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Article(id=1241522861064646674, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202309270, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1694534400000, receivedDateStr=2023-09-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931716456, onlineDateStr=2026-03-19, pubDate=1707494400000, pubDateStr=2024-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931716456, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931716456, creator=13701087609, updateTime=1773931716456, updator=13701087609, issue=Issue{id=1241522846384583426, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931712956, creator=13701087609, updateTime=1773931842201, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523388544504301, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523388544504302, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=433, endPage=438, ext={EN=ArticleExt(id=1241522861584740410, articleId=1241522861064646674, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the relationship between dietary flavonoid intake and total bone mineral content in human body, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between the intake of flavonoids in diet and total bone mineral content in human body.

Methods

Adults aged 20 to 59 years in the National Health and Nutrition Examination Surveys (NHANES) from 2017 to 2018 were selected as research subjects. A multivariate linear regression model was constructed to explore the relationship between dietary flavonoid intake and total bone mineral content adjusting gender, age, race, education level, marital status, economic status, BMI, alcohol consumption, hypertension, diabetes, and cardiovascular disease.

Results

A total of 2 110 participants were included in the study, with the ratio of male to female 1:1. The average total mineral content was 2 341.4 g, and the median intake of total flavonoids in diet was 74.45 mg. After adjusting for sex, age, race, education, marital status, economic status, BMI, alcohol consumption, hypertension, diabetes and cardiovascular disease, the linear regression model showed that the total bone mineral content of the whole body was positively correlated with dietary isoflavone intake (β=0.68, 95%CI:0.26-1.09), and there was a dose-response relationship (Ptrend=0.001). In addition, the results of subgroup analysis showed that the positive correlation was stronger in men (βmale=1.39, 95%CI: 0.67-2.11 vs. βFemale=0.18, 95%CI: -0.31 to 0.67, Pinter=0.038).

Conclusion

the intake of isoflavones in diet may increase the content of total bone minerals in human body, but whether there is a gender difference needs to be further explored.

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目的

探讨饮食中黄酮类化合物的摄入与人体总骨矿物质含量之间的关系。

方法

选择2017—2018年美国国家健康和营养调查（NHANES）中20～59岁成年人作为研究对象，通过构建多变量线性回归模型，对性别、年龄、种族、受教育水平、婚姻状况、经济情况、BMI、饮酒情况、高血压、糖尿病及心血管疾病进行调整，探究饮食中黄酮类化合物摄入量和人体总骨矿物质含量之间的关系。

结果

研究共纳入2 110人，男女比例约为1:1，平均总矿物质含量为2 341.4 g，饮食中总黄酮摄入量的中位数为74.45 mg。在调整了性别、年龄、种族、受教育水平、婚姻状况、经济情况、BMI、饮酒情况、高血压、糖尿病和心血管疾病后的线性回归模型显示全身总骨矿物质含量与饮食中异黄酮摄入量呈正相关（β=0.68, 95%CI: 0.26～1.09），并存在剂量反应关系（Ptrend=0.001），此外，亚组分析结果表明，该正相关关系在男性中更为强烈［男性（β=1.39, 95%CI: 0.67～2.11） vs. 女性（β=0.18, 95%CI: -0.31～0.67）, Pinter=0.038］。

结论

饮食中异黄酮摄入可能会增加人体全身总骨矿物质的含量，但是否具有性别差异仍需进一步探究。

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熊静远，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=hmxKRuCfZMWfdwPTFOCEzw==, magXml=LuNcRjy0LkXHYV7C7riJbA==, pdfUrl=null, pdf=sRK2DgDblSKH6gxiZwqNaQ==, pdfFileSize=1449258, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=d0+RP7DA4Jd1N901pdvvdw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=sKuE+YnN755ihr4IRVRtbg==, mapNumber=null, authorCompany=null, fund=null, authors=

马国琛（1997—），男，硕士在读，研究方向：劳动卫生与环境卫生

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马国琛（1997—），男，硕士在读，研究方向：劳动卫生与环境卫生

