本文選題：營(yíng)養(yǎng)干預(yù) + 骨質(zhì)疏松��； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：目的探討濟(jì)南市社區(qū)中老年人對(duì)骨質(zhì)疏松癥(Osteoporosis, OP)的認(rèn)知現(xiàn)狀；通過對(duì)濟(jì)南市社區(qū)中老年人進(jìn)行為期一年的基于骨膠原肽的飲食行為干預(yù),評(píng)價(jià)干預(yù)前后研究人群膳食結(jié)構(gòu)、行為習(xí)慣調(diào)整和體格指標(biāo)、骨密度T值、骨轉(zhuǎn)換生化指標(biāo)的變化。對(duì)干預(yù)前后OP患者及對(duì)照人群的營(yíng)養(yǎng)知、信、行情況的改善效果進(jìn)行分析評(píng)價(jià)。為社區(qū)中老年人群的骨骼健康管理提供參考,為OP患者的健康促進(jìn)方案和疾病防治措施提供理論基礎(chǔ)。方法隨機(jī)抽取2013年9月至2013年12月到山東中醫(yī)藥大學(xué)第二附屬醫(yī)院健康體檢中心檢查的濟(jì)南市5個(gè)行政區(qū)社區(qū)中老年人。納入標(biāo)準(zhǔn)：思維正常、語(yǔ)言流暢、意識(shí)清晰,有正常行為能力；知情同意。排除標(biāo)準(zhǔn)：神志不清晰、交流障礙；患急慢性肝炎、腎臟及內(nèi)分泌相關(guān)疾�。荒壳皯�(yīng)用激素類藥物、抗骨質(zhì)疏松藥物以及利尿劑等影響骨代謝藥物。前期共納入研究對(duì)象368例,其中有效樣本366例,包括男123例,女243例(已絕經(jīng))；OP患者147例,非OP人群219例。對(duì)納入的研究對(duì)象進(jìn)行為期1年的基于骨膠原肽的飲食行為干預(yù),主要包括隨訪確認(rèn)研究對(duì)象每天以規(guī)定的劑量服用骨膠原肽,指導(dǎo)三餐飲食、普及骨骼知識(shí)健康教育及根據(jù)個(gè)人情況進(jìn)行干預(yù)方案和力度調(diào)整。經(jīng)過一年時(shí)間干預(yù)后,除去失訪人數(shù)、半途退出試驗(yàn)人數(shù)、后期數(shù)據(jù)不全、問卷不合格人數(shù),總共完成干預(yù)全程且問卷數(shù)據(jù)有效者205人,包括男74例,女131例(已絕經(jīng)),年齡在49～88歲范圍內(nèi),平均年齡(69.23±7.65)歲,男性平均年齡(71.80±7.22)歲,女性平均年齡(68.30±6.84)歲。OP患者82例,非OP人群123例。分別在干預(yù)前干預(yù)后由專業(yè)人員進(jìn)行問卷調(diào)查(主要包括基本信息、日常行為習(xí)慣、骨健康的認(rèn)知及態(tài)度、骨骼健康狀況生活史、家族史、既往疾病史、特殊用藥史及女性月經(jīng)史等信息)、體格測(cè)量和骨轉(zhuǎn)換生化指標(biāo)檢測(cè)包括：骨密度T值、血清鈣、磷、堿性磷酸酶(Alkaline Phosphatase, ALP)、甲狀旁腺激素(Parathyroid Hormone,PTH)；問卷收集后對(duì)問卷調(diào)查、體格檢查和骨轉(zhuǎn)換生化指標(biāo)結(jié)果進(jìn)行分析評(píng)價(jià)。結(jié)果1.干預(yù)前期研究對(duì)象的體質(zhì)指數(shù)(Body Mass Index, BMI)均值為(24.97±2.95),高于正常值范圍,超重者占46.8%；肥胖者占15.6%。女性BMI高于男性,差異不明顯,60～70歲年齡組的BMI值最高,組間差異明顯,組內(nèi)差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.干預(yù)前期男性O(shè)P檢出率為35.1%,女性的OP檢出率為53.4%,女性的OP檢出率高于男性,差異明顯(X26.360,P0.01)。研究對(duì)象骨密度T均值為(-2.47+1.37)g/cm2處于骨量減少范圍內(nèi),女性為(-2.74+1.37)g/cm2,男性為(-2.03±1.27)g/cm2,女性遠(yuǎn)低于男性(P0.01)。骨密度T值隨年齡增長(zhǎng)逐漸降低,且組間、組內(nèi)差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。骨密度T值隨BMI升高有升高趨勢(shì),組內(nèi)差異明顯(P0.01),正常組和超重組的組間差異不明顯,其他各組間有明顯差異(P0.05)。3.研究對(duì)象的血清鈣、磷、PTH、ALP均值均在正常范圍內(nèi),血清鈣、磷、ALP均值的性別差異均具有統(tǒng)計(jì)學(xué)意義,且為女性偏高(P0.05)。血清鈣水平隨年齡升高逐漸升高,組內(nèi)差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。血清磷水平隨年齡升高有下降趨勢(shì),組內(nèi)差異明顯(P0.05)。PTH水平隨年齡增長(zhǎng)有升高趨勢(shì),ALP水平隨年齡增長(zhǎng)有輕微降低,組內(nèi)差異均不具有統(tǒng)計(jì)學(xué)意義。4.OP組和對(duì)照組的血清鈣、PTH水平差異不具有統(tǒng)計(jì)學(xué)意義,血清磷、ALP水平差異具有統(tǒng)計(jì)學(xué)意義(P0.05),OP組的ALP和血清磷水平較高。5.對(duì)骨密度T值與骨轉(zhuǎn)換生化指標(biāo)作相關(guān)性分析,經(jīng)身高、體重、年齡調(diào)整后,OP組骨密度T值與ALP之間呈現(xiàn)的負(fù)相關(guān)具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組骨密度T值與血清磷離子之間的負(fù)相關(guān)具有統(tǒng)計(jì)學(xué)意義(P0.01)。6.干預(yù)前后男性的骨質(zhì)疏松營(yíng)養(yǎng)知識(shí)回答正確率要高于女性,對(duì)照組的骨質(zhì)疏松營(yíng)養(yǎng)知識(shí)平均得分高于OP組差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)后男、女和總?cè)巳旱钠骄梅指哂诟深A(yù)前,差異具有統(tǒng)計(jì)學(xué)意義(P0.01),正確回答率在80%以上的題目占總題目的60%。與干預(yù)前相比,研究對(duì)象“骨質(zhì)疏松的主要缺乏元素”、“防治骨關(guān)節(jié)疾病最適宜的方法”、“檢測(cè)骨質(zhì)疏松的金標(biāo)準(zhǔn)”正確回答率明顯提高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)�！