基于骨胶原肽的饮食干预对中老年人骨转换指标的影响研究

发布时间：2018-06-15 22:03

本文选题：营养干预 + 骨质疏松　；参考：《山东大学》2015年硕士论文

【摘要】：目的探讨济南市社区中老年人对骨质疏松症(Osteoporosis, OP)的认知现状；通过对济南市社区中老年人进行为期一年的基于骨胶原肽的饮食行为干预,评价干预前后研究人群膳食结构、行为习惯调整和体格指标、骨密度T值、骨转换生化指标的变化。对干预前后OP患者及对照人群的营养知、信、行情况的改善效果进行分析评价。为社区中老年人群的骨骼健康管理提供参考,为OP患者的健康促进方案和疾病防治措施提供理论基础。方法随机抽取2013年9月至2013年12月到山东中医药大学第二附属医院健康体检中心检查的济南市5个行政区社区中老年人。纳入标准：思维正常、语言流畅、意识清晰,有正常行为能力；知情同意。排除标准：神志不清晰、交流障碍；患急慢性肝炎、肾脏及内分泌相关疾病；目前应用激素类药物、抗骨质疏松药物以及利尿剂等影响骨代谢药物。前期共纳入研究对象368例,其中有效样本366例,包括男123例,女243例(已绝经)；OP患者147例,非OP人群219例。对纳入的研究对象进行为期1年的基于骨胶原肽的饮食行为干预,主要包括随访确认研究对象每天以规定的剂量服用骨胶原肽,指导三餐饮食、普及骨骼知识健康教育及根据个人情况进行干预方案和力度调整。经过一年时间干预后,除去失访人数、半途退出试验人数、后期数据不全、问卷不合格人数,总共完成干预全程且问卷数据有效者205人,包括男74例,女131例(已绝经),年龄在49～88岁范围内,平均年龄(69.23±7.65)岁,男性平均年龄(71.80±7.22)岁,女性平均年龄(68.30±6.84)岁。OP患者82例,非OP人群123例。分别在干预前干预后由专业人员进行问卷调查(主要包括基本信息、日常行为习惯、骨健康的认知及态度、骨骼健康状况生活史、家族史、既往疾病史、特殊用药史及女性月经史等信息)、体格测量和骨转换生化指标检测包括：骨密度T值、血清钙、磷、碱性磷酸酶(Alkaline Phosphatase, ALP)、甲状旁腺激素(Parathyroid Hormone,PTH)；问卷收集后对问卷调查、体格检查和骨转换生化指标结果进行分析评价。结果1.干预前期研究对象的体质指数(Body Mass Index, BMI)均值为(24.97±2.95),高于正常值范围,超重者占46.8%；肥胖者占15.6%。女性BMI高于男性,差异不明显,60～70岁年龄组的BMI值最高,组间差异明显,组内差异不具有统计学意义(P0.05)。2.干预前期男性OP检出率为35.1%,女性的OP检出率为53.4%,女性的OP检出率高于男性,差异明显(X26.360,P0.01)。研究对象骨密度T均值为(-2.47+1.37)g/cm2处于骨量减少范围内,女性为(-2.74+1.37)g/cm2,男性为(-2.03±1.27)g/cm2,女性远低于男性(P0.01)。骨密度T值随年龄增长逐渐降低,且组间、组内差异均具有统计学意义(P0.05)。骨密度T值随BMI升高有升高趋势,组内差异明显(P0.01),正常组和超重组的组间差异不明显,其他各组间有明显差异(P0.05)。3.研究对象的血清钙、磷、PTH、ALP均值均在正常范围内,血清钙、磷、ALP均值的性别差异均具有统计学意义,且为女性偏高(P0.05)。血清钙水平随年龄升高逐渐升高,组内差异具有统计学意义(P0.05)。血清磷水平随年龄升高有下降趋势,组内差异明显(P0.05)。PTH水平随年龄增长有升高趋势,ALP水平随年龄增长有轻微降低,组内差异均不具有统计学意义。4.OP组和对照组的血清钙、PTH水平差异不具有统计学意义,血清磷、ALP水平差异具有统计学意义(P0.05),OP组的ALP和血清磷水平较高。5.对骨密度T值与骨转换生化指标作相关性分析,经身高、体重、年龄调整后,OP组骨密度T值与ALP之间呈现的负相关具有统计学意义(P0.05)。对照组骨密度T值与血清磷离子之间的负相关具有统计学意义(P0.01)。6.干预前后男性的骨质疏松营养知识回答正确率要高于女性,对照组的骨质疏松营养知识平均得分高于OP组差异不具有统计学意义(P0.05)。干预后男、女和总人群的平均得分高于干预前,差异具有统计学意义(P0.01),正确回答率在80%以上的题目占总题目的60%。与干预前相比,研究对象“骨质疏松的主要缺乏元素”、“防治骨关节疾病最适宜的方法”、“检测骨质疏松的金标准”正确回答率明显提高,差异具有统计学意义(P0.05)。“男、女哪个比较容易患骨质疏松”干预后正确回答率提高,但是差异不具有统计学意义。“骨质疏松是否会引起骨折”的回答正确率有轻微降低,差异不具有统计学意义。7.干预前后女性的日常饮食行为习惯平均得分高于男性,对照组的饮食行为习惯平均得分高于OP组,差异不具有统计学意义。干预后男、女和总人群的饮食行为习惯平均得分高于干预前,差异具有统计学意义(P0.05),干预后“膳食口味”、“乳制品摄入情况”、 “芝麻及芝麻制品摄入情况”、“坚持饮食运动相结合的生活方式”的回答情况明显好于干预前(P0.05)。“海产品摄入情况”、“大豆及豆制品摄入情况”、“饮用咖啡情况”、 “饮酒情况”、“户外运动情况”的回答情况好于干预前,但差异不具有统计学意义。8.干预后“关节肌肉的疼痛、肿胀状况”明显减轻,“关节灵活度”升高,关节僵硬、活动困难等现象发生率降低,干预前后的得分差异均有统计学意义(P0.01)；“骨骼的疼痛状况"好转,疼痛发生率降低,干预前后差异不明显,但是“骨痛感的疼痛程度”明显降低,程度分级得分差异具有统计学意义；研究对象干预后心情变好,感觉皮肤有轻微的变细变软现象,但是干预前后得分差异不明显；研究对象干预后自我感觉爬楼梯轻松,抽筋次数减少、症状减轻,老年斑颜色变浅,且干预前后差异均具有统计学意义(P0.05)。9.研究对象干预后骨密度T值、血清钙、PTH有轻微上升, BMI值、血清磷下降,骨密度T值、血清钙干预前后差异具有统计学意义(P0.05),ALP水平显著下降(P0.01)。干预后,男性骨密度T值有上升倾向,血清钙水平明显上升(P0.05),血清ALP和PTH有下降趋势,ALP干预前后差异具有统计学意义(P0.01)；女性骨密度T值、血清钙水平上升,骨密度T值水平变化明显(P0.01),血清ALP、PTH有明显降低(P0.05)。结论1.社区中老年人对骨骼营养相关知识掌握不够全面,日常饮食习惯不够合理,OP人群知识掌握、饮食习惯相对较差。OP组骨密度T值与ALP之间呈现明显负相关,对照组骨密度T值与血清磷离子之间呈现负相关。2.经过骨胶原蛋白肽和饮食行为健康干预后,研究对象的骨骼健康知识、态度、行为总体水平得到提高,部分提高有限,但总体的干预效果良好。3.骨胶原肽饮食行为干预对骨转换生化指标的干预效果明显,骨量减少检出率升高,OP检出率降低。伴随着骨密度T值的提高,血清钙、钙磷比、PTH均有提高,ALP水平显著下降。4.干预后对日常饮食行为习惯效果明显,乳制品类、豆制品类、海产品类、芝麻制品的摄入量有所升高,生活质量有明显改善,但对具体的膳食营养素的准确影响还需要在今后的干预过程中进行探索、改进和完善。