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Drug Design, Development and Therapy, 2013, 7:435-448., articleTitle=Osteoporosis-a current view of pharmacological prevention and treatment, refAbstract=null), Reference(id=1241680468731547922, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, doi=null, pmid=null, pmcid=null, year=2005, volume=16, issue=8, pageStart=479, pageEnd=488, url=null, language=null, rfNumber=[23], rfOrder=23, authorNames=Watkins BA, Reinwald S, Li Y, journalName=Journal of Nutritional Biochemistry, refType=null, unstructuredReference=Watkins BA, Reinwald S, Li Y, et al. Protective actions of soy isoflavones and n-3 PUFAs on bone mass in ovariectomized rats[J]. 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Journal of Cellular Biochemistry, 2002, 84(4): 725-735., articleTitle=Phytoestrogen genistein stimulates the production of osteoprotegerin by human trabecular osteoblasts, refAbstract=null)], funds=[Fund(id=1241680464637907088, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, awardId=2021YJ0156, language=CN, fundingSource=四川省科技厅应用基础项目(2021YJ0156), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241680455238472410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, xref=null, ext=[AuthorCompanyExt(id=1241680455246861020, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, companyId=1241680455238472410, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241680455255249630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, companyId=1241680455238472410, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)])], figs=[ArticleFig(id=1241680462523977774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Figure 1, caption=Flow chart of sample screening, figureFileSmall=zGIx/qnTY8tyeVgOIMrX3A==, figureFileBig=PTlaocGQkVDs++S26xAUeA==, tableContent=null), ArticleFig(id=1241680462654001202, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=图1, caption=样本筛选流程图, figureFileSmall=zGIx/qnTY8tyeVgOIMrX3A==, figureFileBig=PTlaocGQkVDs++S26xAUeA==, tableContent=null), ArticleFig(id=1241680462804996153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Figure 2, caption=The correlation between all covariates, figureFileSmall=0b5sRPXnjfQJ8rWobJ2m6w==, figureFileBig=I8vX6CfPV5gzrhbT1vQCaA==, tableContent=null), ArticleFig(id=1241680462926630978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=图2, caption=各协变量之间的相关性, figureFileSmall=0b5sRPXnjfQJ8rWobJ2m6w==, figureFileBig=I8vX6CfPV5gzrhbT1vQCaA==, tableContent=null), ArticleFig(id=1241680463027294278, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Figure 3, caption=Forest plot of linear regression analysis results for total and subclass dietary flavonoid intake and total bone mineral content, figureFileSmall=7zZknLyn41TKZ5ixav1trQ==, figureFileBig=8WLw+5uB+bXOQZtOFo2yMg==, tableContent=null), ArticleFig(id=1241680463127957576, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=图3, caption=饮食中黄酮类化合物总和及其亚类摄入量与总骨矿物质含量的线性回归分析结果的森林图

注：模型1未调整；模型2调整了性别、年龄、种族、受教育水平、婚姻状况、经济情况；模型3在模型2的基础上再调整BMI、饮酒情况、高血压、糖尿病及心血管疾病；森林图中的β及95%置信区间表示的是模型3的结果；*P<0.05, **P <0.01。

, figureFileSmall=7zZknLyn41TKZ5ixav1trQ==, figureFileBig=8WLw+5uB+bXOQZtOFo2yMg==, tableContent=null), ArticleFig(id=1241680463232815179, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Figure 4, caption=Forest plot of subgroup analysis results for dietary isoflavones intake and total body mineral content, figureFileSmall=+94/XTmRsnJloFLmVpSqeQ==, figureFileBig=AEkqLr4ty9COenQw4wuElQ==, tableContent=null), ArticleFig(id=1241680463350255700, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=图4, caption=饮食中异黄酮摄入量与总骨矿物质含量的亚组分析结果森林图

注：BMI整体质量指数；*P<0.05；**P<0.01；***P<0.001。

, figureFileSmall=+94/XTmRsnJloFLmVpSqeQ==, figureFileBig=AEkqLr4ty9COenQw4wuElQ==, tableContent=null), ArticleFig(id=1241680463455113307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Figure 5, caption=Gender subgroup analysis based on age groups, figureFileSmall=ZShf8qsv4njCOjv5X9Ht4Q==, figureFileBig=2SeXNNzBJ8UE+FiajePwyQ==, tableContent=null), ArticleFig(id=1241680463585136737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=图5, caption=不同年龄组中的性别亚组分析