澳小⑴膫�(gè)比較容易患骨質(zhì)疏松”干預(yù)后正確回答率提高,但是差異不具有統(tǒng)計(jì)學(xué)意義。“骨質(zhì)疏松是否會(huì)引起骨折”的回答正確率有輕微降低,差異不具有統(tǒng)計(jì)學(xué)意義。7.干預(yù)前后女性的日常飲食行為習(xí)慣平均得分高于男性,對(duì)照組的飲食行為習(xí)慣平均得分高于OP組,差異不具有統(tǒng)計(jì)學(xué)意義。干預(yù)后男、女和總?cè)巳旱娘嬍承袨榱?xí)慣平均得分高于干預(yù)前,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),干預(yù)后“膳食口味”、“乳制品攝入情況”、 “芝麻及芝麻制品攝入情況”、“堅(jiān)持飲食運(yùn)動(dòng)相結(jié)合的生活方式”的回答情況明顯好于干預(yù)前(P0.05)。“海產(chǎn)品攝入情況”、“大豆及豆制品攝入情況”、“飲用咖啡情況”、 “飲酒情況”、“戶外運(yùn)動(dòng)情況”的回答情況好于干預(yù)前,但差異不具有統(tǒng)計(jì)學(xué)意義。8.干預(yù)后“關(guān)節(jié)肌肉的疼痛、腫脹狀況”明顯減輕,“關(guān)節(jié)靈活度”升高,關(guān)節(jié)僵硬、活動(dòng)困難等現(xiàn)象發(fā)生率降低,干預(yù)前后的得分差異均有統(tǒng)計(jì)學(xué)意義(P0.01)；“骨骼的疼痛狀況"好轉(zhuǎn),疼痛發(fā)生率降低,干預(yù)前后差異不明顯,但是“骨痛感的疼痛程度”明顯降低,程度分級(jí)得分差異具有統(tǒng)計(jì)學(xué)意義；研究對(duì)象干預(yù)后心情變好,感覺皮膚有輕微的變細(xì)變軟現(xiàn)象,但是干預(yù)前后得分差異不明顯；研究對(duì)象干預(yù)后自我感覺爬樓梯輕松,抽筋次數(shù)減少、癥狀減輕,老年斑顏色變淺,且干預(yù)前后差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。9.研究對(duì)象干預(yù)后骨密度T值、血清鈣、PTH有輕微上升, BMI值、血清磷下降,骨密度T值、血清鈣干預(yù)前后差異具有統(tǒng)計(jì)學(xué)意義(P0.05),ALP水平顯著下降(P0.01)。干預(yù)后,男性骨密度T值有上升傾向,血清鈣水平明顯上升(P0.05),血清ALP和PTH有下降趨勢(shì),ALP干預(yù)前后差異具有統(tǒng)計(jì)學(xué)意義(P0.01)；女性骨密度T值、血清鈣水平上升,骨密度T值水平變化明顯(P0.01),血清ALP、PTH有明顯降低(P0.05)。結(jié)論1.社區(qū)中老年人對(duì)骨骼營(yíng)養(yǎng)相關(guān)知識(shí)掌握不夠全面,日常飲食習(xí)慣不夠合理,OP人群知識(shí)掌握、飲食習(xí)慣相對(duì)較差。OP組骨密度T值與ALP之間呈現(xiàn)明顯負(fù)相關(guān),對(duì)照組骨密度T值與血清磷離子之間呈現(xiàn)負(fù)相關(guān)。2.經(jīng)過骨膠原蛋白肽和飲食行為健康干預(yù)后,研究對(duì)象的骨骼健康知識(shí)、態(tài)度、行為總體水平得到提高,部分提高有限,但總體的干預(yù)效果良好。3.骨膠原肽飲食行為干預(yù)對(duì)骨轉(zhuǎn)換生化指標(biāo)的干預(yù)效果明顯,骨量減少檢出率升高,OP檢出率降低。伴隨著骨密度T值的提高,血清鈣、鈣磷比、PTH均有提高,ALP水平顯著下降。4.干預(yù)后對(duì)日常飲食行為習(xí)慣效果明顯,乳制品類、豆制品類、海產(chǎn)品類、芝麻制品的攝入量有所升高,生活質(zhì)量有明顯改善,但對(duì)具體的膳食營(yíng)養(yǎng)素的準(zhǔn)確影響還需要在今后的干預(yù)過程中進(jìn)行探索、改進(jìn)和完善。
[Abstract]:Objective to investigate the cognitive status of Osteoporosis (OP) in the middle-aged and elderly people in Ji'nan, and to evaluate the dietary structure, behavioral habit adjustment and physical index, bone mineral density (BMD) value, bone mineral density (BMD) and bone conversion biochemical index before and after intervention through the diet behavior intervention based on bone gelatin peptide for the elderly in Ji'nan community. Analysis and evaluation of the improvement effect of nutrition knowledge, letter and practice of OP patients and control people before and after intervention. Provide a reference for the bone health management of the elderly in the community, provide a theoretical basis for the health promotion program and disease prevention and control measures for the OP patients. Methods randomly selected from September 2013 to December 2013 in Shandong. The elderly in the 5 administrative districts of Ji'nan, the Second Affiliated Hospital of Medical University, were included in the standard: normal thinking, fluent language, clear consciousness, normal behavior ability, informed consent. Exclusion criteria: uncertainty, communication disorder, acute and chronic hepatitis, kidney and endocrine related diseases; current application Hormone drugs, anti osteoporosis drugs and diuretics influence bone metabolism drugs. 