Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of nutrient intake and dietary diversity score on osteoporosis of middle-aged adults and elderly based on 2015-2017 Korean National Health and Nutrition Examination Survey data

2015-2017년 국민건강영양조사 자료를 활용하여 영양소 섭취와 식이다양성이 중년 이후 성인과 노인의 골다공증에 미치는 영향

  • Received : 2020.03.11
  • Accepted : 2020.03.30
  • Published : 2020.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to investigate the effects of nutrient intake and dietary diversity score (DDS) on osteoporosis after controlling for sex, age, socioeconomic level, drinking, smoking, physical activity, and body mass index (BMI) as mediators using the 2015-2017 Korean National Health and Nutrition Examination Survey (KNHANES) data. Methods: This study was focused on the age group of 50s and older by using the 2015-2017 KNHANES data. Subjects diagnosed with osteoporosis were classified as the osteoporosis group, and the other subjects were classified as the normal group. Logistic regression was used to assess the association between nutrient intake and DDS after controlling for mediators. Results: The risk of osteoporosis was 2.38 times lower in the 50-65 age group than in the 75 years and older group. The mediators affecting the incidence of osteoporosis by age group were sex, age, household income level, and education level in the 50-64 age group; sex, education level, drinking, and BMI in the 65-74 age group; and sex, age, current smoking, drinking, BMI, and energy intake in the 75 years and older group. The effect of nutrient intake on osteoporosis, with the exception of vitamin B1, was fully mediated by these mediators. The effect of vitamin B1 was partially mediated by mediators in the age group of 65-74 years, and vitamin B1 was effective for preventing the risk of osteoporosis by 25% when consumed over EAR. The effect of DDS was partially mediated in the age group of 75 years and older, and DDS of 2 or less increased the risk of osteoporosis by 2.59 times. Conclusion: As a result of this study, it is necessary to recommend the balanced intake of various foods including grains, meat·fish·legumes, vegetables, fruits, and dairy products as dietary guidelines for the prevention of osteoporosis and promotion of bone health in the elderly.

본 연구는 제 6기 3년차 (2015년), 제 7기 1, 2년차 (2016년, 2017년) 국민건강영양조사 자료를 활용하여 50세 이후 연령층을 대상으로 사회경제적 수준, 음주, 흡연 및 신체활동 및 BMI 중 골다공증 발생에 영향을 미치는 변인을 통제변인으로 적용한 후 영양소 섭취 수준과 DDS가 골다공증 발생에 미치는 영향을 파악하고자 하였다. 골다공증으로 의사 진단을 받은 경험이 있는 경우 골다공증 환자군, 골다공증 의사 진단을 받은 경험이 없는 경우 정상군으로 분류하였으며, 정상군으로 분류된 대상자 중 환자군으로 분류한 대상자와 성, 연령 및 사회경제적 수준에 매칭되는 경우만을 자료 분석에 활용하였다. 본 연구결과 연령에 따라 골다공증 발생의 위험도는 75세 이상 연령군에 비해 50-64세 연령군에서 2.38배 정도 낮았으며, 모든 연령군에서 여자의 골다공증 발생의 위험이 8.85배 이상 높았다. 골다공증 발생에 영향을 미치는 통제변인으로 50-64세 연령군의 경우 성, 연령, 가구내 소득수준, 교육수준이었고, 65-74세 연령군의 경우 성, 교육수준, 음주, BMI이었으며, 75세 이상 연령군의 경우 성, 연령, 현재 흡연, 음주, BMI, 에너지 섭취량이었다. 모든 연령군에서 탄수화물, 단백질 (동물성, 식물성), 지방, 식이섬유, 칼슘, 인, 나트륨, 칼륨, 비타민 B1, 비타민 B2, 니아신, 콜레스테롤 섭취량 증가는 골다공증 발생의 위험을 낮추었으나 연령군별 통제변인을 적용할 경우 완전통제 되어 영양소 섭취량은 골다공증 발생에 영향을 미치지 않았다. 단백질, 인, 철, 비타민 B1을 EAR 이상 섭취 시 모든 연령군에서 골다공증 발생의 위험을 19% 이상, 비타민 B2와 칼슘을 EAR 이상 섭취 시 65세 이상 연령군에서 골다공증 발생의 위험을 31% 이상 예방하는 효과가 있었으나 통제변인 적용 시 65-74세 연령군에서 비타민 B2만이 부분통제 되었고, 이외 영양소는 모든 연령군에서 완전통제 되었다. DDS 수준은 50-64세, 75세 이상 연령군에서 2점 이하의 점수를 보일 경우 5점을 보인 대상자에 비해 골다공증 발생의 위험이 각각 1.765배, 3.595배 높았으나, 각 연령군별 통제변인 적용 후 50-64세 연령군에서는 완전 통제되었고, 75세 이상 연령군에서는 부분통제 되었다. 본 연구결과 50세 이상 연령군에서 통제변인 적용 시 영양소 섭취량은 골다공증 발생의 위험에 완전통제되었으나, 75세 이상의 노인 연령군에서 DDS는 통제변인에 의해 부분통제되는 것으로 나타나 노인 연령층에서 DDS가 2점 이하의 낮은 점수를 보일 경우 골다공증 발생의 위험을 증가시겼다. 즉, 노인기 골다공증 예방 및 뼈 건강을 위한 식이치짐으로 곡류군, 육류·어류·콩류군, 채소군, 과일군, 우유 및 유제품군을 포함한 다양한 식품의 균형된 섭취를 권장할 필요가 있으며, 본 연구에서 선정된 통제변인은 추후 50세 이상 연령군을 대상으로 골다공증 관련 연구 수행 시 보정변인으로 활용될 수 있을 것으로 사료된다.