注：图中β及95%CI表示的是调整了性别、年龄、种族、受教育水平、婚姻状况、经济情况、BMI、饮酒情况、高血压、糖尿病及心血管疾病后的结果；*P<0.05, **P<0.01。

, figureFileSmall=ZShf8qsv4njCOjv5X9Ht4Q==, figureFileBig=2SeXNNzBJ8UE+FiajePwyQ==, tableContent=null), ArticleFig(id=1241680463723548779, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Table 1, caption=

The levels of missingness for each variable and the methods used for imputing

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名n (%)插补方法
性别0 (0)-
年龄0 (0)-
种族0 (0)-
教育水平1 (<0.05)多项式回归
婚姻状况1 (<0.05)多项式回归
家庭月贫困水平指数163 (7.73)多项式回归
BMI5 (0.24)多项式回归
饮酒255 (12.09)logistic回归
高血压3 (0.14)logistic回归
糖尿病1 (<0.05)logistic回归
心血管疾病9 (0.43)logistic回归
异黄酮0 (0)-
花青素0 (0)-
黄烷-3-醇0 (0)-
二氢黄酮0 (0)-
黄酮0 (0)-
黄酮醇0 (0)-
总骨矿物质含量0 (0)-
), ArticleFig(id=1241680463849377906, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=表1, caption=

变量的缺失水平及所用的插补方法

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名n (%)插补方法
性别0 (0)-
年龄0 (0)-
种族0 (0)-
教育水平1 (<0.05)多项式回归
婚姻状况1 (<0.05)多项式回归
家庭月贫困水平指数163 (7.73)多项式回归
BMI5 (0.24)多项式回归
饮酒255 (12.09)logistic回归
高血压3 (0.14)logistic回归
糖尿病1 (<0.05)logistic回归
心血管疾病9 (0.43)logistic回归
异黄酮0 (0)-
花青素0 (0)-
黄烷-3-醇0 (0)-
二氢黄酮0 (0)-
黄酮0 (0)-
黄酮醇0 (0)-
总骨矿物质含量0 (0)-
), ArticleFig(id=1241680463996178551, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Table 2, caption=

Characteristics of the study population

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名人数及含量（%）
总人数2 110
性别
男性1 008 (47.7)
女性1 102 (52.2)
年龄（岁）
20～30560 (26.5)
31～45772 (36.5)
46～59778 (36.8)
种族
墨西哥裔美国人320 (15.1)
其他西班牙裔211 (10.0)
非西班牙裔白人664 (31.4)
非西班牙裔黑人415 (19.6)
其他500 (23.6)
受教育水平
高中以下341 (16.1)
高中480 (22.7)
高中以上1 289 (61.0)
婚姻状况
已婚1 252 (59.3)
离婚308 (14.5)
从未结过婚550 (26.0)
家庭月贫困水平指数
≤1.30711 (33.6)
1.31～1.85351 (16.6)
> 1.851 048 (49.6)
BMI (kg/m2)
<25628 (29.7)
25～30655 (31)
>30827 (39.1)
饮酒
是1 136 (53.8)
否974 (46.1)
高血压
是497 (23.5)
否1 613 (76.4)
糖尿病
是164 (7.7)
否1 946 (92.2)
心血管疾病
是399 (18.9)
否1 711 (81)
异黄酮（mg）1.51 (0.01, 10.39)
花青素（mg）13.07 (3.97, 44.03)
黄烷-3-醇（mg）15.27 (4.25, 122.45)
二氢黄酮（mg）0.25 (0.00, 9.67)
黄酮（mg）0.49 (0.14, 1.19)
黄酮醇（mg）12.75 (6.66, 22.74)
黄酮类化合物总和（mg）74.45 (26.62, 238.21)
总骨矿物质含量（g）2 341.40±445.90
), ArticleFig(id=1241680464126201980, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=表2, caption=

