significance, between MMDS and BMC at total body and lumbar spine also significance BMC and BMD at femoral neck in males aged 65 years and older. DASH diet score, however, was negatively correlated with BMD in males and females, but positively correlated with lean mass in males. |
