Pre ve Postmenopozal Kadınlarda Besin Tüketim Durumu FRAX® Kırık Riski ile İlişkili midir?

Amaç: Bu çalışmada premenopozal ve postmenopozal kadınlarda FRAX değerlendirme aracı ile hesaplanan 10 yıllık kırık riski ile besin tüketim durumu arasındaki ilişki incelenmiştir. Bireyler ve Yöntem: Çalışma 40-60 yaş arası premenopoz döneminde olan veya doktor tarafından menopoza girdiği saptanmış 300 kadın ile yürütülmüştür. Bireylere demografik ve genel özellikler ve Kırık Risk Değerlendirme Aracı (Fracture Risk Assessment Tool-FRAX) ölçeklerini içeren bir anket formu ve günlük kalsiyum alımının belirlenmesine yönelik olarak besin tüketim sıklığı anketi uygulanmıştır. Ayrıca bireylerin besin tüketimleri 24 saatlik hatırlatma yöntemi ile alınmıştır. Enerji ve besin ögeleri Beslenme Bilgi Sistemi (BeBis) ile hesaplanmıştır. Verilerin değerlendirilmesinde SPSS 11.5 istatistik programı kullanılmıştır. Bulgular: Majör osteoporotik kırık riski ve kalça kırığı riski açısından pre ve postmenopozal kadınlar arasındaki fark anlamlı bulunmuştur (p=0.011, p=0.032). Pre ve post menopoz kadınların besin tüketim sıklığı ile belirlenen kalsiyum alımı değerlendirildiğinde düzenli fiziksel aktivite yapan bireylerin günlük kalsiyum alımlarının yapmayan bireylerden daha yüksek olduğu belirlenmiştir (p=0.001). Bunun yanında pre ve postmenopozal kadınların enerji ve besin ögeleri (karbonhidrat, protein, posa, kalsiyum, K vitamini, C vitamini, magnezyum, fosfor, sodyum, potasyum) ile PRAL (potential renal acid load) değeri için gruplar arasında istatistiksel olarak anlamlı fark bulunmamıştır (sırasıyla p=0.565, p=0.393, p=0.595, p=0.664, p=0,301, p=0.728, p=0.348, p=0.520, p=0.795, p=0.865, p=0.319, p=0.974). Majör osteoporotik kırık riski ile BKI (r=-0.276, p=0.005), enerji (r=-0.186, p=0.050) arasında negatif yönlü zayıf ilişki olduğu belirlenmiştir ve E vitamini alımı (r=-0.292, p=0,003) ile süt (r=-0.200, p=0.046) ve ayran tüketimi (r=-0.197, p=0.049) arasında negatif yönlü zayıf ilişki olduğu belirlenmiştir. Kalça kırığı riski ile yaş (r=0.195, p=0.050) arasında pozitif yönlü zayıf, BKI (r=-0.307, p=0.002), E vitamini (r=-0.252, p=0.012) ve süt tüketimi (r=-0.201, p=0.045) arasında negatif yönlü zayıf ilişki bulunmuştur. Sonuç: Kemik sağlığının korunmasında düzenli fiziksel aktivite ve beslenme alışkanlıkları önemli rol oynamaktadır ve kemik mineral yoğunluğuna etki eden besin ögelerinin diyetle yeterli ve dengeli alımı desteklenmelidir

Is the Food Consumption Status of Premenopausal and Postmenopausal Women Associated with FRAX® Fracture Risk?