Keywords

References

  1. Arceo-Mendoza RM, Camacho P. Prediction of fracture risk in patients with osteoporosis: a brief review. Womens Health (Lond) 2015; 11(4): 477-482. https://doi.org/10.2217/WHE.15.14
  2. Nuti R, Brandi ML, Checchia G, Di Munno O, Dominguez L, Falaschi P, et al. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med 2019; 14(1): 85-102. https://doi.org/10.1007/s11739-018-1874-2
  3. Seurer A, Huntington MK. Screening and treatment of osteoporosis. S D Med 2015; 68(11): 497-501.
  4. International Osteoporosis Foundation (IOF). What is osteoporosis? [Internet]. Washington, D.C.: International Osteoporosis Foundation; c2020 [cited 2020 Feb 13]. Available from: https://www.iofbonehealth.org/what-osteoporosis-0.
  5. Korea Centers for Disease Control and Prevention (KCDC). 2012 health behavior and chronic disease statistics. Cheongju: Korea Centers for Disease Control and Prevention; 2013.
  6. International Osteoporosis Foundation (IOF). Who's at risk? [Internet]. Washington, D.C.: International Osteoporosis Foundation; c2020 [cited 2020 Feb 13]. Available from: https://www.iofbonehealth.org/whos-risk.
  7. International Osteoporosis Foundation (IOF). Preventing osteoporosis [Internet]. Washington, D.C.: International Osteoporosis Foundation; c2020 [cited 2020 Feb 13]. Available from: https://www.iofbonehealth.org/preventing-osteoporosis.
  8. Hamidi MS, Corey PN, Cheung AM. Effects of vitamin E on bone turnover markers among US postmenopausal women. J Bone Miner Res 2012; 27(6): 1368-1380. https://doi.org/10.1002/jbmr.1566
  9. Holvik K, Meyer HE, Laake I, Feskanich D, Omsland TK, Sogaard AJ. Milk drinking and risk of hip fracture. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Br J Nutr 2018; 121(6): 1-21.
  10. 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
  11. Regu GM, Kim H, Kim YJ, Paek JE, Lee G, Chang N, et al. Association between dietary carotenoid intake and bone mineral density in Korean adults aged 30-75 years using data from the fourth and fifth Korean National Health and Nutrition Examination Surveys (2008-2011). Nutrients 2017; 9(9): 1025-1038. https://doi.org/10.3390/nu9091025
  12. Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, et al. Protective effect of total and supplemental vitamin C intake on the risk of hip fracture--a 17-year follow-up from the Framingham Osteoporosis Study. Osteoporos Int 2009; 20(11): 1853-1861. https://doi.org/10.1007/s00198-009-0897-y
  13. Welch A, MacGregor A, Jennings A, Fairweather-Tait S, Spector T, Cassidy A. Habitual flavonoid intakes are positively associated with bone mineral density in women. J Bone Miner Res 2012; 27(9): 1872-1878. https://doi.org/10.1002/jbmr.1649
  14. Ward KA, Prentice A, Kuh DL, Adams JE, Ambrosini GL. Life course dietary patterns and bone health in later life in a British birth cohort study. J Bone Miner Res 2016; 31(6): 1167-1176. https://doi.org/10.1002/jbmr.2798
  15. Dai Z, Zhang Y, Lu N, Felson DT, Kiel DP, Sahni S. Association between dietary fiber intake and bone loss in the Framingham Offspring Study. J Bone Miner Res 2018; 33(2): 241-249. https://doi.org/10.1002/jbmr.3308
  16. Lee T, Suh HS. Associations between dietary fiber intake and bone mineral density in adult Korean population: analysis of National Health and Nutrition Examination Survey in 2011. J Bone Metab 2019; 26(3): 151-160. https://doi.org/10.11005/jbm.2019.26.3.151
  17. Movassagh EZ, Vatanparast H. Current evidence on the association of dietary patterns and bone health: a scoping review. Adv Nutr 2017; 8(1): 1-16. https://doi.org/10.3945/an.116.013326
  18. Park SJ, Joo SE, Min H, Park JK, Kim Y, Kim SS, et al. Dietary patterns and osteoporosis risk in postmenopausal Korean women. Osong Public Health Res Perspect 2012; 3(4): 199-205. https://doi.org/10.1016/j.phrp.2012.10.005
  19. Shin S, Sung J, Joung H. A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults. Eur J Clin Nutr 2015; 69(4): 442-448. https://doi.org/10.1038/ejcn.2014.231
  20. 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
