Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study

Oxford University Press (OUP) - Tập 15 Số 12 - Trang 2504-2512 - 2000
Marian T. Hannan1, Katherine L. Tucker, Bess Dawson‐Hughes, L. Adrienne Cupples, David T. Felson, Douglas P. Kiel
1Hebrew Rehabilitation Center for Aged, Research and Training Institute and Harvard Medical School Division on Aging, Boston, Massachusetts 02131-1097, USA.

Tóm tắt

Abstract Few studies have evaluated protein intake and bone loss in elders. Excess protein may be associated with negative calcium balance, whereas low protein intake has been associated with fracture. We examined the relation between baseline dietary protein and subsequent 4-year change in bone mineral density (BMD) for 391 women and 224 men from the population-based Framingham Osteoporosis Study. BMD (g/cm2) was assessed in 1988-1989 and in 1992-1993 at the femur, spine, and radius. Usual dietary protein intake was determined using a semiquantitative food frequency questionnaire (FFQ) and expressed as percent of energy from protein intake. BMD loss over 4 years was regressed on percent protein intake, simultaneously adjusting for other baseline factors: age, weight, height, weight change, total energy intake, smoking, alcohol intake, caffeine, physical activity, calcium intake, and, for women, current estrogen use. Effects of animal protein on bone loss also were examined. Mean age at baseline (±SD) of 615 participants was 75 years (±4.4; range, 68-91 years). Mean protein intake was 68 g/day (±24.0; range, 14-175 g/day), and mean percent of energy from protein was 16% (±3.4; range, 7-30%). Proportional protein intakes were similar for men and women. Lower protein intake was significantly related to bone loss at femoral and spine sites (p ≤ 0.04) with effects similar to 10 lb of weight. Persons in the lowest quartile of protein intake showed the greatest bone loss. Similar to the overall protein effect, lower percent animal protein also was significantly related to bone loss at femoral and spine BMD sites (all p < 0.01) but not the radial shaft (p = 0.23). Even after controlling for known confounders including weight loss, women and men with relatively lower protein intake had increased bone loss, suggesting that protein intake is important in maintaining bone or minimizing bone loss in elderly persons. Further, higher intake of animal protein does not appear to affect the skeleton adversely in this elderly population.

Từ khóa


Tài liệu tham khảo

Nevitt, 1994, Epidemiology of osteoporosis, Rheum Dis Clin North Am, 20, 535, 10.1016/S0889-857X(21)00348-3

Melton, 1995, How many women have osteoporosis now?, J Bone Miner Res, 10, 175, 10.1002/jbmr.5650100202

Kanis, 1994, Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report, Osteoporos Int, 4, 368, 10.1007/BF01622200

Heaney, 1993, Nutritional factors in osteoporosis, Annu Rev Nutr, 13, 287, 10.1146/annurev.nu.13.070193.001443

Sherman, 1920, Calcium requirements of maintenance in man, J Biol Chem, 44, 21, 10.1016/S0021-9258(18)86268-8

Pullman, 1954, The influence of dietary protein on specific renal functions in normal man, J Lab Clin Med, 44, 320

Anand, 1974, Effect of protein intake on calcium balance of young men given 500 mg calcium daily, J Nutr, 104, 695, 10.1093/jn/104.6.695

Johnson, 1970, Effect of level of protein intake on urinary and fecal calcium and calcium retention of young adult males, J Nutr, 100, 1425, 10.1093/jn/100.12.1425

Margen, 1974, Studies in calcium metabolism. I. The calciuretic effect of dietary protein, Am J Clin Nutr, 27, 584, 10.1093/ajcn/27.6.584

Walker, 1972, Calcium retention in the adult human male as affected by protein intake, J Nutr, 102, 1297, 10.1093/jn/102.10.1297

Sebastian, 1994, Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate, N Engl J Med, 330, 1776, 10.1056/NEJM199406233302502

Tylavsky, 1988, Dietary factors in bone health of elderly lacto-ovovegetarian and omnivorous women, Am J Clin Nutr, 48, 842, 10.1093/ajcn/48.3.842