研究人群特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名人数及含量（%）
总人数2 110
性别
男性1 008 (47.7)
女性1 102 (52.2)
年龄（岁）
20～30560 (26.5)
31～45772 (36.5)
46～59778 (36.8)
种族
墨西哥裔美国人320 (15.1)
其他西班牙裔211 (10.0)
非西班牙裔白人664 (31.4)
非西班牙裔黑人415 (19.6)
其他500 (23.6)
受教育水平
高中以下341 (16.1)
高中480 (22.7)
高中以上1 289 (61.0)
婚姻状况
已婚1 252 (59.3)
离婚308 (14.5)
从未结过婚550 (26.0)
家庭月贫困水平指数
≤1.30711 (33.6)
1.31～1.85351 (16.6)
> 1.851 048 (49.6)
BMI (kg/m2)
<25628 (29.7)
25～30655 (31)
>30827 (39.1)
饮酒
是1 136 (53.8)
否974 (46.1)
高血压
是497 (23.5)
否1 613 (76.4)
糖尿病
是164 (7.7)
否1 946 (92.2)
心血管疾病
是399 (18.9)
否1 711 (81)
异黄酮（mg）1.51 (0.01, 10.39)
花青素（mg）13.07 (3.97, 44.03)
黄烷-3-醇（mg）15.27 (4.25, 122.45)
二氢黄酮（mg）0.25 (0.00, 9.67)
黄酮（mg）0.49 (0.14, 1.19)
黄酮醇（mg）12.75 (6.66, 22.74)
黄酮类化合物总和（mg）74.45 (26.62, 238.21)
总骨矿物质含量（g）2 341.40±445.90
), ArticleFig(id=1241680464231059585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=EN, label=Table 3, caption=

Relationship between isoflavones intake and total bone mineral content

, figureFileSmall=null, figureFileBig=null, tableContent=
异黄酮摄入量(mg)总骨矿物质含量(g)
Model 1 [β(95%CI)]Model 2 [β(95%CI)]Model 3 [β(95%CI)]
Q1RefRefRef
Q2-29.25 (-83.01, 24.50)-2.407 (-43.88, 39.07)5.19 (-34.09, 44.44)
Q3-61.65 (-115.43, -7.87 )*-21.16 (-63.16, 20.84)0.11 (-39.76, 39.98)
Q4-80.26 (-134.01, -26.50)**12.56 (-30.31, 55.43)44.93 (4.03, 85.83)*
趋势检验P=0.6P=0.082P=0.001
), ArticleFig(id=1241680464335917190, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522861064646674, language=CN, label=表3, caption=

异黄酮摄入量和总骨矿物质含量的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
异黄酮摄入量(mg)总骨矿物质含量(g)
Model 1 [β(95%CI)]Model 2 [β(95%CI)]Model 3 [β(95%CI)]
Q1RefRefRef
Q2-29.25 (-83.01, 24.50)-2.407 (-43.88, 39.07)5.19 (-34.09, 44.44)
Q3-61.65 (-115.43, -7.87 )*-21.16 (-63.16, 20.84)0.11 (-39.76, 39.98)
Q4-80.26 (-134.01, -26.50)**12.56 (-30.31, 55.43)44.93 (4.03, 85.83)*
趋势检验P=0.6P=0.082P=0.001
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饮食中黄酮类化合物摄入量与人体总骨矿物质含量的关联性分析
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马国琛 , 胡一凡 , 字璟 , 李昊奇 , 曾雅贤 , 罗航 , 徐珏 , 熊静远
现代预防医学 | 营养与食品卫生 2024,51(3): 433-438
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现代预防医学 | 营养与食品卫生 2024, 51(3): 433-438
饮食中黄酮类化合物摄入量与人体总骨矿物质含量的关联性分析
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马国琛, 胡一凡, 字璟, 李昊奇, 曾雅贤, 罗航, 徐珏, 熊静远
作者信息
  • 四川大学华西公共卫生学院/华西第四医院，四川 成都 610041

    • 马国琛（1997—），男，硕士在读，研究方向：劳动卫生与环境卫生

通讯作者:

熊静远，E-mail:
Analysis of the relationship between dietary flavonoid intake and total bone mineral content in human body
Guo-chen MA, Yi-fan HU, Jing ZI, Hao-qi LI, Ya-xian ZENG, Hang LUO, Jue XU, Jing-yuan XIONG
Affiliations
  • West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China
出版时间: 2024-02-10 doi: 10.20043/j.cnki.MPM.202309270
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摘要
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目的