368 cases were included in the early stage, of which 366 cases were effective samples, including 123 men, 243 women (menopause), 147 OP patients and 219 non OP people. The following follow-up confirmed that the subjects took the bone glue peptide at the prescribed dose every day to guide the diet of the three meals, popularize the health education of the skeleton knowledge and the intervention programs and adjustments according to the individual situation. After one year's time, the number of lost visitors was removed, the number of people withdrew from the experiment, the late data were incomplete, the number of the questionnaires was not qualified, and a total of the total finished. 205 people, including 74 men, 131 women (menopause), average age (69.23 + 7.65) years, male age (71.80 + 7.22) years, average age (68.30 + 6.84) years (68.30 + 6.84) years (68.30 + 6.84).OP patients 82, and non OP population 123 cases. Examination (including basic information, daily behavior habits, bone health cognition and attitude, bone health status life history, family history, past disease history, special medication history, female menstrual history and other information), physical measurement and bone conversion biochemical indicators including bone mineral density T, serum calcium, phosphorus, alkaline phosphatase (Alkaline Phosphatase, ALP), a Parathyroid Hormone, PTH (PTH); questionnaire survey, physical examination and bone conversion biochemical index results were analyzed and evaluated. Results the mean value of body mass index (Body Mass Index, BMI) was (24.97 + 2.95), higher than the normal range, 46.8% of overweight and obese 15.6%. women. 1. In men, the difference was not obvious. The BMI value of the 60~70 year old group was the highest, the difference between the groups was obvious, the difference in the group was not statistically significant (P0.05) the positive rate of male OP in the early stage of.2. intervention was 35.1%, the rate of OP in the female was 53.4%, the OP detection rate of the female was higher than that of the male, the difference was obvious (X26.360, P0.01). The average T mean of the bone density of the study object was (-2.47+1.37) g/. Cm2 was within the range of bone mass reduction, women were (-2.74+1.37) g/cm2, male was (-2.03 + 1.27) g/cm2, and women were far lower than men (P0.01). The T value of bone density decreased gradually with age, and the differences in the group were statistically significant (P0.05). The T value of bone density increased with BMI, and the difference in the group was obvious (P0.01), normal group and super recombination. There was no obvious difference between the groups. The serum calcium, phosphorus, PTH, and ALP of the subjects in other groups (P0.05) were all in the normal range. The gender differences in serum calcium, phosphorus and ALP were all statistically significant, and were higher in women (P0.05). The serum calcium water level increased gradually with age, and the difference in the group