【摘要】：目的觀察補(bǔ)充強(qiáng)化鈣奶粉對(duì)北京郊區(qū)青少年體格生長(zhǎng)、體成分及骨骼發(fā)育的影響，為改善北京郊區(qū)青少年?duì)I養(yǎng)狀況提供科學(xué)依據(jù)。 方法本研究為隨機(jī)對(duì)照干預(yù)研究。選取北京市懷柔區(qū)3個(gè)鄉(xiāng)鎮(zhèn)，每個(gè)鄉(xiāng)鎮(zhèn)各隨機(jī)選取1所初中初一的健康學(xué)生，共286名作為研究對(duì)象。研究對(duì)象在測(cè)定基線骨量指標(biāo)后，以基線骨量為隨機(jī)指標(biāo)，在各組基線骨量沒(méi)有顯著性差異的基礎(chǔ)上，按照班級(jí)為單位隨機(jī)分為1個(gè)對(duì)照組和3個(gè)補(bǔ)充組。對(duì)照組學(xué)生保持日常飲食，沒(méi)有干預(yù)措施；補(bǔ)充組內(nèi)學(xué)生按照個(gè)體隨機(jī)分為a組（每天補(bǔ)充含鈣300mg和維生素D10μg的奶粉40g）、b組（每天補(bǔ)充含鈣600mg和維生素D10μg的奶粉40g）和c組（每天補(bǔ)充含鈣900mg和維生素D10μg的奶粉40g）。要求家長(zhǎng)每天早上和晚上分兩次為學(xué)生準(zhǔn)備，研究對(duì)象在家長(zhǎng)監(jiān)督下服用。對(duì)干預(yù)組學(xué)生進(jìn)行為期1.5年的鈣強(qiáng)化奶粉補(bǔ)充。通過(guò)問(wèn)卷調(diào)查收集研究對(duì)象的一般情況、家庭環(huán)境狀況、膳食攝入情況及身體活動(dòng)情況，并檢查其生長(zhǎng)發(fā)育狀況。采用雙能X線吸收儀(Dual Energy X-rayAbsorptiometry，DEXA)測(cè)量學(xué)生全身、腰椎、股骨頸、全股骨及Wards區(qū)的骨礦物含量（Bone Mineral Content，BMC）、骨礦物密度(Bone Mineral Density，BMD)及骨面積（Bone Area，BA），同時(shí)測(cè)定全身體成分。所有測(cè)量分別在干預(yù)前、干預(yù)1年時(shí)及干預(yù)1.5年時(shí)各測(cè)量一次。采用混合線性模型分析干預(yù)效果。 結(jié)果（1）共調(diào)查初中生286人，平均年齡13.1±0.6歲。（2）干預(yù)前，四組間年齡、身高、體重、BMI、全身BMC、全身BMD和BA及體力活動(dòng)均無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）；每天總能量攝入、碳水化合物攝入量、鐵、維生素E、青春發(fā)育分期略有差異（P0.05）；（3）干預(yù)后，男、女生身高各組間差異均無(wú)顯著性，中期和末期身高的增量男、女各組間差異同樣無(wú)統(tǒng)計(jì)學(xué)意義。調(diào)整混雜因素后，男生身高干預(yù)效應(yīng)有統(tǒng)計(jì)學(xué)意義（P=0.0359），但女生身高干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義。調(diào)整混雜因素后，男生體重有干預(yù)效應(yīng)但無(wú)統(tǒng)計(jì)學(xué)意義（P=0.0621）；女生體重干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義。男、女BMI中期及末期增量各組間差異無(wú)統(tǒng)計(jì)學(xué)意義。調(diào)整混雜因素后，男生BMI無(wú)顯著性組間效應(yīng)而女生BMI組間效應(yīng)有統(tǒng)計(jì)學(xué)意義（P=0.045）；男生BMI有干預(yù)效應(yīng)但無(wú)統(tǒng)計(jì)學(xué)意義（P=0.1536），女生BMI干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義。男、女生瘦體重、體脂和體脂百分比四組間差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；干預(yù)中期及末期三指標(biāo)均有所增加，但組間均無(wú)統(tǒng)計(jì)學(xué)差異。調(diào)整混雜因素后，男生瘦體重、體脂及體脂百分比組間效應(yīng)、時(shí)間效應(yīng)及干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義；女生瘦體重、體脂和體脂百分比時(shí)間效應(yīng)均有統(tǒng)計(jì)學(xué)意義（P0.05），瘦體重干預(yù)組學(xué)生增加有高于對(duì)照組趨勢(shì)，但無(wú)統(tǒng)計(jì)學(xué)意義（P=0.1081），體脂及體脂百分比干預(yù)效應(yīng)均無(wú)統(tǒng)計(jì)學(xué)意義。(4)調(diào)整可能混雜因素后，男生全身骨量時(shí)間效應(yīng)有統(tǒng)計(jì)學(xué)意義（P0.05），干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義（P=0.0916）；女生中期全身骨量a組及b組分別增加241.0g和213.1g較對(duì)照組學(xué)生176.3g高36.7%和20.9%，c組學(xué)生增加171.5g，較對(duì)照組學(xué)生低2.7%（P=0.0422）；末期全身骨量a組及b組學(xué)生分別增加327.7g和308.7g較對(duì)照組學(xué)生251g高30.6%和23.0%，c組學(xué)生增加244.4g較對(duì)照組學(xué)生低2.7%（P=0.0692）。調(diào)整可能混雜因素后，，女生全身骨量時(shí)間效應(yīng)有統(tǒng)計(jì)學(xué)意義（P0.0001），但干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義（P=0.1919）；（5）男生全身骨密度中期增量a組、b組及c組分別為0.042g/cm2、0.037g/cm2和0.049g/cm2較對(duì)照組的0.033g/cm2高27.3%、12.1%和48.5%（P0.05）；調(diào)整混雜因素后，男生中期全身BMD較基線a組和c組分別增加0.047g/cm2和0.051g/cm2，較對(duì)照組學(xué)生的0.038g/cm2分別高23.7%和34.2%，b組學(xué)生增量與對(duì)照組相等；末期全身骨密度較基線a組和b組學(xué)生分別增加0.078g/cm2和0.071g/cm2，較對(duì)照組學(xué)生0.081g/cm2分別低3.7%和12.3%，c組學(xué)生為0.081g/cm2與對(duì)照組學(xué)生相等。