探讨饮食中黄酮类化合物的摄入与人体总骨矿物质含量之间的关系。

方法

选择2017—2018年美国国家健康和营养调查（NHANES）中20～59岁成年人作为研究对象，通过构建多变量线性回归模型，对性别、年龄、种族、受教育水平、婚姻状况、经济情况、BMI、饮酒情况、高血压、糖尿病及心血管疾病进行调整，探究饮食中黄酮类化合物摄入量和人体总骨矿物质含量之间的关系。

结果

研究共纳入2 110人，男女比例约为1:1，平均总矿物质含量为2 341.4 g，饮食中总黄酮摄入量的中位数为74.45 mg。在调整了性别、年龄、种族、受教育水平、婚姻状况、经济情况、BMI、饮酒情况、高血压、糖尿病和心血管疾病后的线性回归模型显示全身总骨矿物质含量与饮食中异黄酮摄入量呈正相关（β=0.68, 95%CI: 0.26～1.09），并存在剂量反应关系（Ptrend=0.001），此外，亚组分析结果表明，该正相关关系在男性中更为强烈［男性（β=1.39, 95%CI: 0.67～2.11） vs. 女性（β=0.18, 95%CI: -0.31～0.67）, Pinter=0.038］。

结论

饮食中异黄酮摄入可能会增加人体全身总骨矿物质的含量，但是否具有性别差异仍需进一步探究。

黄酮类化合物  /  异黄酮  /  总骨矿物质含量
Objective

To investigate the relationship between the intake of flavonoids in diet and total bone mineral content in human body.

Methods

Adults aged 20 to 59 years in the National Health and Nutrition Examination Surveys (NHANES) from 2017 to 2018 were selected as research subjects. A multivariate linear regression model was constructed to explore the relationship between dietary flavonoid intake and total bone mineral content adjusting gender, age, race, education level, marital status, economic status, BMI, alcohol consumption, hypertension, diabetes, and cardiovascular disease.

Results

A total of 2 110 participants were included in the study, with the ratio of male to female 1:1. The average total mineral content was 2 341.4 g, and the median intake of total flavonoids in diet was 74.45 mg. After adjusting for sex, age, race, education, marital status, economic status, BMI, alcohol consumption, hypertension, diabetes and cardiovascular disease, the linear regression model showed that the total bone mineral content of the whole body was positively correlated with dietary isoflavone intake (β=0.68, 95%CI:0.26-1.09), and there was a dose-response relationship (Ptrend=0.001). In addition, the results of subgroup analysis showed that the positive correlation was stronger in men (βmale=1.39, 95%CI: 0.67-2.11 vs. βFemale=0.18, 95%CI: -0.31 to 0.67, Pinter=0.038).

Conclusion

the intake of isoflavones in diet may increase the content of total bone minerals in human body, but whether there is a gender difference needs to be further explored.

