Shams-White Marissa M, Chung Mei, Du Mengxi, Fu Zhuxuan, Insogna Karl L, Karlsen Micaela C, LeBoff Meryl S, Shapses Sue A, Sackey Joachim, Wallace Taylor C, Weaver Connie M
Department of Public Health and Community Medicine, School of Medicine, and.
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
Am J Clin Nutr. 2017 Jun;105(6):1528-1543. doi: 10.3945/ajcn.116.145110. Epub 2017 Apr 12.
: Considerable attention has recently focused on dietary protein's role in the mature skeleton, prompted partly by an interest in nonpharmacologic approaches to maintain skeletal health in adult life. The aim was to conduct a systematic review and meta-analysis evaluating the effects of dietary protein intake alone and with calcium with or without vitamin D (Ca±D) on bone health measures in adults. Searches across 5 databases were conducted through October 2016 including randomized controlled trials (RCTs) and prospective cohort studies examining ) the effects of "high versus low" protein intake or ) dietary protein's synergistic effect with Ca±D intake on bone health outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments. Strength of evidence was rated by group consensus. Random-effects meta-analyses for outcomes with ≥4 RCTs were performed. Sixteen RCTs and 20 prospective cohort studies were included in the systematic review. Overall ROB was medium. Moderate evidence suggested that higher protein intake may have a protective effect on lumbar spine (LS) bone mineral density (BMD) compared with lower protein intake (net percentage change: 0.52%; 95% CI: 0.06%, 0.97%, : 0%; = 5) but no effect on total hip (TH), femoral neck (FN), or total body BMD or bone biomarkers. Limited evidence did not support an effect of protein with Ca±D on LS BMD, TH BMD, or forearm fractures; there was insufficient evidence for FN BMD and overall fractures. Current evidence shows no adverse effects of higher protein intakes. Although there were positive trends on BMD at most bone sites, only the LS showed moderate evidence to support benefits of higher protein intake. Studies were heterogeneous, and confounding could not be excluded. High-quality, long-term studies are needed to clarify dietary protein's role in bone health. This trial was registered at www.crd.york.ac.uk as CRD42015017751.
近期，相当多的注意力集中在膳食蛋白质对成熟骨骼的作用上，部分原因是人们对维持成年期骨骼健康的非药物方法感兴趣。目的是进行一项系统评价和荟萃分析，评估单独摄入膳食蛋白质以及蛋白质与钙（无论有无维生素D）联合摄入（钙±维生素D）对成年人骨骼健康指标的影响。截至2016年10月，我们检索了5个数据库，纳入了随机对照试验（RCT）和前瞻性队列研究，这些研究考察了：①“高蛋白摄入与低蛋白摄入”对骨骼健康的影响；②膳食蛋白质与钙±维生素D联合摄入对骨骼健康结局的协同作用。两名研究人员独立进行摘要和全文筛选、数据提取以及偏倚风险（ROB）评估。证据强度通过小组共识进行评级。对至少有4项RCT的结局进行随机效应荟萃分析。系统评价纳入了16项RCT和20项前瞻性队列研究。总体偏倚风险为中等。中等证据表明，与低蛋白摄入相比，高蛋白摄入可能对腰椎（LS）骨密度（BMD）有保护作用（净百分比变化：0.52%；95%CI：0.06%，0.97%；I² = 5%），但对全髋（TH）、股骨颈（FN）或全身BMD或骨生物标志物无影响。有限的证据不支持蛋白质与钙±维生素D联合摄入对LS BMD、TH BMD或前臂骨折有影响；关于FN BMD和总体骨折，证据不足。目前的证据表明高蛋白摄入没有不良影响。虽然在大多数骨部位BMD有积极趋势，但只有LS有中等证据支持高蛋白摄入有益。研究存在异质性，且无法排除混杂因素。需要高质量的长期研究来阐明膳食蛋白质在骨骼健康中的作用。该试验在www.crd.york.ac.uk上注册，注册号为CRD42015
017751。
