1991—2015年我国九省(自治区)老年人膳食微量营养素摄入的变化趋势
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摘要
[背景]人口老龄化所带来的健康问题是社会普遍关注的。平衡膳食及合理营养是预防老年慢性病,提高老年生活质量的重要途径,其中微量营养素的摄入与老年人的健康息息相关。[目的]分析我国九省(自治区)60岁及以上老年人微量营养素摄入的长期变化趋势,为老年人膳食提供建议和慢性病的预防及政策制定提供科学依据。[方法]研究利用"中国健康与营养调查"1991—2015年间的九轮膳食随访数据。该调查采用多阶段分层整群随机抽样,以城市居委会、县城居委会、村和郊区村作为基本调查点,每个调查点随机抽取20户,户内所有家庭成员均作为调查对象。采用连续"3天24小时膳食回顾法"和家庭称重记账法(食用油和调味品)收集膳食资料,借助食物成分表将食物消费量转换成能量及微量营养素摄入量。本研究选择调查中九省(自治区)60岁及以上老年人作为研究对象,删除人口学信息缺失和膳食数据缺失及能量摄入异常的观测对象,共选取19 116个观测对象进行研究。[结果] 2015年我国九省(自治区)老年人视黄醇和硫胺素、核黄素、维生素C、维生素E的年龄标化后平均摄入水平分别为637.65μg/d(以视黄醇活性当量计)和0.78、0.70、74.53、29.08 mg/d。1991—2015年,硫胺素摄入量呈现下降趋势,但幅度不大。高收入水平老年人核黄素及维生素C (均P <0.001)的摄入量较高。维生素E的摄入量自1997年起有所提升,但在2015年又恢复到2006年的水平。2015年钙、磷、钠、钾的平均摄入水平分别为339.06、832.29、4 741.00、1 423.45 mg/d。高收入人群的铁、锌、铜、硒摄入量高于低、中收入人群(均P <0.001);城市人群的硒摄入量高于农村(P <0.001);1991—2015年,钠、磷、镁、锰、锌、铜的摄入量呈下降趋势。视黄醇、硫胺素、核黄素、维生素C及钙摄入量小于平均需要量的老年人比例为59.04%～98.21%,视黄醇、硫胺素、维生素C摄入不足的人口比例呈增长趋势,钙摄入不足人口比例最低也有94.61%。[结论]我国九省(自治区)老年人水溶性维生素和钙质的缺乏较为严重,可能是由于蔬果类和奶及奶制品摄入不足造成。建议老年人食物应多样,多吃奶制品、水产品以及豆制品这类富含钙的食物,视个人情况也可食用营养补充剂弥补微量营养素的摄入不足。
[Background] The health problems of an aging population have raised social concerns. A balanced diet and reasonable nutrient intakes are critical to the improvement of senior lives, especially micronutrient intakes.[Objective] This study aims to analyze the secular trends of micronutrient intakes of the residents aged 60 years and older in nine provinces(autonomous regions) of China, and provide scientific data for dietary recommendations and formulation of policies to prevent chronic diseases for the elderly.[Methods] The longitudinal data of nine follow-up visits of China Health and Nutrition Surveys from 1991 to 2015 were used. By multi-stage stratified cluster random sampling method, urban communities, county towns, suburban villages, and rural villages were primary sampling units; in each unit, 20 households were randomly selected and all household members were interviewed. Dietary intakes were collected by 3-day 24-hour dietary recall, and edible oil and condiment intakes were collected by weighing method. Food consumption was converted into energy and various micronutrient intakes by an established food composition table. In this study, the participants aged 60 years or above in nine provinces(autonomous regions) were selected as the study subjects. After excluding those with missing demographic and dietary data or with abnormal energy intakes, a total of 19 116 subjects were included in the study.[Results] In 2015, the average age-standardized intakes of retinol, thiamine, riboflavin, vitamin C, and vitamin E were 637.65 μg/d(in retinol activity equivalent) and 0.78, 0.70, 74.53, and 29.08 mg/d, respectively. Thiamine intake decreased slightly from 1991 to 2015. The intakes of riboflavin and vitamin C(Ps < 0.001) were higher in the high-income elderly. Vitamin E intake increased since 1997, but recovered to 2006 level in 2015. The intakes of calcium, phosphorus, sodium, and potassium in 2015 were 339.06, 832.29, 4 741.00, and 1 423.45 mg/d, respectively. The intakes of iron, zinc, copper, and selenium(Ps < 0.001) in the high-income group were higher than those in the low-and middle-income groups, and the intake of selenium in urban areas was higher than that in rural areas(Ps < 0.001); the intakes of phosphorus, magnesium, zinc, and copper decreased over the years. The proportions of the elderly whose intakes of retinol, thiamine, riboflavin, vitamin C, and calcium were less than the corresponding estimated average requirements ranged from 59.04% to 98.21% of total subjects. The participants with insufficient intakes of retinol, thiamine, and vitamin C were on the rise, and those with insufficient calcium intake accounted for at least 94.61% of total subjects.[Conclusion] The elderly in nine provinces(autonomous regions) of China are deficient in water-soluble vitamins and calcium, which may be caused by insufficient intakes of vegetables and milk and dairy products. Suggestions for the elderly include: diverse foods, foods rich in calcium such as dairy products, aquatic products, and soy products, and micronutrient supplements as appropriate.
