Evaluation of Sodium Intake and Relationship between Sodium Intake and the Bone Mineral Density of Female University Students

중부 지역 여대생에서 음식섭취빈도조사지를 이용한 나트륨 섭취량 평가 및 나트륨 섭취와 골밀도와의 관련성 조사

  • Bae, Yun-Jung (Dept. of Food and Nutritional Sciences, Hanbuk University) ;
  • Yeon, Jee-Young (Dept. of Food and Nutrition, Sookmyung Women's University)
  • 배윤정 (한북대학교 식품영양학과) ;
  • 연지영 (숙명여자대학교 식품영양학과)
  • Received : 2011.07.15
  • Accepted : 2011.10.05
  • Published : 2011.10.31

Abstract

The purpose of this study was to evaluate the relationship between bone health and sodium intake in female university students using a dish frequency questionnaire (DFQ 125), anthropometric checkups, food records for 3 days, and ultrasound measurement of calcaneus bone mineral density. Subjects were divided into two groups: normal (n=196) and osteopenia (n=52). There were no significant differences in age or height between the two groups. The average weight, body mass index, and body fat in the normal group were significantly higher than in the osteopenia group. The sodium intake of DFQ was positively correlated with the sodium intake of 3 days of dietary records (p=0.0003). There were no significant differences in the sodium intake between the two groups from DFQ. The dishes were ranked by sodium intake: kimchies were 17.68%, noodles and mandu were 16.36%, stews were 13.69%, main dishes such as meat, egg, and beans were 11.47%, and fish and shellfish were 11.07%. The frequency of eating noodles and mandu (p=0.0116), stews (p=0.0008), kimchies (p=0.0482), fish and shellfish (p=0.0362), vegetables (p=0.0064) and seasoning (p=0.0347) were negatively associated with bone mineral density. Bone health was not significantly different with increasing quartiles of sodium intake. As excessive sodium intakes may indirectly affect bone mineral density, these results suggest that to prevent osteoporosis, university students needed to be more educated about diets containing less sodium through nutrition education programs.

