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首页> 美国卫生研究院文献>Clinical Cases in Mineral and Bone Metabolism >P25 - Growing Strong and Healthy with Mister Bone: An Educational Programme to Ensure Strong Bones Later in Life
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P25 - Growing Strong and Healthy with Mister Bone: An Educational Programme to Ensure Strong Bones Later in Life

机译：P25-与骨先生一起成长强壮健康：确保人生后期骨骼健康的教育计划

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Bone mass increases steadily until the age of 20–30 years and most bone mass is acquired during the first two decades of life. Nutrition plays a critical role in the achievement of one’s optimal genetically programmed peak bone mass (PBM), reducing the risk of osteoporosis later in life. PBM is the amount of bony tissue present in the skeleton at the end of skeletal maturation. Even though 90% of PBM is acquired by the end of second decade of life, skeletal mass continues to increase for up to 10–15 years after that, through the process of bone consolidation, with maximal PBM occurring at around 30 years of age. As a 10% increase in PBM corresponds to a gain of one standard deviation in bone mineral density in adulthood, osteoporotic fracture risk may be reduced by up to 50% by interventions aimed at maximising PBM in a sustainable manner in childhood and adolescence. Although genetic factors are the strongest predictors of bone mass, accounting for 50–80% of its variance, nutritional and lifestyle factors can explain an additional 20–30% of bone mass variance.Bone is living tissue like any other, and its cells have the same kinds of nutrient needs as those of the rest of the body; it does not require only an energy supply, but also protein and micronutrients, calcium and vitamin D in primis. In a balanced western-style diet, about 60% of dietary calcium should come from milk and dairy products, 20% from fresh vegetables and dried fruits, and the rest from drinking water or other discrete sources.Current research indicates that calcium intake in school-age children is below the recommended adequate level.The recommended adequate intake of calcium for children between the ages of 9 and 11 years is about 1100–1200 mg.In response to this critical health issue it is essential to monitor children’s intake of dairy products and nutrients important for bone health, such as calcium and vitamin D, in order to ensure that their nutritional needs are met and that they are receiving the nutritional intakes needed to safeguard their health later in life. The aim of our study was to monitor and promote the intake of dairy products, calcium and vitamin D in children, in order to help them achieve their optimal PBM and to safeguard their bone health later in life. Modifications in schoolchildren’s nutritional behaviour were evaluated through a nutritional programme designed to increase calcium intake. The project was conducted with the support of novel instruments specifically created for this educational programme.Our study sample comprised 180 children (48% males and 52% females) aged 9–11 years from a primary school in Florence. We evaluated the children’s eating habits through a questionnaire designed to assess intake of calcium, dairy products, and total caloric energy intake at baseline and at follow up. Data were processed using nutrition software (Win-Food 2.7-MediMatica) and analysed using Student’s paired T-test to determine pre- versus post-intervention differences. The results showed that total caloric intakes rose from 1690±290 before the educational intervention to 1700±330 kcal/day after the educational intervention in boys and from 