[Background] The health problems of an aging population have raised social concerns. A balanced diet and reasonable nutrient intakes are critical to the improvement of senior lives, especially micronutrient intakes.[Objective] This study aims to analyze the secular trends of micronutrient intakes of the residents aged 60 years and older in nine provinces(autonomous regions) of China, and provide scientific data for dietary recommendations and formulation of policies to prevent chronic diseases for the elderly.[Methods] The longitudinal data of nine follow-up visits of China Health and Nutrition Surveys from 1991 to 2015 were used. By multi-stage stratified cluster random sampling method, urban communities, county towns, suburban villages, and rural villages were primary sampling units; in each unit, 20 households were randomly selected and all household members were interviewed. Dietary intakes were collected by 3-day 24-hour dietary recall, and edible oil and condiment intakes were collected by weighing method. Food consumption was converted into energy and various micronutrient intakes by an established food composition table. In this study, the participants aged 60 years or above in nine provinces(autonomous regions) were selected as the study subjects. After excluding those with missing demographic and dietary data or with abnormal energy intakes, a total of 19 116 subjects were included in the study.[Results] In 2015, the average age-standardized intakes of retinol, thiamine, riboflavin, vitamin C, and vitamin E were 637.65 μg/d(in retinol activity equivalent) and 0.78, 0.70, 74.53, and 29.08 mg/d, respectively. Thiamine intake decreased slightly from 1991 to 2015. The intakes of riboflavin and vitamin C(Ps < 0.001) were higher in the high-income elderly. Vitamin E intake increased since 1997, but recovered to 2006 level in 2015. The intakes of calcium, phosphorus, sodium, and potassium in 2015 were 339.06, 832.29, 4 741.00, and 1 423.45 mg/d, respectively. The intakes of iron, zinc, copper, and selenium(Ps < 0.001) in the high-income group were higher than those in the low-and middle-income groups, and the intake of selenium in urban areas was higher than that in rural areas(Ps < 0.001); the intakes of phosphorus, magnesium, zinc, and copper decreased over the years. The proportions of the elderly whose intakes of retinol, thiamine, riboflavin, vitamin C, and calcium were less than the corresponding estimated average requirements ranged from 59.04% to 98.21% of total subjects. The participants with insufficient intakes of retinol, thiamine, and vitamin C were on the rise, and those with insufficient calcium intake accounted for at least 94.61% of total subjects.[Conclusion] The elderly in nine provinces(autonomous regions) of China are deficient in water-soluble vitamins and calcium, which may be caused by insufficient intakes of vegetables and milk and dairy products. Suggestions for the elderly include: diverse foods, foods rich in calcium such as dairy products, aquatic products, and soy products, and micronutrient supplements as appropriate.
引文
[1]国家统计局.中国统计年鉴[EB/OL].[2019-01-14].http://www.stats.gov.cn/tjsj/ndsj/2018/indexch.htm.
[2]YANG Y,ZHENG A,LI M,et al. Medical economic burden of the ageing population:a multistage sampling analysis of3 532 517 cases[J]. Lancet,2016,388(S1):S79.
[3]周海腾,王少康,尹鑫,等.南京市溧水区老年人群营养与健康状况调查[J].重庆医学,2014,43(25):3333-3335.
[4]李彩虹,卡丽比努尔·雅克甫,袁倩倩,等.乌鲁木齐某社区中老年人膳食营养状况分析[J].中华疾病控制杂志,2014,18(6):526-529.