Aim: In this study the relationship between dietary habits and risk of fracture during 10-years in premenopausal and postmenopausal women was examined by using FRAX (Fracture Risk Assessment Tool). Subjects and Methods: This study was carried out with 300 women between 40 and 60 years of age, in premenopausal period or in menopausal period diagnosed by a medical doctor. A survey about demographic and general features and Fracture Risk Assessment Tool-FRAX® scales and another survey about food consumption frequency to determine daily calcium intake was applied to individuals. Also food consumption of individuals were taken by 24 hour recall method. Energy and food items were calculated by Nutrition Information System (BeBis). SPSS 15 statistics program was used to evaluate data. Results: Difference of major osteoporotic fracture risk and hip fracture risk were statistically significant between pre and postmenopausal women (p=0.011, p=0.032). Difference of dietary calcium intake estimated with food frequency questionnaire between pre and postmenopausal women was not statistically significant (p>0.05). On the other hand higher calcium intake was determined in physically active individuals (p=0.001). And also there was no significant difference between energy intake some nutrients (carbohydrate, protein, fiber, calcium, vitamin K, vitamin C, magnesium, phosphorous, sodium, potassium) and dietary PRAL (potential renal acid load) between pre and postmenopausal women (p=0.565, p=0.393, p=0.595, p=0.664, p=0,301, p=0,728, p=0,348, p=0.520, p=0.795, p=0.865, p=0.319, p=0.974, respectively). There was a negative weak correlation between major osteoporotic fracture risk and BMI (r=-0.276, p=0.005), energy (r=-0.186, p=0.054) and vitamin E (r=-0.292, p=0.003) intake, milk (r=-0.200, p=0.046) and ayran (r=-0.197, p=0.049) consumption. There was a positive low correlation between hip fracture and age (r=0.195, p=0.052); and there was a negative correlation between BMI (r=-0.307, p=0:002) and intake of vitamin E (r=-0.252, p=0.012) and milk consumption (r=-0.201, p=0.045) with hip fracture risk. Conclusion: As a conclusion, physical activity and healthy eating habits play an important role in protection of bone health accordingly adequate dietary intake which impacts bone mineral density and regular physical activity should be supported

Kaynakça

1. Görgel E, Çakıroğlu P. Menopoz döneminde kadın. Ankara: Ankara Üniversitesi Yayınevi, 2007;1-15.

2. Gallager JC. Effect of early menopause on bone mineral density and fractures. Menopause 2007;14(3):567-571.

3. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17(1):25-54.

4. Aydil S. Osteoporozda egzersiz programının solunum fonksiyonlarına ve yaşam kalitesine etkisi. T.C. Sağlık Bakanlığı İstanbul 70.yıl Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi 2. Klinik Uzmanlık Tezi, İstanbul, 2005;1-109.

5. Cosman F, Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 2014;25:2359- 2381.

6. Özcan H, Oskay Ü. Menopoz döneminde semptom yönetiminde kanıta dayalı uygulamalar. Göztepe Tıp Dergisi 2013;28(4):157-163.

7. Kim JW, Koh J, Park JH, Chang JS. Validation of Frax without BMD: An age-related analysis of the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-1, 2010). Bone 2015;75:27–31.

8. Kanis JA, Oden A, Johansson H, McCloskey EV. Fracture Risk Assessment: The development and application of Frax. Osteoporos Int 2013;68:1611-1637.

9. International Osteoporosis Foundation. Official Positions on Frax 2010;1-12.

10. Tuzun S, Eskiyurt N, Akirmak U, Saridoga M, Johansson H, McCloskey E, et al. The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study. Arch Osteoporos 2012;7:229–235.

11. FRAX 2011 (Turkey). Avaliable at: https://www.shef. ac.uk/FRAX/tool.aspx?country=6 Accessed October 17,2017.

12. FRAX 2011. Avaliable at: https://www.shef.ac.uk/ FRAX/ Accessed November 19,2016.

13. IOF, 2015. Available at: https://www.iofbonehealth.org/ calcium-calculator Accessed April 26, 2016.

14. Karaçil MŞ. Okul çağı çocuklarda alkali diyet ve beslenme alışkanlıklarının, ağız sağlığı ile ilişkisinin değerlendirilmesi. Beslenme ve Diyet Dergisi 2016;2:97-105.

15. WHO. Avaliable at: http://apps.who.int/bmi/index. jsp?introPage=intro_3.html Accessed April 27, 2016.

16. Cohen J. Statistical power analysis for the behavioral sciences. Curr Dir Psychol Sci 1988;1(3):98-101.

17. Francucci CM, Romagnia P, Camilletti A, Fiscaletti P, Amoroso L, Cenci G, et al. Effect of natural early menopause on bone mineral density. Maturitas 2008;59:323–328.

18. National Clinical Guideline Centre. Osteoporosis: assessing the risk of fragility fracture. Clinical guideline. 2012; 1-97.

19. Alderson TL. Osteoporosis in postmenopausal women. American Osteopathic Association, Woman and wellness, 2009; 11-13.

20. Fawzy T, Muttappallymyalil J, Sreedharan J, Ahmed A, Alshamsi SOS, Bin Bader Al, et al. Association between body mass index and bone mineral density in patients referred for dual-energy X-ray absorptiometry scan in Ajman J Osteoporosis 2011:1-4.

21. Sodi R, Hazell MJ, Durham BH, Rees C, Ranganath LR, Fraser WD. The circulating concentration and ratio of total and high molecular weight adiponectin in postmenopausal women with and without osteoporosis and its association with body mass index and biochemical markers of bone metabolism. Clin Biochem 2009; 42(6):1375–1380.

