BMJ：钙和蛋白质的膳食来源对护理院老年人髋部骨折和跌倒的影响：整群随机对照试验

分享智慧

共同成长

Abstract

Abstract

Objective To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day.

Design Two year cluster randomised controlled trial.

Setting 60 accredited residential aged care facilities in Australia housing predominantly ambulant residents.

Participants 7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years).

Intervention Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight).

Main outcome measures Group differences in incidence of fractures, falls, and all cause mortality.

Results Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08).

Conclusions Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents.

Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000228785.

摘要翻译（仅供参考）

目的 

评估营养干预在机构化老年人中的抗骨折疗效和安全性，这些老年人维生素 D 充足，但平均钙摄入量为 600 毫克/天，蛋白质<1 克/千克体重/天。

设计 两年整群随机对照试验。在澳大利亚设立 60 个经认可的住宅老年护理机构，主要容纳流动居民。

参与者  

7195 名永久居民（4920 (68%) 名女性；平均年龄 86.0 (SD 8.2) 岁）。干预设施按位置和组织进行分层，其中 30 个设施随机为居民提供额外的牛奶、酸奶和奶酪，这些牛奶、酸奶和奶酪含有 562 (166) 毫克/天的钙和 12 (6) 克/天的蛋白质，总摄入量为 1142 ( 353) 毫克钙/天和 69 (15) 克/天蛋白质（1.1 克/公斤体重）。30 个控制设施保持他们通常的菜单，居民消耗 700 (247) 毫克/天的钙和 58 (14) 克/天的蛋白质（0.9 克/公斤体重）。主要结局指标 骨折、跌倒和全因死亡率的组别差异。

结果 

分析了来自 27 个干预设施和 29 个控制设施的数据。共观察到 324 次骨折（135 次髋部骨折）、4302 次跌倒和 1974 人死亡。干预与所有骨折风险降低 33% 相关（121 对 203；风险比 0.67，95% 置信区间 0.48 至 0.93；P=0.02），髋部骨折风险降低 46%（42 对 93；0.54，0.35 至 0.83） ；P=0.005），跌倒为 11%（1879 对 2423；0.89、0.78 至 0.98；P=0.04）。髋部骨折和跌倒的风险分别在五个月 (P=0.02) 和三个月 (P=0.004) 时显着降低。死亡率没有变化（900 对 1074；风险比为 1.01、0.43 至 3.08）。

结论 

通过使用乳制品来提高钙和蛋白质的摄入量是一种容易获得的干预措施，可降低老年护理居民中常见的跌倒和骨折风险。

Full Text

原文链接：

https://www.bmj.com/content/375/bmj.n2364

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