Flavonoids  /  Isoflavones  /  Total bone mineral content
马国琛, 胡一凡, 字璟, 李昊奇, 曾雅贤, 罗航, 徐珏, 熊静远. 饮食中黄酮类化合物摄入量与人体总骨矿物质含量的关联性分析. 现代预防医学, 2024 , 51 (3) : 433 -438 . DOI: 10.20043/j.cnki.MPM.202309270
Guo-chen MA, Yi-fan HU, Jing ZI, Hao-qi LI, Ya-xian ZENG, Hang LUO, Jue XU, Jing-yuan XIONG. Analysis of the relationship between dietary flavonoid intake and total bone mineral content in human body[J]. Modern Preventive Medicine, 2024 , 51 (3) : 433 -438 . DOI: 10.20043/j.cnki.MPM.202309270
正文
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骨骼是生物体的支架，有维持体形、保护内脏器官、支持体重和运动的作用，骨的组成包含骨基质和骨矿物质两种成分，其中骨矿物质决定了骨的硬度[1]，骨密度降低或骨矿物质含量减少往往伴随着骨折、骨质疏松症等骨骼疾病的发生风险升高[2-3]。据报道，骨代谢紊乱与众多因素有关，如遗传、饮食、生活行为、药物的使用等[4-5]，近年来，骨矿物质含量与饮食之间的关系越来越受到关注[6-8]。
饮食与人体健康的关系已经被广泛研究，大量的证据表明坚持某种膳食模式、摄入某些特定的食物类型或营养素，能够对人体健康产生积极影响，同时还可以促进预防一些非传染性疾病[9]。流行病学研究表明，水果、蔬菜类食物摄入丰富者骨折风险较低且能够减少骨质的吸收[10-11]，这其中的保护作用可能与蔬菜和水果中存在的一些活性分子有关[12]。黄酮类化合物就是其中一种，它是一种天然植物化学物质，具有抗氧化、抗炎、抗癌等众多生物特性[13]，有报道称它们在骨骼健康和预防骨质疏松症上起着关键作用[14]，但目前较少有黄酮类化合物亚类与骨骼健康关系的研究，而这对于总黄酮类化合物摄入以及每种黄酮类化合物亚类与骨骼健康之间关系的阐述十分重要。因此，本横断面研究旨在探讨饮食中总黄酮类化合物摄入以及各黄酮类化合物亚类摄入与骨骼健康之间的关系。
1　对象与方法
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1.1　研究对象
美国国家健康和营养调查项目（NHANES）是一项旨在评估美国成人与儿童健康和营养状况的调查（https://www.cdc.gov/nchs/nhanes/about_nhanes.htm），该调查采用多阶段抽样方式在全国进行抽样，获得的样本具有全国代表性。美国国家卫生统计中心伦理审查委员会对NHANES调查协议进行了审查，所有参与者已签订知情同意书。在本研究中，我们选取了 2017—2018年的调查样本作为研究对象，该两年中共有9 254人参与调查，参与者的基本人口学特征通过问卷调查获得，饮食信息通过问卷和电话随访获得，此外，参与这还被要求进行一系列的体格检查和血液样本采集。我们排除了年龄在20岁以下、未完成两次饮食调查、未进行全身骨矿物质检测的人，最终纳入了2 110人进行饮食中黄酮类化合物摄入量与全身骨矿物质含量关系的研究，研究对象筛选过程见图1。在 2 110人中，有不同程度的人口学变量的缺失，我们使用了多项式回归和logistic回归对这些缺失数据进行了插补，变量的缺失水平见表1。
1.2　黄酮类化合物摄入量的评估
总黄酮及其亚类的相关信息是从美国饮食研究食品和营养数据库（FNDDS, https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/fndds-flavonoid-database/）获得的，该数据库和NHANES数据库相关联，它提供了29种黄酮类化合物，并将这29种黄酮类化合物分成了6个类别，分别是：异黄酮、花青素、黄烷-3-醇、二氢黄酮、黄酮、黄酮醇。相关研究人员通过饮食问卷和电话随访获得的饮食信息计算得到黄酮类化合物的摄入量，我们将两次访谈所计算出的摄入量求取平均值用于估计研究对象饮食中每日黄酮类化合物的摄入[15]。
1.3　全身总骨矿物质含量测定
在NHANES中，使用双能X线吸收法测量了8～59岁人群的骨矿物质的含量，孕妇、过去7 d使用过放射造影剂（钡）以及体重超过204kg（450磅）或身高超过195.6 cm（6英尺5英寸）的调查对象将被排除在外。较低的骨矿物质含量可能表明患有骨骼疾病的风险增加[16]。