調(diào)整混雜因素后全身骨密度干預(yù)效應(yīng)有統(tǒng)計(jì)學(xué)意義（P=0.0187）。（6）女生全身骨密度中期增量a組和b組分別為0.050g/cm2和0.042g/cm2，較對(duì)照組學(xué)生的0.033g/cm2高51.5%和27.3%，c組為0.029g/cm2較對(duì)照組學(xué)生低12.1%（P=0.0625）；全身骨密度末期增量a組和b組學(xué)生分別為0.082g/cm2和0.069g/cm2，較對(duì)照組學(xué)生的0.054g/cm2高51.9%和27.8%，c組為0.051g/cm2較對(duì)照組學(xué)生低5.6%（P=0.0074）；調(diào)整混雜因素后，女生中期全身BMD較基線a組和b組分別增加0.050g/cm2和0.041g/cm2，較對(duì)照組學(xué)生的0.33g/cm2分別高51.5%和24.2%，而c組為0.029g/cm2較對(duì)照組學(xué)生低12.1%；女生末期全身BMD較基線a組、b組和c組分別增加0.081g/cm2、0.068g/cm2及0.057g/cm2，較對(duì)照組學(xué)生0.054g/cm2分別高50%、25.9%及5.6%；調(diào)整混雜因素后，全身骨密度干預(yù)效應(yīng)有統(tǒng)計(jì)學(xué)意義（P=0.0307）。(7)調(diào)整混雜因素后，男、女生BAP及TRAP-5b和男生IGF-1、女生PTH均時(shí)間效應(yīng)有統(tǒng)計(jì)學(xué)意義（P0.05）；男、女生各生化指標(biāo)均無(wú)組間效應(yīng)，男生IGF-1（P=0.0125）和PTH（P=0.0348）干預(yù)效應(yīng)有統(tǒng)計(jì)學(xué)意義，女生各生化指標(biāo)均干預(yù)效應(yīng)無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論北京郊區(qū)青少年平均每日鈣攝入水平較低，通過(guò)1.5年補(bǔ)充鈣強(qiáng)化奶粉能促進(jìn)男、女生骨量、骨密度增長(zhǎng)，并對(duì)其營(yíng)養(yǎng)狀況有一定改善作用，但對(duì)男、女生身高和體重影響不顯著；青少年應(yīng)保持適當(dāng)體力活動(dòng)，增加鈣攝入以滿足體格生長(zhǎng)發(fā)育需要。
[Abstract]:Objective To observe the effects of supplementation of fortified calcium milk powder on physical growth, body composition and bone development of adolescents in Beijing suburbs, and to provide scientific basis for improving nutritional status of adolescents in Beijing suburbs.
Methods A randomized controlled intervention study was conducted in three townships in Huairou District of Beijing. A total of 286 healthy junior middle school students were randomly selected from each of the townships. The students in the supplementary group were randomly divided into group a (supplemented with milk powder containing 300 mg calcium and 10 mg vitamin D daily) and group B (supplemented with milk powder containing 600 mg calcium and 10 mg vitamin D daily) and group C (supplemented with milk powder containing 40 g vitamin D daily). Calcium 900MG and vitamin D 10 mg of milk powder 40g. Parents were asked to prepare for the students twice a day in the morning and evening. The subjects were given calcium supplementation under the supervision of their parents. The students in the intervention group were given calcium supplementation for 1.5 years. Bone Mineral Content (BMC), bone mineral density (BMD) and bone area (BA) in the whole body, lumbar spine, femoral neck, femur and Wards region were measured by dual energy X-ray absorptiometry (DEXA). All measurements were taken before intervention, 1 year after intervention and 1.5 years after intervention respectively. Mixed linear model was used to analyze the effect of intervention.