본 연구는 여대생 248명을 대상으로 음식섭취빈도조사지에 의한 나트륨 섭취량과 골밀도와의 관련성을 규명하고자 하였다. 조사 대상자의 평균 연령은 정상군 20.15세, 골감소군 20.04세였으며, 두 군간 유의적인 차이는 보이지 않았다. 평균 신장과 체중은 정상군 161.14 cm, 54.99 kg, 골감소군은 161.02 cm, 52.20 kg으로 나타나, 골감소군에서 체중이 유의적으로 낮은 것으로 나타났다. 평균 체질량지수와 체지방량은 정상군 20.90 kg/$m^2$, 26.09%, 골감소군은 20.08 kg/$m^2$, 24.27%으로 체질량지수와 체지방이 골감소군에서 유의적으로 낮은 것으로 나타났다. 평균 종골의 골격 상태 측정 결과에서 BUA, SOS, QUI는 정상군 118.44 dB/MHz, SOS 1,578.12 m/s, QUI 124.59%, 골감소군은 99.24 dB/MHz, SOS 1534.50 m/s, QUI 98.83%로 골감소군이 유의적으로 낮은 것으로 나타났다. 음식섭취빈도지에 의한 나트륨 섭취량(3,176.51 mg)은 식사 기록법에 의한 나트륨 섭취량(1,898.62 mg)과 유의한 양의 상관관계를 보였으며, 정상군 3,598.60 mg, 골감소군 3,748.25 mg으로 두 군간 유의적인 차이를 보이지 않았다. 나트륨 섭취의 주요 급원식품으로 정상군은 배추김치(10.13%), 라면(5.05%), 된장찌개(3.27%), 김치찌개(3.23%), 멸치볶음(2.48%) 순으로나타났으며, 골감소군은 배추김치(12.78%), 라면(6.04%), 김치찌개(2.94%), 된장찌개(2.62%), 자반고등어(2.34%) 순으로 나트륨 섭취량이 많게 나타났다. 음식군별 나트륨 섭취에 기여하는 음식군별 결과를 살펴보면, 정상군은 김치류(16.91%), 면류 및 만두류(16.34%), 찌개 및 탕류(13.88%), 주반찬(육류, 난류, 콩류, 11.73%), 어패류(11.02%) 순으로 나타났으며, 골감소군은 김치류(20.51%), 면류 및 만두류(17.03%), 찌개 및 탕류(12.98%), 어패류(10.76%), 주반찬(육류, 난류, 콩류, 10.63%) 순으로 나타났다. 두 군 모두에서 김치류, 면류 및 만두류, 찌개 및 탕류, 주반찬(육류, 난류, 콩류), 어패류로부터 전체 나트륨 섭취의 70% 정도를 공급받고 있는 것으로 나타났다. 조사대상자의 각 식품군의 나트륨 섭취량과 골밀도와의 상관 관계 분석결과, 면류 및 만두류(r=-0.0276, p=0.0426)와 나물 및 생채류(r=-0.0587, p=0.0015)와 골밀도간의 유의적인 음의 상관관계를 나타내었다. 각 식품군의 섭취빈도와 골밀도와의 상관관계 결과, 면류 및 만두류(r=-0.0344, p=0.0116), 찌개 및 탕류(r=-0.0376, p=0.0008), 김치류(r=-0.0421, p=0.0482), 어패류(r=-0.0160, p=0.0362), 나물 및 생채류(r=-0.0503, p= 0.0064), 양념류(r=-0.0407, p=0.0347) 등과 유의적인 음의 상관관계를 보였다. 나트륨 섭취 상태와 골밀도와의 관련성을 알아보기 위하여 나트륨 섭취량에 따라 4분 위수로 대상자를 나누어 비교한 결과, 정상군의 T-score는 Q1 군 0.90 g/$cm^2$, Q2군 1.03 g/$cm^2$, Q3군 0.91 g/$cm^2$, Q4군 0.98 g/$cm^2$으로 군간 유의적인 차이를 보이지 않았고, 골감소군은 Q1군 -1.48 g/$cm^2$, Q2군 -1.61 g/$cm^2$, Q3군 -1.59 g/$cm^2$, Q4군 -1.71 g/$cm^2$으로 군간 유의적인 차이를 보이지 않았다. 이상의 연구 결과에서 여대생의 주요 나트륨 급원 식품인 배추김치, 김치찌개, 된장찌개 이외의 라면, 멸치볶음, 스낵 과자의 식품으로부터 나트륨 섭취가 높은 것으로 나타났다. 또한 나트륨 총 섭취량과 골밀도는 상관성이 없었고 나트륨 섭취 기여도가 높은 식품의 섭취빈도가 높은 경우 나트륨 섭취도 높았는데, 이는 골밀도에 따른 군간 나트륨 섭취가 유사하여 나트륨 섭취가 골밀도에 미치는 효과가 미약하게 나타나 것으로 보인다. 따라서 골밀도에 관련성이 있는 골대사 지표 및 다양한 측정 방법을 통한 골밀도와 나트륨 섭취수준과의 관련성 연구가 필요하다고 생각된다.

