Journal of Nutrition and Health

  • 제49권3호
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  • Pages.165-178
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  • 2016
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  • 2288-3886(pISSN)
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  • 2288-3959(eISSN)
한국영양학회 (The Korean Nutrition Society)
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50세 이상 한국인의 성·연령군별 우유류와 두류 섭취량과 골 건강과의 관련성 : 2008~2011 국민건강영양조사 자료를 이용하여

Sex- and age group-specific associations between intakes of dairy foods and pulses and bone health in Koreans aged 50 years and older: Based on 2008~2011 Korea National Health and Nutrition Examination Survey

  • 서현비 (대구대학교 식품영양학과) ;
  • 최영선 (대구대학교 식품영양학과)
  • 투고 : 2016.03.16
  • 심사 : 2016.05.19
  • 발행 : 2016.06.30
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초록

본 연구는 50세 이상 한국인을 성 연령군으로 나누어 골밀도에 근거한 골 건강상태와 우유류와 두류 섭취 간의 관련성을 조사하고자 수행되었다. 국민건강영양조사 (2008~2011년)에 참여한 만 50세 이상 남성 3,201명과 여성 3,581명을 대상으로 '50~64세 남성', '50~64세 여성', '65세 이상 남성', '65세 이상 여성' 성 연령군 집단으로 나누어 정상, 골감소증, 골다공증의 골 건강상태에 따른 영양소 및 식품 섭취량을 비교하고, 로지스틱 회귀분석에 의해 우유류와 두류 섭취빈도에 따른 골다공증 오즈비를 구하였다. 통계 분석은 SAS 9.3 version을 이용하였으며, 모든 통계처리는 층화, 집락, 가중치를 고려한 복합표본설계 자료 분석 방법을 적용하였다. 50~64세 남성 1,721명 중 3.8%, 65세 이상 남성 1,480명 중 13.1%가 골다공증이었으며, 50~64세 여성 1,950명 중 15.9%, 65세 이상 여성 1,631명 중 63.0%가 골다공증이었다. 여성이 남성에 비해 4~5배 정도 골다공증 비율이 높고, 남녀 모두 연령 증가와 함께 골다공증 발생이 증가 하였다. 모든 성 연령군 집단에서 대상자의 체중과 체질량지수는 정상, 골감소증, 골다공증 순이었다. 에너지, 단백질, 나트륨, 칼륨, 칼슘 및 비타민 C 섭취량은 남성의 경우 전반적으로 정상, 골감소증, 골다공증 순이었으며, 여성도 유사한 경향을 보였다. 칼슘 섭취량의 사분위 섭취량에 따른 골다공증 오즈비 (OR)가 연령, BMI, 에너지 섭취량에 의한 보정 후 50~64세 여성과 65세 이상 남성에서 4사분위 섭취량이 1사분위 섭취량에 비해 유의하였으며, 칼슘섭취량이 많을수록 골다공증이 감소하는 경향성 (p for trend = 0.01)을 나타내었다. 그러나 음주, 흡연, 신체활동도 포함하여 보정한 후 경향성은 각각 p값이 0.055, 0.051 수준으로 낮아졌다. 50~64세 남성에서 골 건강상태가 나쁠수록 우유류와 우유 섭취량은 감소하는 경향성을 보였으며, 50~64세 여성에서는 골다공증군의 우유류와 우유 섭취량이 골감소증군에 비해 유의하게 적었다. 두류와 두부 섭취량은 모든 성 연령군에서 골 건강상태에 따른 유의적인 차이 및 경향성을 보이지 않았다. 50~64세 남성에서 우유 섭취빈도는 골다공증 위험 감소와 유의적인 관련성을 보이지 않은 반면에 65세 이상 남성에서는 우유 섭취빈도가 월 1회 미만에 비해 주 2회 이상일 경우 골다공증 위험 (OR 0.45, 95% CI 0.24~0.85)이 감소하였고, 감소하는 경향성 (p for trend = 0.022)을 보였다. 50~64세 여성에서 우유를 월 1회 미만 섭취하는 것에 비해 월1회~주1회 (OR 0.63, 95% CI 0.41~0.98) 섭취할 경우 오즈비가 유의하게 낮았다. 요구르트의 경우 50~64세 여성에서 섭취빈도가 높을수록 골다공증 위험이 감소하는 경향성 (p for trend = 0.019)을 보였다. 모든 성 연령군에서 두부 섭취빈도와 골다공증 위험과의 연관성은 나타나지 않은 반면에 두유를 주 2회 이상 섭취한 65세 이상 여성군에서는 골다공증 위험이 높게 나타났다. 혈청 25-hydroxy vitamin D 농도는 50~64세 여성에서 골 건강상태가 나쁠수록 뚜렷하게 낮았다. 이상의 결과를 요약하면, 여성의 경우는 50~64세 연령 시기에 칼슘 섭취량, 우유 및 요구르트 섭취와 골다공증 위험 감소 사이에 연관성이 있으며, 남성의 경우 65세 이후 칼슘 섭취량과 우유 섭취와 골다공증 위험 감소 사이에 연관성이 있었다. 반면 두부, 두유 등 두류 섭취는 골다공증 위험 감소에 효과적이지 않았다. 따라서 50세 이상 한국인에서 성 연령군에 적절한 골 건강상태 향상을 위한 식생활 및 생활습관 관리가 필요한 것으로 판단된다.