1.4　协变量
本研究中协变量包括性别（男、女）、年龄（20～30岁、31～45岁、46～59岁）、种族（墨西哥裔美国人、 其他西班牙裔、非西班牙裔白人、 非西班牙裔黑人、其他）、受教育水平（高中以下、高中、高中以上）、婚姻状况（已婚、未婚、从未结过婚）、经济情况（家庭月贫困水平指数≤1.30、1.31～1.85、>1.85）、BMI（<25 kg/m2、25～30 kg/m2、>30 kg/m2）、饮酒情况（一年中喝酒次数超过12次定义为饮酒）、以及高血压（对“是否曾被医生或其他健康专业人士告知过患有高血压”回答“是”即定义为患有高血压）、糖尿病（对“是否曾被医生或其他健康专业人士告知过患有糖尿病”回答“是”即定义为糖尿病）、心血管疾病（对“是否曾被医生或其他健康专业人士告知过患有哮喘、心力衰竭、冠心病、心绞痛、心脏病和中风”中的任意一种回答“是”即定义为患有心血管疾病）。
1.5　统计分析
分类变量采用频数（百分比）表示，连续型变量采用（均值±标准差）或中位数（四分位数间距）表示。采用单变量和多变量线性回归模型评估总黄酮和6种黄酮亚类摄入量与总骨矿物质含量的关系。黄酮类化合物摄入量采用连续型变量的形式进入模型，若出现统计学意义者进一步将其按四分位数形式进入模型并进行趋势检验。为了调整混杂因素，构建了三个模型，模型1未调整协变量；模型2调整性别、年龄、种族、受教育水平、婚姻状况、经济情况；模型3在模型2的基础上再调整BMI、饮酒情况、高血压、糖尿病及心血管疾病，并采用Spearman秩相关对所有的协变量之间进行了相关性分析。对于经上述分析后具有统计学意义的黄酮类化合物与总骨矿物质含量的关系，进行亚组分析以及年龄分层基础上的性别亚组分析，以探讨各亚组与黄酮类化合物摄入量对总骨矿物质含量的潜在交互作用。所有计算均使用R4.2.0进行，检验水准α=0.05。
2　结果
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2.1　研究对象的一般特征
研究共纳入2 110人，其中男女比例约为1:1，年龄31～59岁、非西班牙裔白人、高中以上受教育水平、已婚、家庭月贫困水平指数大于1.8、BMI大于30 kg/m2、饮酒、未患高血压、糖尿病和心血管疾病的人群占比较多。在 2 110人中，饮食总黄酮类化合物摄入量的中位数为74.453 mg，6种黄酮类化合物亚类中，黄烷-3-醇摄入量的中位数最大，二氢黄酮摄入量中位数最小，2 110人的平均总骨矿物质含量为 2 341.4 g，见表2。此外，各混杂因素之间无强相关性，见图2。
2.2　黄酮类化合物摄入量与总骨矿物质含量的关系
图3表示了总骨矿物质含量与饮食中总黄酮化合物和6种黄酮化合物亚类摄入量之间的关系，在对性别、年龄、种族、受教育水平、婚姻状况、经济情况、BMI、饮酒情况、高血压、糖尿病及心血管疾病等因素进行调整后的线性回归模型中可以看到，总骨矿物质含量与饮食中异黄酮摄入量呈正相关，并具有统计学意义(β=0.677, 0.261～1.094)，而与总黄酮化合物、花青素、黄烷-3-醇、二氢黄酮、黄酮、黄酮醇的摄入量之间的关系无统计学意义，说明饮食中异黄酮的摄入可能会增加全身骨矿物质的含量。此外，将异黄酮摄入量按四分位数分为4个水平后，与最低四分位数摄入量（Q1）相比，全身总骨矿物质含量与饮食中异黄酮摄入量的正相关关系仍存在，且趋势检验具有统计学意义，表明饮食中异黄酮摄入量与总骨矿物质含量可能存在剂量反应关系（β=44.93，4.03～85.83，Ptrend=0.001）。见表3。
2.3　亚组分析
亚组分析后发现异黄酮摄入量对总骨矿物质含量的影响在性别亚组中存在显著的交互作用，异黄酮摄入量与总骨矿物质含量之间的正相关关系在男性参与者中更为强烈［（男性β=1.391,95%CI: 0.669～2.114 ） vs. （女性β=0.183, 95%CI:-0.312～0.668）, Pinter=0.038］，见图4。在进一步进行年龄基础上性别亚组分析后发现，三个年龄组中，均只在男性中观察到异黄酮摄入量与总骨矿物质含量之间存在显著统计学差异的正相关关系，见图5。
3　讨论
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本研究从NHANES数据库纳入了共2 110名研究对象，分析后发现在异黄酮、花青素、黄烷-3-醇、二氢黄酮、黄酮、黄酮醇6种膳食黄酮类化合物中，异黄酮摄入量与人体总骨矿物质含量呈显著的正相关，且这种正相关关系在按不同年龄分层后只在男性人群中出现。
