Bone mineral density and body composition in underweight and normal elderly subjects
Bone mineral density and body composition in underweight and normal elderly subjects
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DOI：
10.1007/s001980070026
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发表时间：
2000-01-01
影响因子：
4
通讯作者：
Enzi, G
中科院分区：
文献类型：
--
作者：
Coin, A;Sergi, G;Enzi, G
营养不良作为骨质疏松症的危险因素的重要性是由股骨近端骨折患者经常营养不良的证据所强调的。本研究调查了低体重和正常体重老年人的营养状况、骨矿物质含量及其与身体成分的关系。此外，还验证了老年人营养不良与骨质疏松症风险较高相关的假设。参与者是111名老年受试者，根据体重指数（BMI）分为两组：51名患者体重不足（BMI < 22 kg/m2），60名受试者的BMI范围为22至30 kg/m2。在所有患者的人体测量参数和营养不良和骨转换的血液指标进行了测量。采用双能X线骨密度仪测量无脂软组织（FFSM）、脂肪量（FM）、骨矿物质含量（BMC）和全身及髋部骨矿物质密度（BMD）。膳食摄入量采用膳食史法进行评估，而静息能量消耗（REE）采用间接量热法进行测量。低体重受试者还存在其他营养不良体征，如低内脏蛋白、肌肉减少症和能量摄入不足。此外，与正常人相比，他们的BMC和BMD显着降低。在BMI为22 kg/m2的男性中，T评分低于-2.5（股骨颈为-3，全髋为-2.7），而对照组的男性骨矿物质参数正常。体重不足的女性在不同部位的T评分低于体重不足的男性，总是显示低于-3.5的值，具有明显的骨质疏松症和高骨折风险。在健康女性中，T评分值表明存在轻度骨质疏松症。在体重过轻的受试者中，低水平的白蛋白（< 35 g/l）与较高的股骨骨丢失相关。使用偏相关模型，BMC，调整年龄，骨面积，膝关节高度和白蛋白显示出与女性FM（r = 0.48; p < 0.01）和男性FFSM（r = 0.48; p < 0.05）显著相关。在调整其他变量后，白蛋白仅与女性股骨颈BMC显著相关（r = 0.52; p < 0.05）。总之，在老年人体重不足的状态与营养不良和骨质疏松症;营养不良发生的其他因素，除了身体成分的变化，如蛋白质缺乏，可能参与体重不足和骨质疏松症之间的关联。此外，男性的骨矿物质状况似乎与无脂肪软组织有关，而女性的骨矿物质状况则与全身脂肪密切相关。
The importance of malnutrition as a risk factor in osteoporosis is emphasized by the evidence that patients with fractures of the proximal femur are often undernourished. In this study, nutritional status, bone mineral mass and its association with body composition were investigated in underweight and normal weight elderly subjects. Moreover the hypothesis that malnutrition in elderly is associated with a higher risk of osteoporosis was tested. The participants were 111 elderly subjects divided into two groups according to body mass index (BMI): 51 patients were underweight (BMI < 22 kg/m(2)) while in 60 subjects BMI ranged from 22 to 30 kg/m(2). In all patients anthropometric parameters and blood indices of malnutrition and of bone turnover were measured. Fat-free soft mass (FFSM), fat mass (FM), bone mineral content (BMC) and bone mineral density (BMD) 'total body' and at the hip were obtained by dual-energy X-ray densitometry. Dietary intake was evaluated with the diet history method, while resting energy expenditure (REE) was measured by indirect calorimetry, Underweight subjects had other signs of malnutrition, such as low visceral proteins, sarcopenia, and an inadequate energy intake. Moreover they showed a significant reduction of BMC and BMD compared with normal subjects. In men with BMI (22 kg/m(2), T-score was below -2.5 (-3 at femoral neck and -2.7 at total hip) while men in the control group had normal bone mineral parameters. T-score at different sites was lower in underweight women than in underweight men, always showing values under -3.5, with clear osteoporosis and a high fracture risk. In healthy women the T-score values indicated the presence of mild osteoporosis. In underweight subjects, low levels of albumin (< 35 g/l) were associated with higher femoral bone loss. Using a partial correlation model, BMC, adjusted for age, bone area, knee height and albumin showed a significant association with FM in women (r = 0.48; p < 0.01) and with FFSM in men (r = 0.48; p < 0.05). Albumin, when adjusted for other variables, was significantly correlated (r = 0.52; p < 0.05) with femoral neck BMC only in women. In conclusion, the underweight state in the elderly is associated with malnutrition and osteoporosis; other factors occurring in malnutrition, besides body composition changes, such as protein deficiency, could be involved in the association between underweight and osteoporosis. Moreover bone mineral status seems to be related to fat-free soft mass tissue in men while in women it is much more closely associated with total body fat.