Purpose: This study was performed to examine associations of intakes of milk and dairy products, pulses, and soy foods with bone health in Koreans aged 50 yr and older. Methods: A total of 3,201 men and 3,581 women aged 50 yr and older who participated in the 2008~2011 Korea National Health and Nutrition Examination Survey were grouped by sex and age groups of 50~64 yr and 65 yr and older. Subjects within each sex and age group were divided into three bone health groups: normal, osteopenia, and osteoporosis groups based on bone mineral density. Intakes of nutrients and foods derived from 24-hour recall data were compared among three bone health groups. Associations between intake frequencies of foods, including milk, yogurt, tofu, or soy milk, and osteoporosis risk were evaluated based on confounding risk factor-adjusted logistic regression. Results: Calcium intake was in the order of normal, osteopenia, and osteoporosis in men (p < 0.01) and women (p < 0.05) aged 50~64 yr as well as in men aged 65 yr and older (p < 0.001). In women aged 50~64 yr, intake of milk and dairy products was lower in the osteoporosis group (p < 0.01) as compared with the osteopenia group. Intake of pulses or tofu was not significantly different among bone health groups. Odds ratio (OR) for milk intake frequency (${\geq}2$ times/week) compared to intake frequency less than 1 time/month was 0.45 (95% CI 0.24~0.85, p for trend = 0.022) in men aged 65 yr and older. The OR for yogurt intake frequency (1 time/month~1 time/week) was 0.47 (95% CI 0.30~0.73, p for trend = 0.019) in women aged 50~64 yr. Intake frequency of tofu or soy milk was not associated with reduced risk of osteoporosis in all groups. Conclusion: Dairy food intake was significantly associated with bone health, and its effect was sex- and age group-specific, whereas soy food intake was not. Dietary intervention to prevent osteoporosis would be effective for women aged 50~64 yr old and for men aged 65 yr and older.