本研究结果与目前的研究有一致之处也有矛盾之处。一致之处在于目前的流行病学研究均提示膳食异黄酮摄入量增加与骨骼健康程度改善有关[17-18]，该现象在动物研究中也有相应体现[19]。矛盾之处在于本研究仅在男性中观察到异黄酮摄入量与人体总骨矿物质含量之间呈正相关关系，而在中国广州进行的一项关于膳食类黄酮化合物摄入和骨密度之间关系的横断面研究[20]中发现，女性中膳食总类黄酮或其亚类的高摄入量与更高的骨密度值均相关，而在男性中未发现该现象，研究者认为出现该现象的可能原因是该调查中的男性样本太小。而在本研究中，我们在男性中观察到了高膳食异黄酮摄入量与较高的骨矿物质含量之间的正相关关系，而在女性中未观察到。我们赞同上述在广州进行的研究中研究者提出的样本量太小引起的性别差异的可能性，同时，我们也推测出现本研究和上述研究出现性别差异相反的现象的原因可能是两项调查纳入的人群并不一样，存在种族差异的可能性。尽管两项研究在男女性别上的结果不同，但异黄酮的摄入增加与骨骼健康状态的改善这一相关性是一致的。
骨骼处于一个不断的塑造和重塑的动态过程中，成骨细胞和破骨细胞的活动维持了骨的正常生理结构和矿物质含量[21]，随着年龄的增长，骨细胞嵌入矿化骨中，向破骨细胞发出信号以吸收骨，造成骨量丢失[22]。最近关于黄酮类化合物对骨的潜在保护作用机制的综述表明，它们可以通过减少破骨细胞分化因子（RANKL）和活化T-细胞核因子（NFATc1）来降低破骨细胞活性，从而抑制骨吸收，减少骨量丢失[21]，异黄酮是黄酮类化合物的一个亚类，本研究中异黄酮摄入量和骨矿物质含量之间的正相关可能与此机制有关。此外，异黄酮是一类天然的植物雌激素，具有拟雌激素效应。有动物实验表明，行卵巢切除术之后的雌性大鼠体内内源性雌激素含量显著降低，骨质流失风险增大，在进行大豆异黄酮喂养12周之后，与假手术组相比，大豆异黄酮喂养组雌性大鼠的胫骨骨矿物质含量显著升高[23]。雌激素在骨代谢中具有抗骨吸收的作用，这种作用被认为是通过骨蛋白介导的[24]，骨蛋白则是防止骨吸收的一种保护因素[22]，因此，我们认为饮食中异黄酮摄入量增加也可能通过此途径增加骨矿物质的含量。
本研究的研究对象从NHANES中获得，该调查的样本是通过复杂的分层多阶段抽样获得，所得样本具有全国代表性；此外，我们对研究对象的社会人口学特征进行了全面的调整，减少了混杂因素的影响；最后，我们还进行了亚组分析，探讨了各亚组与黄酮类化合物摄入量对总骨矿物质含量的潜在交互作用。但本研究仍具有一些局限性。首先，该研究是一个横断面研究，限制了因果关系的推导；其次，研究中黄酮类化合物的摄入量是通过问卷和电话访问形式获得，存在一定的信息偏倚；最后，本研究是基于人群的流行病学研究，饮食中黄酮类化合物摄入和骨矿物质含量之间的机制仍需进一步的研究来解释。因此，接下来需要更多的纵向研究以及更加精确的饮食营养素评估方法来深入研究饮食中黄酮类化合物摄入量与骨骼健康之间的关系。
综上所述，本研究结果为通过饮食来促进骨骼健康这一途径提供了一定的基础，即饮食中更高的异黄酮摄入与全身总矿物质含量增加有关，但这种相关关需要包括更多种族类别和样本量的流行病学研究来进一步探究异黄酮摄入与骨骼健康之间的关系。
基金
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  • 四川省科技厅应用基础项目(2021YJ0156)
文献
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2024年第51卷第3期
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doi: 10.20043/j.cnki.MPM.202309270
  • 接收时间：2023-09-13
  • 首发时间：2026-03-19
  • 出版时间：2024-02-10
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  • 收稿日期：2023-09-13
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四川省科技厅应用基础项目(2021YJ0156)
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    四川大学华西公共卫生学院/华西第四医院，四川 成都 610041

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熊静远，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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