was statistically significant (P0.0 5). The level of serum phosphorus decreased with age, and the difference in the group (P0.05).PTH level increased with age, and the level of ALP decreased slightly with age. The difference in the level of serum phosphorus was not statistically significant in the.4.OP group and the control group. The difference of the level of PTH was not statistically significant, and the difference of serum phosphorus and ALP levels had a significant difference. Statistical significance (P0.05), group OP ALP and serum phosphorus level was higher.5. correlation analysis of bone mineral density T value and bone conversion biochemical index, after height, weight, age adjusted, OP group bone density T value and ALP between the negative correlation between the statistical significance (P0.05). The negative correlation between the bone density T value and serum phosphorus ions in the control group has a negative correlation The correct rate of the male osteoporosis nutrition knowledge before and after.6. intervention (P0.01) was higher than that of the female. The average score of osteoporosis knowledge in the control group was higher than that of the OP group (P0.05). The average score of the male, female and total population after intervention was higher than that before intervention, and the difference was statistically significant (P0.01). More than 80% of the subjects accounted for the 60%. of the general topic before the intervention, the subject "the main lack of osteoporosis", "the most suitable method for the prevention and treatment of bone and joint disease", the correct answer rate of "gold standard for detecting osteoporosis" was obviously improved, and the difference was statistically significant (P0.05). "Men and women are more likely to suffer from bone." The correct response rate increased after the intervention, but the difference did not have statistical significance. "Whether the osteoporosis will cause fracture" has a slight decrease in the correct rate, and the difference is not statistically significant. The average score of daily dietary habits and habits of women before and after.7. intervention is higher than that of men, and the average scores of dietary habits and habits in the control group are higher. In the OP group, the difference was not statistically significant. The average scores of dietary habits and habits of men, women and the general population were higher than those before intervention, and the difference was statistically significant (P0.05). The outcome of "dietary taste", "dairy ingestion", "sesame and sesame products intake", "adhere to the lifestyle of diet and exercise" The response was better than before intervention (P0.05). "Intake of seafood", "intake of soy and bean products", "drinking coffee", "drinking", "drinking", "outdoor exercise" were better than before intervention, but the difference was not statistically significant in.8. after the "joint muscle pain, swelling state". The incidence of "joint flexibility" increased, joint stiffness, difficulty