【作者】 刘颖；

【导师】 李军； 马冠生；

【作者基本信息】 山东大学 ， 儿少卫生与妇幼保健学， 2010， 硕士

【摘要】 [研究目的]钙和维生素D是维持骨骼健康和体重正常的必需营养素,我国老年妇女由于钙和维生素D缺乏导致的骨质疏松和超重、肥胖普遍存在。国外大量研究表明,适量补充钙和维生素D能够有效地改善老年妇女的骨量丢失和超重肥胖状况,但国内相关研究较少,而东西方之间的种族和膳食习惯等存在较大差异,因此,在我国进行这样一项研究是十分必要的。本文主要研究补充钙和维生素D对北京城区老年绝经妇女骨矿物含量(BMC)和体成分(BC)的作用,以期为老年人尤其是老年绝经妇女多发的骨质疏松(OP)和老年性超重和肥胖提供预防和治疗的依据和参考,从而延缓老年妇女骨量降低的速度,减少骨折的发生,抑制其体脂过快增长,预防与之相关的慢性病,提高老年人晚年的生活质量,减少家庭、社会和国家的负担。[研究方法]用整群随机抽样的方法在春末夏初从北京3个城区17个社区中随机选取60岁以上老年绝经妇女400名,用量表和体检的方法进行现况研究。再从现况研究的400名老年妇女中随机选取305人作为干预研究对象,并随机分为两组,单纯补钙组(A组)和补钙+维生素D组(B组),分别服用钙剂和钙+维生素D各-年,比较其干预前后身体各部位的体成分和骨量是否有所改变。[结果]1、现况研究结果北京城区老年妇女平均年龄是(68.7±5.6)岁,血钙平均水平为2.087mg,血清25(OH)D平均水平为(14.4±5.7)ng/ml,其中维生素D缺乏的比例达到62.4%,不足的比例为21.8%,处于正常水平的比例仅为15.8%。研究对象BMI均值为(25.9±3.6)kg/m2,PBF的均值为(39.2±5.3)%,以PBF和BMI判定的超重率分别达到：17.4%和48.5%,肥胖率分别达到76.7%和22.3%。研究对象全身、腰椎和股骨颈的BMD分别为(0.829±0.090)、(0.916±0.125)和(0.679±0.106)g/cm2,腰椎(L2-4)和股骨颈骨量减少的检出率分别为41.8%和38.5%,骨质疏松检出率分别为14.2%和12.3%。研究结果显示,血清25(OH)D水平与身高、体重相关性不显著(r=0.04,r=-0.06,P>0.05),与全身、髋部及双下肢的体脂百分比(PBF)、髋部和双下肢的体脂(BF)均呈显著负相关(r=-0.14～-0.10,P<0.05),与全身、股骨颈、大转子、腹中部和双上肢部位的BMD呈显著正相关(r=0.114～0.168,P<0.05)；血清25(OH)D正常组研究对象全身、髋部和右下肢的PBF均显著低于25(OH)D不足组和缺乏组,其中全身PBF分别低2.4%和5.8%；血清25(OH)D正常组研究对象全身及全身各部位(腹中部除外)的BMD水平均显著高于25(OH)D不足组和缺乏组,其中全身BMD分别高4.7%和6.4%,股骨颈BMD分别高7.3%和8.9%。2、干预研究结果A、B组老年妇女血钙水平分别为2.25mg和2.28mg,血清25(OH)D水平分别为14.66ng/ml和23.98ng/ml,,干预后B组老年妇女的血清25(OH)D水平显著高于A组(P<0.05),前者比后者高63.66%;A组老年妇女体重和BMI有所增加,而B组有所减少；B组老年妇女全身、腹中部、髋部以及双下肢的PBF和BF的减少量均高于A组,两组之间均无显著性差异(P>0.05)；B组老年妇女全身、腰椎、髋部、和左右下肢的BMD显著高于A组(P<0.05),分别比A组高3.4%、5.8%、5.8%、4.5%和3.8%。干预后,两组老年妇女全身、腹中部和左下肢部位的BF和PBF均有所减少,与干预前相比均有显著性差异(P<0.05),其中,A、B两组全身的BF和PBF分别比干预前降低4.8%、3.5%和5.3%、5.2%；干预后两组老年妇女全身和双上肢部位的LBM均有所增加,显著高于干预前(P<0.05),分别比干预前高出2.3%和1.5%。干预后A组老年妇女Wards’三角、大转子和双上肢部位的BMD有所增长,Wards’三角和双上肢部位的BMD与干预前相比有显著性差异(P<0.05),分别比干预前高出7.5%、3.5%和1.9%；干预后B组老年妇女全身、腰椎、股骨颈、大转子、Wards’三角、髋部、右下肢和双上肢部位的BMD均有所增长,干预后全身、髋部、Wards’三角和双上肢部位的BMD显著高于干预前(P<0.05),分别比干预前高出1.0%、2.7%、8.9%、3.8%和2.6%。[结论]北京城区老年妇女血清维生素D水平不足和缺乏的现象比较普遍,维生素D水平较高者体脂和体脂百分比水平较低,维生素D营养状况与全身、腰椎、股骨近端、髋部以及四肢骨量密切相关,提示良好的维生素D营养状况对维持我国老年绝经妇女适宜体重和骨骼健康有重要意义。同时补充钙和维生素D能够有效减缓老年妇女的骨量丢失,增加骨密度,同时能够帮助其减少体脂,控制体重,因此补充适宜的钙和维生素D对于老年肥胖和骨质疏松的预防有一定作用,单纯补钙不如同时补充钙和维生素D对体成分和骨密度的改善效果明显。更多还原