[5]王淑英,马爱国.沿海地区长寿老人营养状况调查分析[J].营养学报,2017,39(2):116-120.
[6]翟凤英,王惠君,杜树发,等.中国居民膳食结构与营养状况变迁追踪[J].医学研究杂志,2006,35(4):3-6.
[7]POPKIN B M,DU S,ZHAI F,et al. Cohort Profile:The China Health and Nutrition Survey—monitoring and understanding socio-economic and health change in China,1989-2011[J].Int J Epidemiol,2010,39(6):1435-1440.
[8]“中国健康与营养调查”项目组. 1989—2009年中国九省区居民膳食营养素摄入状况及变化趋势(一)健康与营养调查项目总体方案[J].营养学报,2011,33(3):234-236.
[9]张兵,王惠君,杜文雯,等.队列研究的进展及其对中国健康与营养调查的启示[J].中华预防医学杂志,2011,45(4):295-298.
[10]王志宏,张兵,王惠君,等.中国成年人红肉摄入量对体重指数、体重及超重危险性影响的多水平纵向研究[J].中华流行病学杂志,2013,34(7):661-667.
[11]于冬梅,何宇纳,郭齐雅,等. 2002—2012年中国居民能量营养素摄入状况及变化趋势[J].卫生研究,2016,45(4):527-533.
[12]TROESCH B,EGGERSDORFER M,WEBER P. 100 years of vitamins:adequate intake in the elderly is still a matter of concern[J]. J Nutr,2012,142(6):979-980.
[13]WATSON J,LEE M,GARCIA-CASAL M N. Consequences of inadequate intakes of vitamin a,vitamin B12,vitamin D,calcium,iron,and Folate in older persons[J]. Curr Geriatr Rep,2018,7(2):103-113.
[14]WHITING S J,KOHRT W M,WARREN M P,et al. Food fortification for bone health in adulthood:a scoping review[J]. Eur J Clin Nutr,2016,70(10):1099-1105.
[15]DE MOURA F F,MOURSI M,ANGEL M D,et al. Biofortifiedβ-carotene rice improves vitamin A intake and reduces the prevalence of inadequacy among women and young children in a simulated analysis in Bangladesh,Indonesia,and the Philippines[J]. Am J Clin Nutr,2016,104(3):769-775.
[16]J??SKEL?INEN T,ITKONEN S T,LUNDQVIST A,et al. The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population:evidencefroman11-yfollow-upbasedon standardized 25-hydroxyvitamin D data[J]. Am J Clin Nutr,2017,105(6):1512-1520.
[17]BALK E M,ADAM G P,LANGBERG V N,et al. Global dietary calcium intake among adults:asystematic review[J].Osteoporos Int,2017,28(12):3315-3324.
[18]CHUNG M,TANG A M,FU Z,et al. Calcium intake and cardiovascular disease risk:an updated systematic review and meta-analysis[J]. Ann Intern Med,2016,165(12):856-866.
[19]YANG B,CAMPBELL P T,GAPSTUR S M,et al. Calcium intake and mortality from all causes,cancer,and cardiovascular disease:the Cancer Prevention Study II Nutrition Cohort[J].Am J Clin Nutr,2016,103(3):886-894.
[20]KONG S H,KIM J H,HONG A R,et al. Dietary calcium intake and risk of cardiovascular disease,stroke,and fracture in a population with low calcium intake[J]. Am J Clin Nutr,2017,106(1):27-34.
[21]WEAVER C M,ALEXANDER D D,BOUSHEY C J,et al. Calcium plus vitamin D supplementation and risk of fractures:an updated meta-analysis from the National Osteoporosis Foundation[J]. Osteoporos Int,2016,27(1):367-376.
[22]HILDEBOLT C F,PILGRAM T K,DOTSON M,et al. Estrogen and/or calcium plus vitamin D increase mandibular bone mass[J]. J Periodontol,2017,75(6):811-816.
[23]周蔚,夏蒨,李香亭,等.上海市杨浦区居民不同季节膳食微量营养素的摄入状况[J].环境与职业医学,2018,35(6):511-515.
[2]YANG Y,ZHENG A,LI M,et al. Medical economic burden of the ageing population:a multistage sampling analysis of3 532 517 cases[J]. Lancet,2016,388(S1):S79.
