| 摘要: | 背景：台灣最近的研究調查顯示中老年人髖部骨折病例的總數持續增加，從1996年的12,479例逐年攀升至2010年的19,841例。而身體活動和地中海飲食可能有利於骨骼健康。針對地中海飲食於骨骼健康的具體效果的研究鮮少，目前也尚無研究探討合併地中海飲食和身體活動對骨骼健康的影響。本研究旨在調查合併地中海飲食和身體活動對骨骼健康的影響。
材料與方法：本研究利用2013年1月1日至2016年12月31日間的「台灣國民營養健康調查」(NAHSIT)數據進行橫斷面研究。參與者包括具有戶籍的台灣公民，不包括居住在軍事單位、醫療機構、學校、職業訓練中心、宿舍、監獄或居住在國外的人。總共有1618名19至64歲的參與者被納入分析。本研究的自變量為地中海飲食分數和身體活動程度，控制變量包括年齡、性別、教育水平、身體質量指數（Body Mass Index,以下簡稱BMI）、個人每月收入、血鈣、25-羥基維生素D (25?hydroxyvitamin D，以下簡稱25(OH)D）、吸菸與飲酒習慣。依變量是股骨頸骨密度（g/cm?）和骨質T-score分數，原本皆為連續變項，將股骨頸骨質T評分>-1定義為骨質正常，?-1定義為骨質不足。根據身體活動的代謝當量(metabolic equivalents ,以下簡稱MET）? 600當量的個體被分類為中高度身體活動程度。地中海飲食分數得分5分(含)以上者被歸類為高地中海飲食組。基於這些標準，參與者被分為四組：低地中海飲食分數和低身體活動、低地中海飲食分數和中高身體活動、高地中海飲食分數和低身體活動、高地中海飲食分數和中高身體活動。使用羅吉斯迴歸和線性迴歸模型進行數據分析，並利用結構方程模型（SEM）探討變項間的關係。
結果：研究共1618名參與者被納入，其中493人有骨質不足，1125人骨質正常。主要分為四組：低地中海飲食分數和低身體活動（26.76%）、低地中海飲食分數和中高身體活動（38.75%）、高地中海飲食分數和低身體活動（10.07%）、高地中海飲食分數和中高身體活動（24.41%）。在控制干擾後，高地中海飲食分數和中高身體活動組相比於低地中海飲食和低身體活動組對於骨質健康顯示出顯著的保護作用，降低了骨質不足的風險（OR=0.476; CI: 0.341-0.666; p<.0001）。在線性迴歸分析，亦顯示骨質顯著增加（β = 0.039, p<.0001）。在分群分析中，仍獲得一致性結果。結構方程模型的結果顯示，身體活動和地中海飲食對骨密度有直接正向影響(直接效果分別為0.0525及0.0463)，模型與觀察數據匹配良好（卡方57.78, 自由度=11 (p<0.0001), CFI: 0.97, 調整後CFI: 0.99, SRMR: 0.03）。
結論：這是台灣首次探討合併地中海飲食和身體活動對骨骼健康的影響。遵循地中海飲食原則並進行中高強度身體活動有助於預防骨質不足，顯示出生活型態在維持骨骼健康中的重要性。這種影響在不同年齡組、性別組或BMI組均見效。結構方程模型分析顯示，地中海飲食和身體活動水平對骨密度有直接的正面影響，為相關預防策略提供了實證支持。此外，這項在台灣進行的研究確認了地中海飲食在非地中海地區的適應性和益處，對預防骨質疏鬆症具有重要意義。
Background: Physical activity and the Mediterranean diet may be beneficial for bone health, although there is limited information on the effectiveness of the Mediterranean diet specifically for bone health. There is no research on whether the effects of adherence to Mediterranean nutritional principles combined with moderate to high physical activity levels on bone health. Our research objective was to investigate the impacts of adherence to Mediterranean dietary principles and moderate to high levels of physical activity on bone health.
Materials and Methods: A cross-sectional study used data from the Nutrition and Health Survey in Taiwan (NAHSIT) from January 1, 2013, to December 31, 2016. Participants included Taiwanese citizens with household registration, exclusions for those residing in military units, medical institutions, schools, vocational training centers, dormitories, prisons, and those living abroad. A total of 1618 participants aged 19 to 64 were included for analysis. The independent variables for this study were Mediterranean diet score (MD) and physical activity level (PA). Control variables included age, gender, education level, body mass index(BMI), personal monthly income, blood calcium levels (25?hydroxyvitamin D,25(OH)D), smoking, and drinking. The dependent variables were femoral neck bone density (g/cm?) and the bone quality T-score, with a femoral neck bone quality T-score > -1 defined as usual bone quality and ? -1 as osteopenia. Individuals with metabolic equivalents(MET) ? 600 were classified into the moderate to high physical activity group based on physical activity. Individuals scoring five or above are categorized into the high Mediterranean diet group for the Mediterranean diet score. Four groups are formed based on these criteria: low MD+low PA, low MD+moderate to high PA, moderate to high MD+low PA, and high MD+ moderate to high PA. Logistic and linear regression models were used to analyze data, and structural equation models (SEM) were used to see the relationship between variables.
Results: A total of 1618 participants were included, with 493 individuals having osteopenia and 1125 individuals having average bone density. They were primarily categorized into four groups: low Mediterranean diet score and low physical
activity (26.76%), low Mediterranean diet score and moderate-to-high physical activity (38.75%), high Mediterranean diet score and low physical activity (10.07%), and high Mediterranean diet score and moderate-to-high physical activity (24.41%). After adjusting for confounders, the high Mediterranean diet score and moderate to high physical activity group showed a significant protective effect against osteopenia compared to the low Mediterranean diet and low physical activity group (OR=0.476; CI: 0.341-0.666; p<.0001). There is a significant increase in linear regression (β = 0.039, p<.0001). Both physical activity and Mediterranean diet were found to have a direct impact on bone density. The final SEM diagram is shown in the figures. The model showed an excellent fit [Chi-square 57.78, degrees of freedom = 11 (p<0.0001), CFI: 0.97, adjusted CFI: 0.99, SRMR: 0.03], indicating a significant match between the model and the observed data.
Conclusion: This is the first study to discuss the effects of adherence to Mediterranean dietary principles combined with moderate to high levels of physical activity on bone health. Adherence to Mediterranean dietary principles combined with moderate to high levels of physical activity may protect against osteopenia, indicating the importance of lifestyle factors in maintaining bone health. This effect can be seen regardless of different age groups, gender groups, or BMI groups. Structural equation Model analysis shows that the Mediterranean diet and physical activity levels directly impact bone density, providing empirical support for related prevention strategies. Additionally, this research conducted in Taiwan has confirmed the adaptability and benefits of the Mediterranean diet in non-Mediterranean regions, which is significant for preventing osteoporosis. |
