膝骨关节炎患者膳食模式与骨质疏松症的相关性研究 [中文引用][英文引用]

目的  探索膝骨关节炎患者膳食模式与骨密度（bone mineral density，BMD）及骨质疏松症（osteoporosis，OP）之间的相关性，筛查出能降低 OP 风险的膳食模式，为预防 OP 提供参考。方法  调取珠江骨关节炎队列数据库（Pearl Riverosteoarthritis cohort，PROC）2020 年 4 月— 2024 年 4 月中 600 例膝骨关节炎患者的一般资料、膳食频率问卷及 BMD 数据，使用因子分析法识别膳食模式，将膳食模式因子得分作为连续变量或分类变量（根据四分位数进行分组），使用多重线性回归分析膳食模式因子得分与 BMD 之间的关系，并使用二分类 Logistic 回归分析膳食模式因子得分与 OP 之间的关系。结果  本研究膝骨关节炎患者合并 OP 的患病率为 19.8%。因子分析共提取出水产坚果、畜禽肉类、杂粮水果、面食蛋类、鱼奶蔬菜、豆类水果、大米面粉、豆浆奶类 8 种膳食模式。调整混杂因素后发现，杂粮水果模式与左股骨颈 BMD 及腰椎 BMD 呈正相关（均 P<0.01），鱼奶蔬菜模式与腰椎 BMD 呈正相关（P<0.01）。将 8 种膳食模式因子得分分别按照四分位数离散化后，豆类水果模式得分 Q3组对比 Q1 组，OP 的风险降低 68.2%（P<0.05）。结论  豆类水果模式与膝骨关节炎患者 OP 的风险降低有关，杂粮水果及鱼奶蔬菜模式与较高的 BMD 有关，对 OP 的预防有潜在益处。为了骨骼健康，建议患者坚持营养均衡、健康的膳食模式，包括豆类、水果、蔬菜、杂粮、鱼、坚果、乳制品等。

Objective To explore the associations of dietary patterns with bone mineral density（BMD）and osteoporosis（OP） in patients with knee osteoarthritis（KOA）in south China，identify the dietary patterns that could reduce the risk of OP，and provide a reference for prevention of OP. Methods Data from 600 KOA patients who were enrolled in the Pearl River Osteoarthritis Cohort （PROC）between April 2020 and April 2024 were extracted，including general characteristics，dietary questionnaire and BMD test. Factor analysis was employed to identify dietary patterns. Scores of dietary pattern were treated as continuous or categorical variables（quartilebased groups）. Multivariable linear regression was used to assess associations between scores of dietary pattern and BMD，while the relationships with OP were analysed by binary logistic regression. Results The prevalence of OP in KOA patients was 19.8%. Factor analysis extracted eight dietary patterns：seafood-nuts，livestock-poultry meats，coarse grains-fruits，wheat-eggs，fish-dairy-vegetables， legumes-fruits，rice-wheat flour，and soy-dairy. After adjusting for confounders，it was found that the pattern of coarse grains-fruits was positively correlated with the BMD of left femoral neck and lumbar spine（P<0.01）and the fish-dairy-vegetables pattern was positively correlated with the BMD of lumbar spine（P<0.01）. When pattern scores were discretized into quartiles，the legumes-fruits pattern（Q3 vs. Q1）was found in association with a 68.2% reduction in the risk of OP（P<0.05）. Conclusion This study has identified that the pattern of legumes-fruits may lower a risk of OP，while the patterns of coarse grains-fruits and fish-dairy-vegetables correlate with higher BMD. The diet patterns are potentially beneficial to prevention of OP. For bone health，a balanced diet rich in legumes，fruits，vegetables， coarse grains，fish，nuts and dairy is recommended.