1620±256 to 1640±260 kcal/day in girls. Statistical analysis of the data did not show any significant variation in pre- versus post-educational assessments (p<0.05), although the protein percentage increased by two points, from 14.5 to 16.5%, while both carbohydrate and lipid intake decreased by one percentage point. Student’s T-test analysis of dietary intakes evaluated, through the questionnaire, before and after the educational intervention revealed a significant increase (p<0.05) in calcium intake, which rose from 860±190 to 1060±200 mg/day in the girls and from 890±200 to 1100±210 mg/day in the boys, and in vitamin D intake, which rose from 3.6±1.53 μg/day to 4.1±2 μg/day, without significant differences emerging between the boys and girls. Although sub-optimal, the calcium intake obtained after the educational programme was sufficient to attain the target RDI of 1100–1200 mg/day. During the educational programme the percentage of children who drank milk rose from 92 to 96%. A change in the quantity of milk intake was also detected: the results showed a significant increase from 200±35 to about 270±65 ml/day in boys and girls (p<0.05). The observations on hard cheese intake revealed an increase in cheese consumers, from 84% to 91% at the end of the educational period. Similarly, a positive change was recorded in the percentage of children eating fresh vegetables: an increase from 89% to 96%.Our educational programme appears to be significantly effective in modifying calcium intake in children. Analysis of the questionnaire data, which showed significantly increased consumption of dairy products and vegetables, without significant changes in total caloric intakes, revealed an important change in these children’s dietary habits. These behavioural modifications are the result of progressive nutritional education imparted through lessons, brochures, calendars, games, and crosswords. These findings may prompt school policy-makers to introduce educational strategies to promote students’ skeletal health.
机译：直到20至30岁为止，骨量一直稳定增长，并且大部分骨量是在生命的前二十年获得的。营养在实现最佳的遗传程序性峰值骨量（PBM）方面起着至关重要的作用，从而降低了以后生活中发生骨质疏松症的风险。 PBM是骨骼成熟结束时骨骼中存在的骨组织数量。即使在生命的第二个十年的末期获得了90％的PBM，但骨骼质量在长达10-15年的时间内仍通过骨骼固结过程持续增加，最大的PBM发生在30岁左右。由于PBM增加10％，相当于成年后骨矿物质密度增加了一个标准差，因此，旨在通过以可持续方式在儿童和青春期最大化PBM的干预措施，骨质疏松性骨折的风险可以降低多达50％。尽管遗传因素是骨骼质量的最强预测因子，占骨骼质量变异的50％至80％，但营养和生活方式因素可以解释骨骼质量变异的另外20％至30％。骨骼像其他组织一样是活体组织，其细胞具有与身体其他部位相同种类的营养需求；它不仅需要能源，而且还需要蛋白质和微量营养素，初生中的钙和维生素D。在均衡的西式饮食中，约60％的饮食钙应来自牛奶和奶制品，20％的新鲜蔬菜和干果，其余的则来自饮用水或其他离散来源。当前的研究表明，学校的钙摄入量年龄不足的儿童低于建议的适当水平。9至11岁儿童的建议充足钙摄入量约为1100-1200 mg。针对这一严重的健康问题，必须监控儿童的乳制品摄入量以及钙和维生素D等对骨骼健康至关重要的营养素，以确保满足他们的营养需求，并确保他们在以后的生活中获得所需的营养摄入。我们研究的目的是监测和促进儿童乳制品，钙和维生素D的摄入，以帮助他们达到最佳的PBM并在以后的生命中维护其骨骼健康。通过旨在增加钙摄入量的营养计划，评估了学童营养行为的变化。该项目是在专门为此教育计划创建的新型仪器的支持下进行的。我们的研究样本包括来自佛罗伦萨小学的180名9-11岁的儿童（男48％，女52％）。我们通过设计用来评估钙摄入量，乳制品以及基线和随访时总热量摄入的问卷调查，评估了孩子的饮食习惯。数据使用营养软件（Win-Food 2.7-MediMatica）处理，并使用学生配对T检验进行分析，以确定干预前后的差异。结果表明，男孩的总热量摄入量从教育干预前的1690±290升高到教育干预后的1700±330 kcal /天，女孩的从1620±256增加到1640±260 kcal /天。数据的统计分析未显示出教育前后评估的任何显着变化（p <0.05），尽管蛋白质百分比增加了两个点，从14.5增至16.5％，而碳水化合物和脂质的摄入量均减少了一个百分点点。在教育干预前后，通过问卷对学生的饮食摄入量进行T检验分析，结果表明，女孩的钙摄入量显着增加（p <0.05），从860±190毫克/天增至1060±200毫克/天。男孩从890±200毫克/天增加到1100±210毫克/天，维生素D摄入量从3.6±1.53微克/天增加到4.1±2微克/天，男孩和女孩之间没有显着差异。尽管次优，但通过教育计划获得的钙摄入量足以达到1100-1200 mg /天的目标RDI。在教育计划中，喝牛奶的儿童比例从92％上升到96％。还检测到牛奶摄入量的变化：结果表明，男孩和女孩的牛奶摄入量从200±35毫升/天显着增加到约270±65毫升/天（p <0.05）。关于硬质奶酪摄入量的观察表明，在教育阶段结束时，奶酪消费量从84％增加到91％。同样，吃新鲜蔬菜的儿童百分比也呈积极变化：从89％增加到96％。我们的教育计划对改善儿童的钙摄入量似乎有效。问卷数据分析该研究表明，乳制品和蔬菜的消费量显着增加，而总热量摄入量没有显着变化，表明这些孩子的饮食习惯发生了重要变化。这些行为上的改变是通过课程，小册子，日历，游戏和填字游戏进行的逐步营养教育的结果。这些发现可能会促使学校决策者引入教育策略来促进学生的骨骼健康。

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