[Abstract]:Objective to investigate the cognitive status of Osteoporosis (OP) in the middle-aged and elderly people in Ji'nan, and to evaluate the dietary structure, behavioral habit adjustment and physical index, bone mineral density (BMD) value, bone mineral density (BMD) and bone conversion biochemical index before and after intervention through the diet behavior intervention based on bone gelatin peptide for the elderly in Ji'nan community. Analysis and evaluation of the improvement effect of nutrition knowledge, letter and practice of OP patients and control people before and after intervention. Provide a reference for the bone health management of the elderly in the community, provide a theoretical basis for the health promotion program and disease prevention and control measures for the OP patients. Methods randomly selected from September 2013 to December 2013 in Shandong. The elderly in the 5 administrative districts of Ji'nan, the Second Affiliated Hospital of Medical University, were included in the standard: normal thinking, fluent language, clear consciousness, normal behavior ability, informed consent. Exclusion criteria: uncertainty, communication disorder, acute and chronic hepatitis, kidney and endocrine related diseases; current application Hormone drugs, anti osteoporosis drugs and diuretics influence bone metabolism drugs. 368 cases were included in the early stage, of which 366 cases were effective samples, including 123 men, 243 women (menopause), 147 OP patients and 219 non OP people. The following follow-up confirmed that the subjects took the bone glue peptide at the prescribed dose every day to guide the diet of the three meals, popularize the health education of the skeleton knowledge and the intervention programs and adjustments according to the individual situation. After one year's time, the number of lost visitors was removed, the number of people withdrew from the experiment, the late data were incomplete, the number of the questionnaires was not qualified, and a total of the total finished. 205 people, including 74 men, 131 women (menopause), average age (69.23 + 7.65) years, male age (71.80 + 7.22) years, average age (68.30 + 6.84) years (68.30 + 6.84) years (68.30 + 6.84).OP patients 82, and non OP population 123 cases. Examination (including basic information, daily behavior habits, bone health cognition and attitude, bone health status life history, family history, past disease history, special medication history, female menstrual history and other information), physical measurement and bone conversion biochemical indicators including bone mineral density T, serum calcium, phosphorus, alkaline phosphatase (Alkaline Phosphatase, ALP), a Parathyroid Hormone, PTH (PTH); questionnaire survey, physical examination and bone conversion biochemical index results were analyzed and evaluated. Results the mean value of body mass index (Body Mass Index, BMI) was (24.97 + 2.95), higher than the normal range, 46.8% of overweight and obese 15.6%. women. 1. In men, the difference was not obvious. The BMI value of the 60~70 year old group was the highest, the difference between the groups was obvious, the difference in the group was not statistically significant (P0.05) the positive rate of male OP in the early stage of.2. intervention was 35.1%, the rate of OP in the female was 53.4%, the OP detection rate of the female was higher than that of the male, the difference was obvious (X26.360, P0.01). The average T mean of the bone density of the study object was (-2.47+1.37) g/. Cm2 was within the range of bone mass reduction, women were (-2.74+1.37) g/cm2, male was (-2.03 + 1.27) g/cm2, and women were far lower than men (P0.01). The