School of Public Health, Wuhan University, Wuchang District, Wuhan 430071, China.
School of Nursing, Wuchang University of Technology, Jiangxia District, Wuhan 430223, China.
Int J Environ Res Public Health. 2021 Dec 30;19(1):355. doi: 10.3390/ijerph19010355.
This study aimed to explore the risk factors of bone mineral density (BMD) in American residents and further analyse the extent of effects, to provide preventive guidance for maintenance of bone health. A cross-sectional study analysis was carried out in this study, of which data validity was identified and ethics approval was exempted based on the National Health and Nutrition Examination Survey (NHANES) database. Candidates' demographics, physical examination, laboratory indicators and part of questionnaire information were collected and merged from NHANES in 2015-2016 and 2017-2018. The least absolute shrinkage selection operator (lasso) was used to select initial variables with "glmnet" package of R, quantile regression model to analyze influence factors of BMD and their effects in different sites with "qreg" code in Stata. Among 2937 candidates, 17 covariates were selected by lasso regression (λ = 0.00032) in left arm BMD, with 16 covariates in left leg BMD (λ = 0.00052) and 14 covariates in total BMD (λ = 0.00065). Quantile regression results displayed several factors with different coefficients in separate sites and quantiles: gender, age, educational status, race, high-density lipoprotein (HDL), total cholesterol (TC), lead, manganese, ethyl mercury, smoking, alcohol use and body mass index (BMI) ( < 0.05). We constructed robust regression models to conclude that some demographic characteristics, nutritional factors (especially lipid levels, heavy metals) and unhealthy behaviors affected BMD in varying degrees. Gender and race differences, Low-fat food intake and low exposure to heavy metals (mostly lead, manganese and mercury) should be considered by both clinical doctors and people. There is still no consensus on the impact of smoking and alcohol use on bone mineral density in our study.
本研究旨在探讨美国居民骨密度（BMD）的危险因素，并进一步分析其影响程度，为维护骨骼健康提供预防指导。本研究采用横断面研究分析，根据国家健康和营养调查（NHANES）数据库，对数据有效性进行了识别，并豁免了伦理批准。从 2015-2016 年和 2017-2018 年的 NHANES 中收集了候选者的人口统计学、体格检查、实验室指标和部分问卷调查信息。使用 R 中的“glmnet”包的最小绝对收缩选择算子（lasso）选择具有初始变量，使用 Stata 中的“qreg”代码进行分位数回归模型分析 BMD 的影响因素及其在不同部位的影响。在 2937 名候选人中，lasso 回归选择了 17 个协变量（λ=0.00032）用于左手臂 BMD，16 个协变量用于左腿 BMD（λ=0.00052）和 14 个协变量用于总 BMD（λ=0.00065）。分位数回归结果显示，不同部位和分位数的几个因素具有不同的系数：性别、年龄、教育程度、种族、高密度脂蛋白（HDL）、总胆固醇（TC）、铅、锰、乙基汞、吸烟、饮酒和体重指数（BMI）（<0.05）。我们构建了稳健回归模型，得出一些人口统计学特征、营养因素（特别是血脂水平、重金属）和不健康行为在不同程度上影响 BMD 的结论。性别和种族差异、低脂肪食物摄入和低重金属暴露（主要是铅、锰和汞）应引起临床医生和人们的重视。在我们的研究中，吸烟和饮酒对骨矿物质密度的影响仍存在争议。