[3]周海腾,王少康,尹鑫,等.南京市溧水区老年人群营养与健康状况调查[J].重庆医学,2014,43(25):3333-3335.
[4]李彩虹,卡丽比努尔·雅克甫,袁倩倩,等.乌鲁木齐某社区中老年人膳食营养状况分析[J].中华疾病控制杂志,2014,18(6):526-529.
[5]王淑英,马爱国.沿海地区长寿老人营养状况调查分析[J].营养学报,2017,39(2):116-120.
[6]翟凤英,王惠君,杜树发,等.中国居民膳食结构与营养状况变迁追踪[J].医学研究杂志,2006,35(4):3-6.
[7]POPKIN B M,DU S,ZHAI F,et al. Cohort Profile:The China Health and Nutrition Survey—monitoring and understanding socio-economic and health change in China,1989-2011[J].Int J Epidemiol,2010,39(6):1435-1440.
[8]“中国健康与营养调查”项目组. 1989—2009年中国九省区居民膳食营养素摄入状况及变化趋势(一)健康与营养调查项目总体方案[J].营养学报,2011,33(3):234-236.
[9]张兵,王惠君,杜文雯,等.队列研究的进展及其对中国健康与营养调查的启示[J].中华预防医学杂志,2011,45(4):295-298.
[10]王志宏,张兵,王惠君,等.中国成年人红肉摄入量对体重指数、体重及超重危险性影响的多水平纵向研究[J].中华流行病学杂志,2013,34(7):661-667.
[11]于冬梅,何宇纳,郭齐雅,等. 2002—2012年中国居民能量营养素摄入状况及变化趋势[J].卫生研究,2016,45(4):527-533.
[12]TROESCH B,EGGERSDORFER M,WEBER P. 100 years of vitamins:adequate intake in the elderly is still a matter of concern[J]. J Nutr,2012,142(6):979-980.
[13]WATSON J,LEE M,GARCIA-CASAL M N. Consequences of inadequate intakes of vitamin a,vitamin B12,vitamin D,calcium,iron,and Folate in older persons[J]. Curr Geriatr Rep,2018,7(2):103-113.
[14]WHITING S J,KOHRT W M,WARREN M P,et al. Food fortification for bone health in adulthood:a scoping review[J]. Eur J Clin Nutr,2016,70(10):1099-1105.
[15]DE MOURA F F,MOURSI M,ANGEL M D,et al. Biofortifiedβ-carotene rice improves vitamin A intake and reduces the prevalence of inadequacy among women and young children in a simulated analysis in Bangladesh,Indonesia,and the Philippines[J]. Am J Clin Nutr,2016,104(3):769-775.
[16]J??SKEL?INEN T,ITKONEN S T,LUNDQVIST A,et al. The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population:evidencefroman11-yfollow-upbasedon standardized 25-hydroxyvitamin D data[J]. Am J Clin Nutr,2017,105(6):1512-1520.
[17]BALK E M,ADAM G P,LANGBERG V N,et al. Global dietary calcium intake among adults:asystematic review[J].Osteoporos Int,2017,28(12):3315-3324.
[18]CHUNG M,TANG A M,FU Z,et al. Calcium intake and cardiovascular disease risk:an updated systematic review and meta-analysis[J]. Ann Intern Med,2016,165(12):856-866.
[19]YANG B,CAMPBELL P T,GAPSTUR S M,et al. Calcium intake and mortality from all causes,cancer,and cardiovascular disease:the Cancer Prevention Study II Nutrition Cohort[J].Am J Clin Nutr,2016,103(3):886-894.
[20]KONG S H,KIM J H,HONG A R,et al. Dietary calcium intake and risk of cardiovascular disease,stroke,and fracture in a population with low calcium intake[J]. Am J Clin Nutr,2017,106(1):27-34.
[21]WEAVER C M,ALEXANDER D D,BOUSHEY C J,et al. Calcium plus vitamin D supplementation and risk of fractures:an updated meta-analysis from the National Osteoporosis Foundation[J]. Osteoporos Int,2016,27(1):367-376.
[22]HILDEBOLT C F,PILGRAM T K,DOTSON M,et al. Estrogen and/or calcium plus vitamin D increase mandibular bone mass[J]. J Periodontol,2017,75(6):811-816.
[23]周蔚,夏蒨,李香亭,等.上海市杨浦区居民不同季节膳食微量营养素的摄入状况[J].环境与职业医学,2018,35(6):511-515.