Results (1) A total of 286 junior middle school students were investigated, with an average age of 13.1 (+ 0.6 years). (2) Before the intervention, there were no significant differences in age, height, weight, BMI, BMC, BMD, BA and physical activity among the four groups (P 0.05); daily total energy intake, carbohydrate intake, iron, vitamin E, and puberty stages (P 0.05); and (3) After the intervention, there were slight differences in male and female. There was no significant difference in height among different groups, and there was no significant difference in height increment between male and female at the middle and final stages. There was no significant difference in BMI increment between male and female. After adjusting the confounding factors, there was no significant inter-group effect in BMI of male students and significant inter-group effect in BMI of female students (P = 0.045); there was no significant intervention effect in BMI of male students but no significant difference in BMI of female students (P = 0.1536). There was no significant difference in BMI intervention effect between male and female students. There was no significant difference in lean weight, body fat and body fat percentage among the four groups (P There was no significant difference in the pre-effect; there was significant difference in lean weight, body fat and percentage of body fat between girls (P 0.05). The increase of lean weight intervention group was higher than that of the control group, but there was no significant difference (P = 0.1081). There was no significant difference in the intervention effect of body fat and percentage of body fat between the two groups. (4) After adjusting the possible confounding factors, there was no significant difference in body fat and percentage of body fat among boys. Bone mass time effect was statistically significant (P 0.05), intervention effect was not statistically significant (P = 0.0916); girls in the mid-term total body bone mass group A and group B increased 241.0 g and 213.1 g respectively higher than the control group students 176.3 g 36.7% and 20.9%, group C students increased 171.5 g, lower than the control group students 2.7% (P = 0.0422); end-stage total body bone mass group A and group B students increased 3.7% respectively. 27.7g and 308.7g were 30.6% and 23.0% higher than 251g in control group, and 244.4g in group C was 2.7% lower than that in control group (P = 0.0692). After adjusting the possible confounding factors, the time effect of whole body bone mass of female students was statistically significant (P 0.0001), but the intervention effect was not statistically significant (P = 0.1919); (5) the mid-term increment of bone mineral density of male students in group a, group B and group C 0.042g/cm2, 0.037g/cm2 and 0.049g/cm2 were 27.3%, 12.1% and 48.5% higher than those of the control group (P 0.05), respectively. After adjusting the confounding factors, the BMD of the boys in the middle period increased by 0.047g/cm2 and 0.051g/cm2 respectively, 23.7% and 34.2% higher than those of the control group, and the increment of the students in group B was the same as that of the control group. Bone mineral density increased by 0.078 g/cm 2 and 0.071 g/cm 2 respectively compared with baseline group A and group b, which were 3.7% and 12.3% lower than that of control group 0.081 g/cm 2, respectively, and 0.081 g/cm 2 was equal to that of control group C. The intervention effect of whole body bone mineral density after adjusting the confounding factors was statistically significant (P = 0.0187). (6) Medium-term increment of whole body bone mineral density of female students in group A and group B was significantly lower than that of control group.081 g/cm 2, respectively. 0.050g/cm2 and 0.042g/cm2, 51.5% and 27.3% higher than that of the control group, 0.029g/cm2 lower than that of the control group by 12.1% (P = 0.0625), total body bone mineral density (BMD) increment of 0.082g/cm2 and 0.069g/cm2 in group A and group b, 51.9% and 27.8% higher than that of the control group by 0.054g/cm2, and 0.051g/cm2 lower than that of the control group by 5.6% (P = 0.0625). After adjusting the confounding factors, the BMD of girls in the middle period increased by 0.050 g/cm 2 and 0.041 g/cm 2 respectively, 51.5% and 24.2% higher than that of the control group, while that of the C group was 0.029 g/cm 2 was 12.1% lower than that of the control group. 7 g/cm2, 50%, 25.9% and 5.6% higher than that of the control group, respectively. After adjusting the confounding factors, the intervention effect of BMD was statistically significant (P = 0.0307). (7) After adjusting the confounding factors, BAP, TRAP-5b and IGF-1 of male, female and PTH of female students were statistically significant (P 0.05); there was no intergroup effect between male and female biochemical indexes. The intervention effects of IGF-1 (P = 0.0125) and P TH (P = 0.0348) in boys were statistically significant, while the intervention effects of biochemical indexes in girls were not statistically significant.
Conclusion The average daily calcium intake level of adolescents in Beijing suburbs is low. Supplementary calcium fortified milk powder for 1.5 years can increase bone mass and bone mineral density of male and female students, and improve their nutritional status to some extent, but has no significant effect on the height and weight of male and female students. Long development needs.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R151.4

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