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참고문헌

  1. Lee J, Jang S. A study on reference values and prevalence of osteoporosis in Korea: the Korea National Health and Nutrition Examination Survey 2008-2011. J Korean Official Stat 2013; 18(2): 42-65.
  2. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary reference intakes for calcium and vitamin D. Washington (D.C.): National Academies Press; 2011.
  3. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2013: Korea National Health and Nutrition Examination Survey (KNHANES VI-1). Cheongju: Korea Centers for Disease Control and Prevention; 2014.
  4. Weinsier RL, Krumdieck CL. Dairy foods and bone health: examination of the evidence. Am J Clin Nutr 2000; 72(3): 681-689. https://doi.org/10.1093/ajcn/72.3.681
  5. Michaëlsson K, Wolk A, Langenskiold S, Basu S, Warensjo Lemming E, Melhus H, Byberg L. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 2014; 349: g6015. https://doi.org/10.1136/bmj.g6015
  6. Heaney RP. Dairy and bone health. J Am Coll Nutr 2009; 28 Suppl 1: 82S-90S. https://doi.org/10.1080/07315724.2009.10719808
  7. Ma DF, Qin LQ, Wang PY, Katoh R. Soy isoflavone intake increases bone mineral density in the spine of menopausal women: meta-analysis of randomized controlled trials. Clin Nutr 2008; 27(1): 57-64. https://doi.org/10.1016/j.clnu.2007.10.012
  8. Liu J, Ho SC, Su YX, Chen WQ, Zhang CX, Chen YM. Effect of long-term intervention of soy isoflavones on bone mineral density in women: a meta-analysis of randomized controlled trials. Bone 2009; 44(5): 948-953. https://doi.org/10.1016/j.bone.2008.12.020
  9. Korea Health Industry Development Institute. National food & nutrition statistics 2011: based on 2011 Korea National Health and Nutrition Examination Survey. Cheongwon: Korea Health Industry Development Institute; 2013.
  10. Mun SO, Kim J, Yang YJ. Factors associated with bone mineral density in Korean postmenopausal women aged 50 years and above: using 2008-2010 Korean National Health and Nutrition Examination Survey. Korean J Community Nutr 2013; 18(2): 177-186. https://doi.org/10.5720/kjcn.2013.18.2.177
  11. Go G, Tserendejid Z, Lim Y, Jung S, Min Y, Park H. The association of dietary quality and food group intake patterns with bone health status among Korean postmenopausal women: a study using the 2010 Korean National Health and Nutrition Examination Survey Data. Nutr Res Pract 2014; 8(6): 662-669. https://doi.org/10.4162/nrp.2014.8.6.662
  12. Shin CS, Choi HJ, Kim MJ, Kim JT, Yu SH, Koo BK, Cho HY, Cho SW, Kim SW, Park YJ, Jang HC, Kim SY, Cho NH. Prevalence and risk factors of osteoporosis in Korea: a communitybased cohort study with lumbar spine and hip bone mineral density. Bone 2010; 47(2): 378-387. https://doi.org/10.1016/j.bone.2010.03.017
  13. Kim YR, Lee TY, Lee JH. Age-related bone mineral density, accumulated bone loss rate at multiple skeletal sites in Korean men. J Korea Acad Ind Coop Soc 2014; 15(6): 3781-3788. https://doi.org/10.5762/KAIS.2014.15.6.3781
  14. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014; 43(1): 69-77. https://doi.org/10.1093/ije/dyt228
  15. Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PW, Kiel DP. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 2000; 15(4): 710-720. https://doi.org/10.1359/jbmr.2000.15.4.710
  16. Choi HJ, Lee DJ. Age-related change of spinal bone mineral density and accumulated bone loss rate in women. J Korean Soc Menopause 2003; 9(2): 171-176.
  17. Lee S, Jang S, Jung D, Lee J. Reconsideration of the mechanical loading hypothesis: is obesity protective against osteoporosis? J Korean Official Stat 2014; 19(2): 1-29.
  18. Bendavid EJ, Shan J, Barrett-Connor E. Factors associated with bone mineral density in middle-aged men. J Bone Miner Res 1996; 11(8): 1185-1190. https://doi.org/10.1002/jbmr.5650110818
  19. Reid IR. Fat and bone. Arch Biochem Biophys 2010; 503(1): 20-27. https://doi.org/10.1016/j.abb.2010.06.027
  20. Kim JH, Choi HJ, Kim MJ, Shin CS, Cho NH. Fat mass is negatively associated with bone mineral content in Koreans. Osteoporos Int 2012; 23(7): 2009-2016. https://doi.org/10.1007/s00198-011-1808-6