Abelow, 1992, Cross-cultural association between dietary animal protein and hip fracture: A hypothesis, Calcif Tissue Int, 50, 14, 10.1007/BF00297291

Hunt, 1989, Bone mineral content in postmenopausal women: Comparison of omnivores and vegetarians, Am J Clin Nutr, 50, 517, 10.1093/ajcn/50.3.517

Patterson, 1992, Protein depletion and metabolic stress in elderly patients who have a fracture of the hip, Am J Bone Joint Surg, 74, 251, 10.2106/00004623-199274020-00011

Bonjour, 1996, Nutritional aspect of hip fractures, Bone, 18, 139S, 10.1016/8756-3282(95)00494-7

Jensen, 1982, Nutrition in orthopaedic surgery, J Bone Joint Surg Am, 64, 1263, 10.2106/00004623-198264090-00001

Bastow, 1983, Undernutrition, hypothermia, and injury in elderly women with fractured femur: An injury response to altered metabolism?, Lancet, 1, 143, 10.1016/S0140-6736(83)92754-X

Dawber, 1951, Epidemiological approaches to heart disease: The Framingham Study, Am J Public Health, 41, 279, 10.2105/AJPH.41.3.279

Dawber, 1980, The Framingham Study, 10.4159/harvard.9780674492097

Shurtleff, 1970

Hannan, 1992, Bone mineral density in elderly men and women: Results from the Framingham Osteoporosis Study, J Bone Miner Res, 7, 547, 10.1002/jbmr.5650070511

Hannan, 2000, Risk factors for longitudinal bone loss in elderly men and women: The Framingham Osteoporosis Study, J Bone Miner Res, 15, 710, 10.1359/jbmr.2000.15.4.710

Kiel, 1995, The effects of analytic software and scan analysis technique on the comparison of dual X-ray absorptiometry with dual photon absorptiometry of the hip in the elderly, J Bone Miner Res, 10, 1130, 10.1002/jbmr.5650100719

Rimm, 1992, Reproducibility and validity of an expanded self-administered semi-quantitative food frequency questionnaire among male health professionals, Am J Epidemiol, 135, 1114, 10.1093/oxfordjournals.aje.a116211

Willett, 1985, Reproducibility and validity of a semiquantitative food frequency questionnaire, Am J Epidemiol, 122, 51, 10.1093/oxfordjournals.aje.a114086

Jacques, 1993, Comparison of micronutrient intake measured by a dietary questionnaire and biochemical indicators of micronutrient status, Am J Clin Nutr, 57, 182, 10.1093/ajcn/57.2.182

Willett, 1990, Nutritional Epidemiology Monographs in Epidemiology & Biostatistics

Kiel, 1990, Caffeine and the risk of hip fracture: The Framingham Study, Am J Epidemiol, 132, 675, 10.1093/oxfordjournals.aje.a115709

Cummings, 1995, Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group, N Engl J Med, 332, 767, 10.1056/NEJM199503233321202

Felson, 1988, Alcohol consumption and hip fractures: The Framingham Study, Am J Epidemiol, 128, 1102, 10.1093/oxfordjournals.aje.a115052

Felson, 1995, Alcohol intake and bone mineral density in elderly men and women. The Framingham Study, Am J Epidemiol, 142, 485, 10.1093/oxfordjournals.aje.a117664

Hannan, 1993, Habitual physical activity is not associated with knee osteoarthritis: The Framingham Study, J Rheumatol, 20, 704

Kannel, 1979, Some health benefits of physical activity. The Framingham Study, Arch Intern Med, 139, 857, 10.1001/archinte.1979.03630450011006

Felson, 1993, The effect of postmenopausal estrogen therapy on bone density in elderly women, N Engl J Med, 329, 1141, 10.1056/NEJM199310143291601

Willett, 1986, Total energy intake: Implications for epidemiologic analyses, Am J Epidemiol, 124, 17, 10.1093/oxfordjournals.aje.a114366