22. Langsetmo L, Hitchcock CL, Kingwell EJ, Davison KS, Berger C, Forsmo S, et al. Physical activity, body mass index and bone mineral density ssociations in a prospective population-based cohort of women and men: The Canadian Multicentre Osteoporosis Study. Bone 2012;50:401–408.

23. Greendale GA, Lee NP, Arriola ER. The menopause. The Lancet 1999;353(2):1-10.

24. Iqbal SI, Morch LS, Rosenzweig M, Dela F. The outcome of bone mineral density measurements on patients referred from general practice. J Clin Densitom 2005;8(2):178–182.

25. Xu J, Lombardi G, Jiao W, Banfi G. Effects of exercise on bone status in female subjects, from young girls to postmenopausal women: an overview of systematic reviews and meta-analyses. Sports Med 2016;1-18.

26. McAndrew LM, Napolitano MA, Albrecht A, Farrell N, Marcus BH, Whiteley JA. When, why and for whom there is a relationship between physical activity and menopause symptoms. Maturitas 2009;64:119–125.

27. Mansikkamäki K, Raitanen J, Malila N, Sarkeala T, Männistö S, Fredman J, et al. Physical activity and menopause-related quality of life –A population-based cross-sectional study. Maturitas 2015;80:69–74.

28. Grindler NM, Santoro NF. Menopause and exercise. Menopause 2015;22(12):1-8.

29. Arazi H, Eghbali E, Saeedi T, Moghadam R. The relationship of physical activity and anthropometric and physiological characteristics to bone mineral density in postmenopausal women. J Clin Densitom 2016;19(3):382-388.

30. Motorwala ZS, Kolke S, Panchal PY, Bedekar NS, Sancheti PK, Shyam A. Effects of Yogasanas on osteoporosis in postmenopausal women. Int J Yoga 2016;9(1):44–48.

31. Stojanovska L, Apostolopoulos V, Polman R, Borkoles E. To exercise, or, not to exercise, during menopause and beyond. Maturitas 2014;77:318–323.

32. Schaafsma A, Vries PJF, Saris WHM. Delay of natural bone loss by higher intakes of specific minerals and vitamins. Crit Rev in Food Sci and Nutr 2010;41(3):225– 249.

33. United States Department of Agriculture. Dietary Reference Intakes: Elements; 2011.

34. Chen L, Omaswa F, Mogedal S, Nordstrom A, Wibulpolprasert S, Horton S. Calcium and vitamin D for osteoporotic fracture risk. Osteoporosis Int 2007;370:632-633.

35. Advani S, Wimalawansa SJ. Bone and nutrition: common sense supplementations for osteoporosis. Cur Women’s Health Rep 2003;3(3):187-192.

36. Michaelsson K, Melhus H, Bellocco R, Wolk A. Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Bone 2003;32:694–703.

37. Ahmadieh H, Arabi A. Vitamins and bone health: beyond calcium and vitamin D. Nutr Rev 2011;69(10): 584–598.

38. Yazdanpanah N, Zillikens MC, Rivadeneira F, Jong R, Lindemans J, Uitterlinden AG, et al. Effect of dietary B vitamins on BMD and risk of fracture in elderly men and women: The Rotterdam Study. Bone 2007;41:987– 994.

39. Dennehy C, Tsourounis C. A review of select vitamins and minerals used by postmenopausal women. Maturitas 2010;66:370–380.

40. Farsinejad-Marj M, Saneei P, Esmaillzadeh A. Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and metaanalysis. Osteoporos Int 2016;27:1389–1399.

41. T.C. Sağlık Bakanlığı. Türkiye Beslenme Rehberi (TÜBER), Ankara, 2015;178-186.

42. Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP. Effect of dietary protein on bone loss in elderly men and women: The Framingham Osteoporosis Study. J Bone Metab 2000;15(12):2504- 2511.

43. U.S. Department of Agriculture. Dietary Guidelines for Americans 2010;1-112.

44. Burckhardt P. The role of low acid load in vegetarian diet on bone health: a narrative review. Swiss Med Wkly 2016;146:14277.

45. Mendoza N, Presa J, Martínez-Amat A, Hita F. The importance of diet in osteoporosis. J Epidemiol Public Health 2013;3(5):79-84.

46. Jia T, Byberg L, Lindholm B, Larsson TE, Lind L, Michaëlsson K, et al. Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women. Osteoporos Int 2015;26:563–570.

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