Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study1-3
Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study1-3
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DOI：
10.3945/ajcn.113.076786
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发表时间：
2014-04-01
影响因子：
7.1
通讯作者：
Prentice, Ross L.
中科院分区：
文献类型：
--
作者：
Beasley, Jeannette M.;LaCroix, Andrea Z.;Prentice, Ross L.
背景：膳食蛋白质对骨骼健康的影响存在争议。目的：在妇女健康倡议（WHI）中，我们研究了蛋白质摄入与骨折和骨密度（BMD）之间的关系。设计：本前瞻性分析纳入了1993-1998年WHI临床试验（ct）和观察性研究（OS）的144,580名50-79岁女性，随访至2011年。自我报告的临床骨折在试验最初结束时每半年收集一次（WHI ct），并每年通过问卷调查收集一次（WHI OS）。髋部骨折是通过对放射学报告的中心审查来判定的。使用双能x线骨密度仪测量了3家WHI诊所9062名女性在基线、3岁和6岁时的全身、髋关节和脊柱骨密度。通过食物频率问卷评估蛋白质摄入量，并使用能量和蛋白质摄入量的生物标志物进行校准。采用Cox比例风险回归估计蛋白质摄入量与骨折之间的关系，采用线性回归估计蛋白质摄入量与骨密度之间的关系。结果：中位生物标志物校准的蛋白质摄入量为能量摄入的15%。校正后的蛋白质摄入量每增加20%（能量百分比），与总骨折（HR: 0.99; 95% CI: 0.97, 1.02）或髋部骨折（HR: 0.91; 95% CI: 0.84, 1.00）没有显著相关性，但与前臂骨折呈负相关（HR: 0.93; 95% CI: 0.88, 0.98）。校准蛋白质摄入量每增加20%，全身骨密度就会显著升高（平均3-y变化：0.003 g/cm）；95% CI: 0.001, 0.005 g/cm(2))和髋部(平均3-y变化：0.002 g/cm(2)；95% CI: 0.001, 0.004 g/cm(2))。结论：在正常摄入范围内，较高的生物标志物校准蛋白质摄入量与前臂骨折呈负相关，并与更好地维持总骨密度和髋部骨密度相关。这些数据表明，较高的蛋白质摄入量对绝经后妇女的骨骼健康没有危害。WHI项目在临床试验中注册。网站编号NCT00000611。
Background: The effects of dietary protein on bone health are controversial.Objective: We examined the relation between protein intake with fracture and bone mineral density (BMD) within the Women's Health Initiative (WHI).Design: This prospective analysis included 144,580 women aged 50-79 y at baseline in the WHI clinical trials (CTs) and observational study (OS) that recruited participants in 1993-1998 with follow-up through 2011. Self-reported clinical fractures were collected semiannually through the original end of the trials (WHI CTs) and annually (WHI OS) by questionnaires. Hip fracture was adjudicated by a central review of radiology reports. BMDs for total body, hip, and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry. Protein intake was assessed via food-frequency questionnaire and calibrated by using biomarkers of energy and protein intakes. Associations between protein intake and fracture were estimated by using Cox proportional hazards regression, and the relation between protein intake and BMD was estimated by using linear regression.Results: Median biomarker-calibrated protein intake was 15% of energy intake. Per 20% increase in calibrated protein intake (percentage of energy), there was no significant association with total fracture (HR: 0.99; 95% CI: 0.97, 1.02) or hip fracture (HR: 0.91; 95% CI: 0.84, 1.00), but there was an inverse association with forearm fracture (HR: 0.93; 95% CI: 0.88, 0.98). Each 20% increase in calibrated protein intake was associated with a significantly higher BMD for total body (mean 3-y change: 0.003 g/cm(2); 95% CI: 0.001, 0.005 g/cm(2)) and hip (mean 3-y change: 0.002 g/cm(2); 95% CI: 0.001, 0.004 g/cm(2)).Conclusions: Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs. These data suggest higher protein intake is not detrimental to bone health in postmenopausal women. The WHI program was registered at clinicaltrials. gov as NCT00000611.