美国成年人的骨密度与健康饮食指数的关联研究

Association Study on Bone Density and Healthy Eating Index in American Adults

目的:研究20岁及以上美国成年人的骨骼矿物质密度(BMD)与健康饮食指数(HEI-2015)的关系。方法:选取美国国家营养与健康调查(NHANES)2011—2018年4个调查周期的成年人作为研究对象,研究包含有完整的性别、年龄、种族、学历与家庭收入等人口学变量信息,完整的膳食数据,体质指数(BMI)、空腹血糖和骨密度数据。本研究最终纳入研究对象人数为4 373人,经过个体加权后,可代表约1亿427万名美国成年人。研究按照三分位数对腰椎骨密度进行分类,分为“<最小三分位数”和“≥最小三分位数”2组,建立以BMD为因变量的二元逻辑回归模型,分析HEI-2015及构成HEI-2015的13个食物或营养素组件与BMD之间的关系。结果:全变量模型中,较高水平的HEI-2015得分对腰椎骨密度呈危害效应,HEI-2015的Q4水平(OR=1.255,95%CI:1.253~1.256)对骨密度危害作用最大。在构成HEI-2015的推荐组件中,水果总量(OR=0.922,95%CI:0.921~0.923)、蔬菜和豆类(OR=0.913,95%CI:0.912~0.914)、全谷物(OR=0.828,95%CI:0.827~0.83)、海鲜和植物蛋白(OR=0.931,95%CI:0.93~0.932)及脂肪酸(OR=0.834,95%CI:0.833~0.835)均为BMD的保护因素;在适当组件中,摄入不超过限制标准的精制谷物(OR=0.909,95%CI:0.908~0.91)和添加糖(OR=0.884,95%CI:0.883~0.885)为BMD的保护因素。结论:更严格地遵守美国膳食指南,获得更高的HEI-2015分数,与较低的美国成年人骨密度有关。

Objective To examine whether Bone Mineral Density(BMD)was associated with Healthy Eating Index(HEI-2015)in US adults aged 20 years and older.Method Adults from four cycles of National Health and Nutrition Examination Survey(NHANES)from 2011 to 2018 were selected as research subjects.The study included complete information on demographic variables such as gender,age,race,education and family income,complete dietary data,body mass index(BMI),fasting blood glucose and bone mineral density.The final study population was 4373,individually weighted to represent about 144.27 million American adults.Lumbar bone mineral density was divided into two groups according to the quintile,"<minimum quintile"and"≥minimum quintile".A binary logistic regression model with BMD as the dependent variable was established to analyze the relationship between BMD and HEI-2015 and 13 components of HEI-2015.Result In the total variable model,a higher level of HEI-2015 score had a detrimental effect on lumbar bone density,and the Q4 level of HEI-2015(OR=1.255,95%CI:1.253—1.256)had the greatest detrimental effect on bone density.Among the recommended components that comprise HEI-2015,total fruit(OR=0.922,95%CI:0.921—0.923),vegetables and legumes(OR=0.913,95%CI:0.912—0.914),whole grains(OR=0.828,95%CI:0.827—0.83),seafood and vegetable protein(OR=0.931,95%CI:0.93—0.932)and fatty acids(OR=0.834,95%CI:0.833—0.835)were protective factors for BMD.In the limited components,intake of refined grains(OR=0.909,95%CI:0.908—0.91)and added sugars(OR=0.884,95%CI:0.883—0.885)not exceeding the limit were protective factors for BMD.Conclusion Greater adherence to U.S.Dietary Guidelines and higher HEI-2015 scores were associated with lower bone density in U.S.adults.