T value of bone density decreased gradually with age, and the differences in the group were statistically significant (P0.05). The T value of bone density increased with BMI, and the difference in the group was obvious (P0.01), normal group and super recombination. There was no obvious difference between the groups. The serum calcium, phosphorus, PTH, and ALP of the subjects in other groups (P0.05) were all in the normal range. The gender differences in serum calcium, phosphorus and ALP were all statistically significant, and were higher in women (P0.05). The serum calcium water level increased gradually with age, and the difference in the group was statistically significant (P0.0 5). The level of serum phosphorus decreased with age, and the difference in the group (P0.05).PTH level increased with age, and the level of ALP decreased slightly with age. The difference in the level of serum phosphorus was not statistically significant in the.4.OP group and the control group. The difference of the level of PTH was not statistically significant, and the difference of serum phosphorus and ALP levels had a significant difference. Statistical significance (P0.05), group OP ALP and serum phosphorus level was higher.5. correlation analysis of bone mineral density T value and bone conversion biochemical index, after height, weight, age adjusted, OP group bone density T value and ALP between the negative correlation between the statistical significance (P0.05). The negative correlation between the bone density T value and serum phosphorus ions in the control group has a negative correlation The correct rate of the male osteoporosis nutrition knowledge before and after.6. intervention (P0.01) was higher than that of the female. The average score of osteoporosis knowledge in the control group was higher than that of the OP group (P0.05). The average score of the male, female and total population after intervention was higher than that before intervention, and the difference was statistically significant (P0.01). More than 80% of the subjects accounted for the 60%. of the general topic before the intervention, the subject "the main lack of osteoporosis", "the most suitable method for the prevention and treatment of bone and joint disease", the correct answer rate of "gold standard for detecting osteoporosis" was obviously improved, and the difference was statistically significant (P0.05). "Men and women are more likely to suffer from bone." The correct response rate increased after the intervention, but the difference did not have statistical significance. "Whether the osteoporosis will cause fracture" has a slight decrease in the correct rate, and the difference is not statistically significant. The average score of daily dietary habits and habits of women before and after.7. intervention is higher than that of men, and the average scores of dietary habits and habits in the control group are higher. In the OP group, the difference was not statistically significant. The average scores of dietary habits and habits of men, women and the general population were higher than those before intervention, and the difference was statistically significant (P0.05). The outcome of "dietary taste", "dairy ingestion", "sesame and sesame products intake", "adhere to the lifestyle of diet and exercise" The response was better than before intervention (P0.05). "Intake