无糖尿病成年人的膳食碳水化合物摄入量与骨密度、骨质疏松症及骨折的关联：来自美国国家健康与营养检查调查的证据

Association of dietary carbohydrate intake with bone mineral density, osteoporosis and fractures among adults without diabetes: Evidence from National Health and Nutrition Examination Survey.

作者信息

Chen Ran, Gong Kai, Chen Wei, Chen Zongfeng, Zhang Lianyang, Tang Ying, Li Yang, Zhou Siru

机构信息

War Trauma Medical Center, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical Center, Daping Hospital, Army Medical University, Chongqing, 400042, PR China.

Department of Orthopaedics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, 610500, PR China.

出版信息

Heliyon. 2024 Aug 2;10(15):e35566. doi: 10.1016/j.heliyon.2024.e35566. eCollection 2024 Aug 15.

BACKGROUND

The impact of dietary carbohydrate intake on bone health remains a subject of controversy, potentially influenced by individuals with diabetic osteoporosis who exhibit normal or elevated bone mineral density (BMD). The cross-sectional study was conducted to explore the association between carbohydrate intake and BMD, osteoporosis and fractures among adults without diabetes, based on the National health and nutrition examination survey (NHANES).

METHODS

Participants were from the NHANES 2005-2010, excluding individuals with diabetes and those with incomplete data. The association between carbohydrate intake and BMD was analyzed using Spearman correlation, linear regression analysis and subgroup analysis, respectively. The association between carbohydrate intake and osteoporosis/fractures was analyzed using weighted logistic regression analysis.

RESULTS

A total of 7275 adult participants were included and their dietary carbohydrate intake was inversely associated with BMD in the total femur [β = -0.20 95%CI (-0.30, -0.10); p < 0.001], femoral neck [β = -0.10 95%CI (-0.20, -0.00); p = 0.002], and lumbar spine [β = -0.10 95%CI (-0.20, -0.00); p = 0.004]. Stratified analysis indicated that individuals aged 65 and over, women, and non-Hispanic whites were more likely to have lower BMD. Furthermore, a higher intake of dietary carbohydrates was associated with an increased risk of osteoporosis [OR = 1.001 95%CI (1.001, 1.001); p < 0.001] and fractures at the hip [OR = 1.005 95%CI (1.005, 1.005); p < 0.001], wrist [OR = 1.001 95%CI (1.001, 1.001), p < 0.001], and spine [OR = 1.003 95%CI(1.003, 1.003); p < 0.001].

CONCLUSIONS

A higher carbohydrate diet is associated with lower BMD and a higher risk of osteoporosis and fractures among adults without diabetes, and a higher carbohydrate consumption show a stronger effect in individuals aged 65 and over, women, and non-Hispanic whites.

背景

饮食中碳水化合物的摄入量对骨骼健康的影响仍然存在争议，可能受到患有糖尿病性骨质疏松症但骨矿物质密度（BMD）正常或升高的个体的影响。本横断面研究基于美国国家健康与营养检查调查（NHANES），旨在探讨无糖尿病成年人碳水化合物摄入量与骨密度、骨质疏松症和骨折之间的关联。

方法

参与者来自2005 - 2010年的NHANES，排除患有糖尿病和数据不完整的个体。分别采用Spearman相关性分析、线性回归分析和亚组分析来分析碳水化合物摄入量与骨密度之间的关联。采用加权逻辑回归分析来分析碳水化合物摄入量与骨质疏松症/骨折之间的关联。

结果

总共纳入了7275名成年参与者，他们的饮食碳水化合物摄入量与全股骨骨密度呈负相关[β = -0.20，95%置信区间（-0.30，-0.10）；p < 0.001]，与股骨颈骨密度呈负相关[β = -0.10，95%置信区间（-0.20，-0.00）；p = 0.002]，与腰椎骨密度呈负相关[β = -0.10，95%置信区间（-0.20，-0.00）；p = 0.004]。分层分析表明，65岁及以上的个体、女性和非西班牙裔白人更有可能骨密度较低。此外，较高的饮食碳水化合物摄入量与骨质疏松症风险增加相关[比值比（OR）= 1.001，95%置信区间（1.001，1.001）；p < 0.001]，与髋部骨折风险增加相关[OR = 1.005，95%置信区间（1.005，1.005）；p < 0.001]，与腕部骨折风险增加相关[OR = 1.001，95%置信区间（1.001，1.001），p < 0.001]，与脊柱骨折风险增加相关[OR = 1.003, 95%置信区间(1.003, 1.003); p < 0.001]。