in activity and other phenomena decreased. The difference of scores before and after intervention were statistically significant (P0.01); "the pain status of bone" improved, the incidence of pain decreased and the difference was not obvious before and after intervention, but the pain degree of bone pain was obviously reduced and the grade score was poor. The difference was statistically significant; after the intervention, the mood of the study was better, and the skin had a slight thinning and softening phenomenon, but the difference was not obvious before and after the intervention. After the intervention, the self felt staircase was relaxed, the number of cramps decreased, the symptoms were reduced, the color of the senile plaque was lighter, and the difference was statistically significant before and after the intervention (P0.0 5) the T value of bone mineral density after the intervention of.9., serum calcium, PTH had a slight increase, BMI value, the decrease of serum phosphorus, the T value of bone density, the difference between the serum calcium and the serum calcium was statistically significant (P0.05), the level of ALP decreased significantly (P0.01). The prognosis of the bone density in male was up, the serum calcium level was up (P0.05), the serum ALP and PTH had a decline. The difference was statistically significant (P0.01) before and after ALP intervention, the T value of bone mineral density in women, the increase of serum calcium level, the T value of bone density (P0.01), serum ALP and PTH significantly decreased (P0.05). Conclusion the knowledge of bone nutrition related knowledge in the 1. community is not comprehensive, the daily diet habits are not reasonable, and the OP crowd knowledge is mastered, The bone mineral density (BMD) T value of.OP group was negatively correlated with ALP, and the negative correlation between T value and serum phosphorus ion in the control group was negatively correlated with the prognosis of bone collagen peptide and dietary behavior health. The level of bone health knowledge, attitude, and behavior general body level of the study subjects were improved, and the overall level was limited, but the overall level of the study was limited. The intervention effect was good, the intervention effect of.3. osteonetin dietary behavior intervention on bone transformation biochemical indexes was obvious, the detection rate of bone mass decreased and the detection rate of OP decreased. With the increase of T value of bone density, serum calcium, calcium and phosphorus ratio, PTH were improved, and ALP level significantly decreased the effect of.4. intervention on daily dietary habits, dairy category, The intake of soybean products, marine products, sesame products increased and the quality of life improved obviously, but the exact influence of the specific dietary nutrients needed to be explored, improved and improved in the process of intervention in the future.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R580

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