Keywords

References

  1. Barger-Lux MJ, Heaney RP (1995) Caffeine and the calcium economy revisited. Osteoporos Int 5: 97-102. https://doi.org/10.1007/BF01623310
  2. Castenmiller JJM, Mensink RP, Kouwenhoven T (1985) The effect of dietary sodium on urinary calcium and potassium excretion in normotensive men with different calcium intake. Am J Clin Nutr 41: 52-60.
  3. Chang UJ, Jo JN (2009) The relationship between food intake, sodium intake and satiety rate and the methods of consuming soup. J Korean Diet Assoc 15: 397-404.
  4. Chiu JF, Lan SJ, Yang CY, Wang PW, Yao WJ, Su LH, Hsieh CC (1997) Long-term vegetarian diet and bone mineral density in postmenopausal Taiwanese women. Calcif Tissue Int 60: 245-249. https://doi.org/10.1007/PL00005812
  5. Choi JH, Kim SK (2008) Comparison of the dietary factors between normal and osteopenia groups by bone mineral density in Korean female college students. J Korean Soc Food Sci Nutr 37: 869-878. https://doi.org/10.3746/jkfn.2008.37.7.869
  6. Choi MK, Jun YS, Sung CJ (1997) Effects of caffeine and calcium intake on calcium utilization in female rats of different age. Kor J Nutr 30: 1160-1169.
  7. Dahl LK (2005) Possible role of salt intake in the development of essential hypertension. Int J Epidemiol 34: 967-972. https://doi.org/10.1093/ije/dyh317
  8. Dawson-Hughes B, Dalal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S (1990) A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 323: 178-183.
  9. Edelstein SL, Barrett-Corner E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138: 160-169.
  10. Hankin JH, Rhoads GG, Glober GA (1975) A dietary method for an epidemiologic study of gastrointestinal cancer. Am J Clin Nutr 28: 1055-1061.
  11. He FJ, Markandu ND, Sagnella GA, de Wardener HE, Mac- Gregor GA (2005) Plasma sodium: ignored and underestimated. Hypertension 45: 98-102.
  12. Heancy RP (2002) Effects of caffeine on bone and the calcium economy. Food Chem Toxicol 40: 1263-1270. https://doi.org/10.1016/S0278-6915(02)00094-7
  13. Heaney RP, Recker RR (1982) Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med 99: 46-55.
  14. Kim KR, Kim KH, Lee EK (2000) A study on the factors affecting bone mineral density in adult women-besed on the mothers of elementary school students. Korean Nutri Soc 33: 241-249.
  15. Kim MS, Koo JO (2008) Comparative analysis of food habits and bone density risk factors between normal and risk women living in the Seoul area. Korean J Community Nutr 13: 125-133.
  16. Kim WY (1994) Osteoporosis & dietary factors. Korean J Nutr 27: 636-645.
  17. Koo JO, Ahn HA, Yoo SY (2008) Study of bone mineral density, body composition and dietary habits of 20-30 years women. Korean J Community Nutr 13: 489-498.
  18. Lee EJ, Son SM (2004) Dietary risk factors related to bone mineral density in the postmenopausal women with low bone mineral density. Korean J Community Nutr 9: 644-653.
  19. Lee HJ, Choi MJ, Lee IK (1996) The effect of anthropometric measurement and body composition on bone mineral density of Korean women in Taegu. Korean Nutri Soc 29: 778-787.
  20. Lee M, Czerwinski SA, Choh AC, Towne B, Demerath EW, Chumlea WC, Sun SS, Siervogel RM (2004) Heritability of calcaneal quantitative ultrasound measures in healthy adults from the Fels Longitudinal Study. Bone 35: 1157-1163. https://doi.org/10.1016/j.bone.2004.07.007
  21. Lim HJ (2011) A study on the calcium and sodium intakes and urinary calcium excretion of adults in Busan. Korean J Community Nutr 16: 215-226. https://doi.org/10.5720/kjcn.2011.16.2.215
  22. Ministry of Health, Welfare and Family Affairs [MOHWFA] & Korea Center for Disease Control and Prevention [KCDCP] (2010) 2009 National Health Statistics- The 4th Korea National Health and Nutrition Examination Survey, the second year(2009), Korea Center for Disease Control and Prevention, Korea.
  23. Mizushima S, Tsuchida K, Yamori Y (1999) Prevent nutritional factors in epidemiology: interaction between sodium and calcium. Clin Erp Pharmacol Physiol 26: 573-575. https://doi.org/10.1046/j.1440-1681.1999.03083.x
  24. Moon HY, Choi SO, Kim JE (2009) Dishes contributing to sodium intake of elderly living in rural areas. Korean J Community Nutr 14: 123-136.
  25. Paul AA, Southgate DAT (1988) Conversion into nutrients. In : Commen ME, van Staveren WA, editors. Manual on methodology for food consumption studies. Oxford University Press, Oxford.
  26. Sellmeyer DE, Schloetter M, Sebastian A (2002) Potassium citrate prevents increased urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endocrinol Metab 87: 2008-2012. https://doi.org/10.1210/jc.87.5.2008
  27. Shin EK, Lee HJ , Lee JJ, Ann MY, Son SM, Lee YK (2010) Estimation of sodium intake of adult female by 24-hour urine analysis, dietary records and dish frequency questionnaire (DFQ55). Korean J Nutr 43: 79-85. https://doi.org/10.4163/kjn.2010.43.1.79
  28. Shortt C, Flynn A (1990) Sodium-calcium inter-relationships with specific reference to osteoporosis. Nutr Res Revr 3: 101-115. https://doi.org/10.1079/NRR19900008
  29. Son SM, Park YS, Lim HJ, Kim SB, Jeong YS (2007a) Sodium intakes of Korean adults with 24-hour urine analysis and dish frequency questionnaire and comparison of sodium intakes according to the regional area and dish group. Korean J Community Nutr 12: 545-558.
  30. Son SM, Park YS, Lim HJ, Kim SB, Jeong YS (2007b) Development and evaluation of validity of short dish frequency questionnaire (DFQ) for estimation of habitual sodium intake for Korean adults. Korean J Community Nutr 12: 838- 853.
  31. The Korean Nutrition Society[KNS] 2010. Dietary Reference Intakes for Koreans.
  32. Tsugane S (2005) Salt, salted food intake, and risk of gastric cancer: epidemiologic evidence. Cancer Sci 96: 1-6. https://doi.org/10.1111/j.1349-7006.2005.00006.x
  33. Walser M (1961) Calcium balances as a function of sodium clearances in the dog. Am J Physiol 200: 1099-1104.