【Abstract】 OBJECTIVE Calcium and vitamin D are the essential nutrients to maintain the bone health and normal weight, osteoporosis resulting from deficiency of calcium and vitamin D of Chinese postmonapausal older women was prevalence. A large number of studies abroad have shown that supplement of calcium and vitamin D can effectively improve the bone health and overweight or obesity of older women. However, domestic researches were relatively deficient and there are large differences between race and diatery habits of east and west, so it is very necessary to perform such a research in our country.This paper aimes at studying the role of supplying calcium and vitamin D to the bone mineral composition and body composition of urban postmonapausal women in Beijing, and providing the experience to the prevention and treatment of osteoporosis, overweight and obesity of Chinese older women, postponing the bone loss, reducing the bone fracture rate, restrainting the excessive growth of body fat, preventing the relative chronic diseases, improving the quality of older women life, releasing the burden of state, society and family.METHODS A total of 400 community-dwelling women were selected randomly from 17 community of 3 districts in Beijing with cluster random sampling methods. Cross-section survey used questionnaire and physical examination. In intervention study,305 women were randomly chosed from 400 objects of cross-section survey, which were divided into two groups randomly. Calcium group(A group) and calcium adding vitamin D group(B group), who took supplemention of calcium and calcium adding vitamin D for one year respectively. We observe if the bone mineral density and body composition improved after controlling confounding factors, and the range. RESULTS 1、Cross-section survey results.The mean age of urban older women of Beijing were (68.7±5.6), mean serum calcium level was 2.087mg, mean serum 25(OH)D was (14.4±5.7) ng/ml. Vitamin D deficiency rate was 62.4%, insufficient rate was 21.8%, and the vitamin D in normal was only 15.8%. Mean BMI of the subject was (25.9±3.6)kg/m2, mean value of PBF was (39.2±5.3)%, and the overweight rate was up to 17.4% and 48.5%, obesity rate was 76.7% and 22.3%, which were calculated by PBF and BMI. BMD of subjects at total, lumbar spine(L2-4) and femneck were respectively (0.829±0.090), (0.916±0.125) and (0.679±0.106)g/cm2, The rate of osteoporosis at lumbar spine(L2-4) and femneck of of urban postmonapausal women in Beijing were respectively 14.2%.and 12.3%, and bone loss rate were 41.8% and 38.5%.Serum 25(OH)D level was not correlated with height and weight(r=0.04, r=-0.06, P>0.05), and were positively correlated with PBF at total, pelvis and lower limbs, and with BF at pelvis and lower limbs(r=-0.14～-0.10,P<0.05). Serum 25(OH)D level was positively correlated with BMD at total and femneck(r=0.165, r=0.184, P<0.05). PBF of subjects with 25(OH)D normal group was significantly higher than that of subjects with vitamin D insufficient or vitamin D deficiency at total, pelvis and right lower limb, with 2.4% or 5.8% lower at total. BMD of subjects with 25(OH)D normal group is significantly higher than that of subjects with vitamin D insufficient or vitamin D deficiency in all parts except midriff, with 4.7% or 6.4% higher at total body, and 7.3% or 8.9% more at femneck.2、Intervention trial resultsThe mean serum calcium level of older women of A and B group were respectively 2.25mg and 2.28mg, the serum 25(OH)D concentration of A and B group were 14.66ng/m/ and 23.98ng/ml respectively, serum 25(OH)D concentration of B group was higher than A group significantly(P<0.05), with 63.66% higher. The weight and BMI of group A increased, while B group decreased. BMD of the B groups at total, lumbar spine, lower limb and pelvis were significantly higher than A group, with 3.4%,5.8%,4.5%,5.8% and 3.8% higher respective.BF and PBF at toal, midriff and left lower limb of the two group all decreased after intervention, and the difference were significant(P<0.05). BF and PBF at total of A and B group were respectively 4.8%m,3.5% and 5.3%,5.2% lower than preintervention. LBM at total and bi-upper limbs were increased, and were 2.3% and 1.5%higher than preintervention(P<0.05). BMD at Wards’, norland and bi-upper limbs of A group increased, BMD of Wards’and bi-upper limbs were 7.5%,3.5%and 1.9% higher than preintervention(P<0.05). BMD at total, lumbar spine(L2-4), femneck, norland, Wards’and bi-upper limbs all increased, and 1.0%,2.7%,8.9%,3.8% and 2.6% higher than preintervention.CONCLUTIONS The level of serum 25(OH)D of urban postmonapausal women in Beijing were insufficient widely, the women who have higher serum 25(OH)D level have lower BF and PBF. There was closely correlation between vitamin D status and BMD at total, lumbar spine, proximal femneck, pelvis and four limbs, which relealed that good nutrition status of vitamin D is very important to maintain normal weight and bone health of Chinese postmonapausal older women.Suppling calcium and vitamin D at the same time can release the bone loss of older women effectively, increase their bone mineral density, and help to reduce body fat and control weight. So the supplemention of calcium and vitamin D is likely to prevent obesity and ostesporosis of older women, which effects was better than simple adding calcium.更多还原