生物标志物校准的蛋白质摄入量与妇女健康倡议临床试验和观察研究中的骨骼健康。
Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study.
机构信息
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (JMB); the Fred Hutchinson Cancer Research Center, Seattle, WA (AZL, JCL, YH, MLN, LFT, and RLP); the Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, OH (RJ); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa (LS); the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (KCJ); and the Department of Family Medicine and Epidemiology, Memorial Hospital of Rhode Island Center for Primary Care and Prevention, Pawtucket, RI (CBE).
出版信息
Am J Clin Nutr. 2014 Apr;99(4):934-40. doi: 10.3945/ajcn.113.076786. Epub 2014 Feb 19.
BACKGROUND
The effects of dietary protein on bone health are controversial.
OBJECTIVE
We examined the relation between protein intake with fracture and bone mineral density (BMD) within the Women's Health Initiative (WHI).
DESIGN
This prospective analysis included 144,580 women aged 50-79 y at baseline in the WHI clinical trials (CTs) and observational study (OS) that recruited participants in 1993-1998 with follow-up through 2011. Self-reported clinical fractures were collected semiannually through the original end of the trials (WHI CTs) and annually (WHI OS) by questionnaires. Hip fracture was adjudicated by a central review of radiology reports. BMDs for total body, hip, and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry. Protein intake was assessed via food-frequency questionnaire and calibrated by using biomarkers of energy and protein intakes. Associations between protein intake and fracture were estimated by using Cox proportional hazards regression, and the relation between protein intake and BMD was estimated by using linear regression.
RESULTS
Median biomarker-calibrated protein intake was 15% of energy intake. Per 20% increase in calibrated protein intake (percentage of energy), there was no significant association with total fracture (HR: 0.99; 95% CI: 0.97, 1.02) or hip fracture (HR: 0.91; 95% CI: 0.84, 1.00), but there was an inverse association with forearm fracture (HR: 0.93; 95% CI: 0.88, 0.98). Each 20% increase in calibrated protein intake was associated with a significantly higher BMD for total body (mean 3-y change: 0.003 g/cm²; 95% CI: 0.001, 0.005 g/cm²) and hip (mean 3-y change: 0.002 g/cm²; 95% CI: 0.001, 0.004 g/cm²).
CONCLUSIONS
Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs. These data suggest higher protein intake is not detrimental to bone health in postmenopausal women.
背景
膳食蛋白质对骨骼健康的影响存在争议。
目的
我们在妇女健康倡议（WHI）中研究了蛋白质摄入量与骨折和骨密度（BMD）之间的关系。
设计
本前瞻性分析包括基线时年龄在 50-79 岁的 144580 名女性，这些女性参加了 WHI 临床试验（CT）和观察性研究（OS），于 1993-1998 年招募参与者，随访至 2011 年。通过原始试验结束时的问卷（WHI CT）和每年（WHI OS）半年度收集临床骨折情况。通过对放射学报告的中央审查确定髋部骨折。在 WHI 诊所的 9062 名女性中，通过双能 X 射线吸收法在基线时和 3 年和 6 年时测量全身、髋部和脊柱的 BMD。通过食物频率问卷评估蛋白质摄入量，并通过能量和蛋白质摄入量的生物标志物进行校准。通过 Cox 比例风险回归估计蛋白质摄入量与骨折之间的关联，通过线性回归估计蛋白质摄入量与 BMD 之间的关系。
结果
中位生物标志物校准的蛋白质摄入量占能量摄入量的 15%。与校准蛋白质摄入量（占能量的百分比）每增加 20%相比，总骨折（HR：0.99；95%CI：0.97，1.02）或髋部骨折（HR：0.91；95%CI：0.84，1.00）无显著关联，但与前臂骨折呈负相关（HR：0.93；95%CI：0.88，0.98）。校准蛋白质摄入量每增加 20%，全身 BMD 显著增加（平均 3 年变化：0.003 g/cm²；95%CI：0.001，0.005 g/cm²），髋部 BMD 也显著增加（平均 3 年变化：0.002 g/cm²；95%CI：0.001，0.004 g/cm²）。
结论
在通常摄入范围内，较高的生物标志物校准蛋白质摄入量与前臂骨折呈负相关，并且与全身和髋部 BMD 的更好维持相关。这些数据表明，绝经后妇女较高的蛋白质摄入不会对骨骼健康造成损害。
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