of seafood", "intake of soy and bean products", "drinking coffee", "drinking", "drinking", "outdoor exercise" were better than before intervention, but the difference was not statistically significant in.8. after the "joint muscle pain, swelling state". The incidence of "joint flexibility" increased, joint stiffness, difficulty in activity and other phenomena decreased. The difference of scores before and after intervention were statistically significant (P0.01); "the pain status of bone" improved, the incidence of pain decreased and the difference was not obvious before and after intervention, but the pain degree of bone pain was obviously reduced and the grade score was poor. The difference was statistically significant; after the intervention, the mood of the study was better, and the skin had a slight thinning and softening phenomenon, but the difference was not obvious before and after the intervention. After the intervention, the self felt staircase was relaxed, the number of cramps decreased, the symptoms were reduced, the color of the senile plaque was lighter, and the difference was statistically significant before and after the intervention (P0.0 5) the T value of bone mineral density after the intervention of.9., serum calcium, PTH had a slight increase, BMI value, the decrease of serum phosphorus, the T value of bone density, the difference between the serum calcium and the serum calcium was statistically significant (P0.05), the level of ALP decreased significantly (P0.01). The prognosis of the bone density in male was up, the serum calcium level was up (P0.05), the serum ALP and PTH had a decline. The difference was statistically significant (P0.01) before and after ALP intervention, the T value of bone mineral density in women, the increase of serum calcium level, the T value of bone density (P0.01), serum ALP and PTH significantly decreased (P0.05). Conclusion the knowledge of bone nutrition related knowledge in the 1. community is not comprehensive, the daily diet habits are not reasonable, and the OP crowd knowledge is mastered, The bone mineral density (BMD) T value of.OP group was negatively correlated with ALP, and the negative correlation between T value and serum phosphorus ion in the control group was negatively correlated with the prognosis of bone collagen peptide and dietary behavior health. The level of bone health knowledge, attitude, and behavior general body level of the study subjects were improved, and the overall level was limited, but the overall level of the study was limited. The intervention effect was good, the intervention effect of.3. osteonetin dietary behavior intervention on bone transformation biochemical indexes was obvious, the detection rate of bone mass decreased and the detection rate of OP decreased. With the increase of T value of bone density, serum calcium, calcium and phosphorus ratio, PTH were improved, and ALP level significantly decreased the effect of.4. intervention on daily dietary habits, dairy category, The intake of soybean products, marine products, sesame products increased and the quality of life improved obviously, but the exact influence of the specific dietary nutrients needed to be explored, improved and improved in the process of intervention in the future.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R580

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