Smit, 1999, Estimates of animal and plant protein intake in U.S. adults: Results from the Third National Health and Nutrition Examination Survey, 1988-1991, J Am Diet Assoc, 99, 813, 10.1016/S0002-8223(99)00193-5

McDowell, 1994, Advance data from Vital and Health Statistics 255

Linkswiler, 1981, Protein-induced hypercalciuria, Fed Proc, 40, 2429

Lutz, 1981, Calcium metabolism in postmenopausal and osteoporotic women consuming two levels of dietary protein, Am J Clin Nutr, 34, 2178, 10.1093/ajcn/34.10.2178

Angus, 1988, Dietary intake and bone mineral density, Bone Miner, 4, 265

Parfitt, 1983, Dietary risk factors for age-related bone loss and fractures, Lancet, 2, 1181, 10.1016/S0140-6736(83)91226-6

Allen, 1979, Protein-induced hypercalciuria: A longer term study, Am J Clin Nutr, 32, 741, 10.1093/ajcn/32.4.741

Massey, 1993, Dietary factors influencing calcium and bone metabolism: Introduction, J Nutr, 123, 1609, 10.1093/jn/123.9.1609

Sowers, 1985, Correlates of mid-radius bone density among postmenopausal women: A community study, Am J Clin Nutr, 41, 1045, 10.1093/ajcn/41.5.1045

Freudenheim, 1986, Relationships between usual nutrient intake and bone-mineral content of women 35-65 years of age: Longitudinal and cross-sectional analysis, Am J Clin Nutr, 44, 863, 10.1093/ajcn/44.6.863

Munger Cerhan, 1999, Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women, Am J Clin Nutr, 69, 147, 10.1093/ajcn/69.1.147

Hirota, 1992, Effect of diet and lifestyle on bone mass in Asian young women, Am J Clin Nutr, 55, 1168, 10.1093/ajcn/55.6.1168

Geinoz, 1993, Relationship between bone mineral density and dietary intakes in the elderly, Osteoporos Int, 3, 242, 10.1007/BF01623827

Delmi, 1990, Dietary supplementation in elderly patients with fractured neck of the femur, Lancet, 335, 1013, 10.1016/0140-6736(90)91073-J

Tkatch, 1992, Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur, J Am Coll Nutr, 11, 519, 10.1080/07315724.1992.10718256

Kerstetter, 1997, Increased circulating concentrations of parathyroid hormone in healthy, young women consuming a protein-restricted diet, Am J Clin Nutr, 66, 1188, 10.1093/ajcn/66.5.1188

Kerstetter, 1998, Dietary protein affects intestinal calcium absorption, Am J Clin Nutr, 68, 859, 10.1093/ajcn/68.4.859

Schurch, 1998, Protein supplements increase serum insulin-like growth factor I levels and attenuate proximal femur bone loss in patients with recent hip fracture, Ann Intern Med, 128, 801, 10.7326/0003-4819-128-10-199805150-00002

Orwoll, 1987, Serum protein concentrations and bone mineral content in aging normal men, Am J Clin Nutr, 46, 614, 10.1093/ajcn/46.4.614

Chu, 1975, Studies in calcium metabolism. II. Effects of low calcium and variable protein intake on human calcium metabolism, Am J Clin Nutr, 28, 1028, 10.1093/ajcn/28.9.1028

Campbell, 1994, Increased protein requirements in elderly people: New data and retrospective reassessments, Am J Clin Nutr, 60, 501, 10.1093/ajcn/60.4.501

Gersovitz, 1982, Human protein requirements: Assessment of the adequacy of the current recommended dietary allowance for dietary protein in elderly men and women, Am J Clin Nutr, 35, 6, 10.1093/ajcn/35.1.6

Hartz, 1992, Nutrition in the elderly: The Boston nutritional status survey

Thông tin
Thông tin xuất bản

Oxford University Press (OUP)

Tập 15 Số 12

2504-2512

Thông tin tác giả