  21. Chung JE, Hwang SJ, Kim MJ, Song JY, Cho HH, Kwon DJ, Lew YO, Lim YT, Kim EJ, Kim JH, Kim JH, Kim MR. Relationship between body composition and bone mineral density in pre-and post-menopausal women. J Korean Soc Menopause 2010; 16(1): 29-38.
  22. Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999; 69(4): 727-736. https://doi.org/10.1093/ajcn/69.4.727
  23. Lim HJ. A study on the calcium and sodium intakes and urinary calcium excretion of adults in Busan. Korean J Community Nutr 2011; 16(2): 215-226. https://doi.org/10.5720/kjcn.2011.16.2.215
  24. Lim YS, Lee SW, Tserendejid Z, Jeong SY, Go G, Park HR. Prevalence of osteoporosis according to nutrient and food group intake levels in Korean postmenopausal women: using the 2010 Korea National Health and Nutrition Examination Survey Data. Nutr Res Pract 2015; 9(5): 539-546. https://doi.org/10.4162/nrp.2015.9.5.539
  25. Kim KH, Lee K, Ko YJ, Kim SJ, Oh SI, Durrance DY, Yoo D, Park SM. Prevalence, awareness, and treatment of osteoporosis among Korean women: the Fourth Korea National Health and Nutrition Examination Survey. Bone 2012; 50(5): 1039-1047. https://doi.org/10.1016/j.bone.2012.02.007
  26. Hong H, Kim EK, Lee JS. Effects of calcium intake, milk and dairy product intake, and blood vitamin D level on osteoporosis risk in Korean adults: analysis of the 2008 and 2009 Korea National Health and Nutrition Examination Survey. Nutr Res Pract 2013; 7(5): 409-417. https://doi.org/10.4162/nrp.2013.7.5.409
  27. Kanis JA, Johansson H, Oden A, De Laet C, Johnell O, Eisman JA, Mc Closkey E, Mellstrom D, Pols H, Reeve J, Silman A, Tenenhouse A. A meta-analysis of milk intake and fracture risk: low utility for case finding. Osteoporos Int 2005; 16(7): 799-804. https://doi.org/10.1007/s00198-004-1755-6
  28. Sahni S, Tucker KL, Kiel DP, Quach L, Casey VA, Hannan MT. Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study. Arch Osteoporos 2013; 8: 119. https://doi.org/10.1007/s11657-013-0119-2
  29. Kim YR, Nam HS, Lee TY. Soy protein consumption and bone mineral density in early postmenopausal Korean women. J Korea Acad Ind Coop Soc 2012; 13(10): 4711-4716. https://doi.org/10.5762/KAIS.2012.13.10.4711
  30. Somekawa Y, Chiguchi M, Ishibashi T, Aso T. Soy intake related to menopausal symptoms, serum lipids, and bone mineral density in postmenopausal Japanese women. Obstet Gynecol 2001; 97(1): 109-115. https://doi.org/10.1016/S0029-7844(00)01080-2
  31. Kim JI, Kang MJ. Recent consumption and physiological status of vitamin D in Korean population. Food Ind Nutr 2012; 17(2): 7-10.
  32. Nakamura K, Saito T, Oyama M, Oshiki R, Kobayashi R, Nishiwaki T, Nashimoto M, Tsuchiya Y. Vitamin D sufficiency is associated with low incidence of limb and vertebral fractures in community-dwelling elderly Japanese women: the Muramatsu Study. Osteoporos Int 2011; 22(1): 97-103. https://doi.org/10.1007/s00198-010-1213-6
  33. Woo J, Lau E, Swaminathan R, Pang CP, MacDonald D. Biochemical predictors for osteoporotic fractures in elderly Chinese--a longitudinal study. Gerontology 1990; 36(1): 55-58. https://doi.org/10.1159/000213176
  34. Scragg R, Camargo CA Jr. Frequency of leisure-time physical activity and serum 25-hydroxyvitamin D levels in the US population: results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2008; 168(6): 577-586. https://doi.org/10.1093/aje/kwn163
  35. Yoon JS, Song MK. Vitamin D intake, outdoor activity time and serum 25-OH vitamin D concentrations of Korean postmenopausal women by season and by age. Korean J Community Nutr 2015; 20(2): 120-128. https://doi.org/10.5720/kjcn.2015.20.2.120
  36. McCabe LD, Martin BR, McCabe GP, Johnston CC, Weaver CM, Peacock M. Dairy intakes affect bone density in the elderly. Am J Clin Nutr 2004; 80(4): 1066-1074. https://doi.org/10.1093/ajcn/80.4.1066
  37. Yoon SS. Review: Distribution, lactose malabsorption, and alleviation strategies of lactose intolerance. J Korean Dairy Technol Sci Assoc 2009; 27(2): 55-62.

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