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BMJ:老年人跌倒要命?增加乳制品摄入以提高钙和蛋白质可以显著降低跌倒和骨折风险!

2022-02-28 MedSci原创 MedSci原创

使用乳制品食品来提高钙和蛋白质的摄入量是一种容易实现的干预措施,可以减少老年护理居民通常发生的跌倒和骨折的风险。

长寿增加了人口中老年人的比例。伴随着慢性病发病率的增加,肌肉骨骼质量的下降,身体虚弱和骨质脆弱,都增加了老年人跌倒和骨折的风险。独立性的丧失增加了需要全职机构护理的人数,这是社区中大约30%的髋部骨折的来源。

广泛使用抗骨质疏松疗法不太可能减少骨折负担,因为对80岁以上人群的抗骨折疗效证据不足,不良事件经常发生。钙和蛋白质是强健骨骼的重要来源。为了评估缺乏维生素D但平均每天摄入600mg钙和<1g/kg体重蛋白质/天的住院老年人的抗骨折效果和安全性。来自澳大利亚墨尔本大学奥斯汀健康学院医学系开展了一项研究,结果发表在BMJ杂志上。

这是一项随机对照试验,纳入澳大利亚60家经认证的老年护理机构,主要是居住在户外的居民。参与者为7195名永久居民(4920名(68%)女性;平均年龄86.0(SD 8.2)岁)。干预设施按地点和组织分层,30家设施被随机提供给居民额外的牛奶、酸奶和奶酪,达到1142(353)毫克/天的钙和69(15)克/天的蛋白质(1.1克/公斤体重)的总摄入。30家对照机构维持其常规菜单,居民每天摄入700(247)毫克的钙和58(14)克/天的蛋白质(0.9克/公斤体重)。主要结果措施是评估骨折、跌倒和所有原因死亡发生率的群体差异。

结果对来自27个干预机构和29个对照机构的数据进行了分析。共观察到324例骨折(135例髋部骨折),4302例跌倒,以及1974例死亡。总的来说,干预措施使所有骨折的风险降低了33%(121vs203;HR=0.67,95%CI 0.48-0.93;P=0.02),髋部骨折的风险降低了46%(42vs93;HR=0.54,0.35-0.83;P=0.005),而跌倒的风险降低了11%(1879vs2423;HR=0.89,0.78=0.98;P=0.04)。

在基线和两年研究期间,两组组平均(SD)每天摄入的乳制品份数、能量、钙和蛋白质。

其中,髋部骨折和跌倒的风险降低分别在五个月(P=0.02)和三个月(P=0.004)时达到显著性。死亡率没有变化(900 vs 1074;HR=1.01,0.43-3.08)。

综上,通过使用乳制品食品来提高钙和蛋白质的摄入量是一种容易实现的干预措施,可以减少老年护理居民通常发生的跌倒和骨折的风险。

 

参考文献:

Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ 2021; 375. doi: https://doi.org/10.1136/bmj.n2364

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    2022-03-17 gaoxiaoe
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