  21. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2015: Korea National Health and Nutrition Examination Survey (KNHANES VI-3). Cheongju: Korea Centers for Disease Control and Prevention; 2016.
  22. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES VII-1). Cheongju: Korea Centers for Disease Control and Prevention; 2017.
  23. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2017: Korea National Health and Nutrition Examination Survey (KNHANES VII-2). Cheongju: Korea Centers for Disease Control and Prevention; 2018.
  24. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70(1): 41-55. https://doi.org/10.1093/biomet/70.1.41
  25. Ministry of Health and Welfare, The Korean Nutrition Society. Dietary reference intake for Koreans 2015. Seoul: The Korean Nutrition Society; 2015.
  26. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51(6): 1173-1182. https://doi.org/10.1037/0022-3514.51.6.1173
  27. Yoo KO, Kim MJ, Ly SY. Association between vitamin D intake and bone mineral density in Koreans aged $\geq$ 50 years: analysis of the 2009 Korea National Health and Nutrition Examination Survey using a newly established vitamin D database. Nutr Res Pract 2019; 13(2): 115-125. https://doi.org/10.4162/nrp.2019.13.2.115
  28. Yu CH, Lee JS, Lee L, Kim SH, Lee SS, Jung IK. Nutritional factors related to bone mineral density in the different age groups of Korean women. Korean J Nutr 2002; 35(7): 779-790.
  29. Yu CH, Lee JS, Lee L, Kim SH, Lee SS, Kang SA. Nutritional factors related to bone mineral density in the different age groups of Korean men. Korean J Nutr 2004; 37(2): 132-142.
  30. Kim JM, Jin MR, Kim HW, Chang N. Associations between daily food and nutrient intake and bone mineral density in men aged 50 years and older. Korean J Nutr 2011; 44(5): 394-405. https://doi.org/10.4163/kjn.2011.44.5.394
  31. 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
  32. Park SJ, Jung JH, Kim MS, Lee HJ. High dairy products intake reduces osteoporosis risk in Korean postmenopausal women: a 4 year follow-up study. Nutr Res Pract 2018; 12(5): 436-442. https://doi.org/10.4162/nrp.2018.12.5.436
  33. Sommer I, Erkkila AT, Jarvinen R, Mursu J, Sirola J, Jurvelin JS, et al. Alcohol consumption and bone mineral density in elderly women. Public Health Nutr 2013; 16(4): 704-712. https://doi.org/10.1017/S136898001200331X
  34. Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int 2015; 26(2): 531-542. https://doi.org/10.1007/s00198-014-2879-y
  35. Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW. Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Braz J Phys Ther 2019; 23(2): 170-180. https://doi.org/10.1016/j.bjpt.2018.11.011
  36. Harding AT, Beck BR. Exercise, osteoporosis, and bone geometry. Sports (Basel) 2017; 5(2): 29-43. https://doi.org/10.3390/sports5020029
  37. Rogers TS, Harrison S, Judd S, Orwoll ES, Marshall LM, Shannon J, et al. Dietary patterns and longitudinal change in hip bone mineral density among older men. Osteoporos Int 2018; 29(5): 1135-1145. https://doi.org/10.1007/s00198-018-4388-x
  38. Feskanich D, Meyer HE, Fung TT, Bischoff-Ferrari HA, Willett WC. Milk and other dairy foods and risk of hip fracture in men and women. Osteoporos Int 2018; 29(2): 385-396. https://doi.org/10.1007/s00198-017-4285-8
  39. Higgs J, Derbyshire E, Styles K. Nutrition and osteoporosis prevention for the orthopaedic surgeon: a wholefoods approach. EFORT Open Rev 2017; 2(6): 300-308. https://doi.org/10.1302/2058-5241.2.160079
  40. Sahni S, Hannan MT, Blumberg J, Cupples LA, Kiel DP, Tucker KL. Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr 2009; 89(1): 416-424. https://doi.org/10.3945/ajcn.2008.26388
  41. Sugiura M, Nakamura M, Ogawa K, Ikoma Y, Ando F, Shimokata H, et al. Dietary patterns of antioxidant vitamin and carotenoid intake associated with bone mineral density: findings from post-menopausal Japanese female subjects. Osteoporos Int 2011; 22(1): 143-152. https://doi.org/10.1007/s00198-010-1239-9

Cited by

  1. Developing the Osteoporosis Risk Scorecard Model in Korean Adult Women vol.46, pp.1, 2021, https://doi.org/10.21032/jhis.2021.46.1.44