食物和营养素与骨质疏松的预防

Diet,Nutrition and the Prevention of Osteoporosis

目的回顾与骨质疏松有关的食品及营养素,提供预防骨质疏松,特别是由骨质疏松引发的骨折的相关建议。方法首先,回顾骨质疏松的定义、诊断及流行病学研究;讨论在世界范围内用骨矿物密度(BMD)定义骨质疏松风险程度并建议将脆性骨折作为疾病终点的难度。其次,完成一个有科学数据支持和持有不同观点的有关食品、营养素与骨质疏松相关文献的综述。后者将涉及钙、维生素D、磷、镁、蛋白质和氟;其他潜在影响骨质健康的饮食因素也将被提及,如维生素、微量元素、电解质、酸碱平衡、植物雌激素、素食以及乳糖不耐受等。结论关于用骨矿物质状态、儿童及青少年的生长发育情况、骨转换加速作为评估长期骨质疏松风险的指标还略显证据不足。对于成年人来讲,除了钙和维生素D之外,其他摄入食物成分与骨折风险无紧密的相关。对于食物及其他方面,目前有充足的证据证明:低钠增钾、增加新鲜蔬菜和水果的健康饮食建议对促进骨骼健康有益。

Objective To review the evidence on diet and nutrition relating to osteoporosis and provide recommendations for preventing osteoporosis,in particular,osteopototic fracture.Approach Firstly,to review the definition,diagnosis and epidemiology of osteoporosis,to discuss the difficulties in using bone mineral density to define osteoporosis risk in a world-wide context and to propose that fragility fracture should be considered as the disease endpoint.Secondly,to provide an overview of the scientific data,the strengths and weaknesses of the evidence and the conceptual difficulties in interpreting studies linking diet,nutrition and osteoporosis.The following were considered：calcium,vitamin D,phosphorus,magnesium,protein and fluorine.Other potential dietary influences on bone health were also discussed,including vitamins,trace elements,electrolytes,acid-base balance,phyto-oestrogens,vegetarianism and lactose intolerance.Conclusions There is insufficient knowledge linking bone mineral status,growth rates or bone turnover in children and adolescents to long-term benefits in old age for these indices to be used as markers of osteoporotic disease risk.For adults,the evidence of a link between intakes of any dietary component and fracture risk is not sufficiently secure to make firm recommendations,with the exception of calcium and vitamin D.For other aspects of the diet,accumulating evidence suggests that current healthy-eating advice to decrease sodium intake,to increase potassium intake,and to consume more fresh fruits and vegetables is unlikely to be detrimental to bone health and may be beneficial.