K I N H TlT 55- 65 TUOI 6 NONG THON
Vu Thi Thu Hien, Nguyen Anh Tu, Nguyin Dodn Dung vd CS
Nghien ciru duoe ticn hanh tir nam 2007 - 2008 de xac dinh nhu cau calci (Ca) cho phu nil da man kinh, tuoi tir 55- 65, sir dung phuong phap can bang chuyen hoa Ca. Co 14 phu nCr du tieu chuan da tham gia nghien ciiu, Mdi doi tugng dugc cung cap khau phan an co kiem soat trong 2 giai doan: 15 ngay dau vdi mirc khau phan Ca khoang 300 mg/ ngay, 15 ngay sau vdi nuic khau phan Ca khoang 600 mg/ ngay, Khau phan Ca duo-c tinh toan dua vao bang thanh phan dmh dudng cac thuc pham Vict nam nam 2000, Giira 2 giai doan la thdi gian nghi 15 ngay: doi tuo-ng an khau phan nhu thirdng lc tai gia dinh, Khau phan an, mau phan va nudc tieu dugc thu thap trong ca 2 giai doan nghien ciru dc phan tich dinh lugng Ca bang phuong phap quang pho hap phu nguyen tir (AAS), Can bang chuyen hoa Ca dugc tinh cho tirng mirc khau phan Ca, Nhu cau Ca dugc irdc tinh dua vao moi tuong quan hoi quy tuyen tinh giua lugng Ca an vao va can bang chuyen hoa Ca, Ket qua nghien ciiu cho thay: nhu cau Ca ude tinh tren doi tugng nghien eiru la 625 mg/ ngay, Nhu cau Ca khuyen nghi cho phu nir man kinh tir 55- 65 tuoi d nong thon la 750 mg. ngay. Can co them cac nghien ciru vc nhu cau Ca cho nhung nhdm tuoi khac nhau va d nhiing vimg khac nhau tren toan quoc de c6 so lieu day du va phong phii cho Bang Nhu cau Dinh dudng khuyen nghi ciia ngudi Viet Nam,
I. DAT VAN DE
Trong nhirng nam gan day, ngay cang cd thSm nhieu bang chirng vS moi liSn quan giii-a khau phan Ca va siic khoe eua bd xuang. Khau phan Ca day du va liSn tuc trong suot cuoc ddi se gop phan cho bp xuang chac khoe, tang khdi lugng xuang dinh khi dSn tudi truang thanh va lam giam su mat chat xuang khi vS gia, tir dd gdp phan phdng benh cdi xuang d tre em va loang xuong d ngudi Idn [1].
Vd vay, nghiSn cuu vS nhu cau Ca cho
tii'ng lii-a tudi, tirng giai doan cua cuoc ddi la van de rat dang quan tam [2, 3].
Nhu cau Ca cho timg lira tudi da dugc nghiSn cii-u tir nhiSu thap ky trudc day, da cd rat nhiSu cdng trinh nghien ciiu khoa hgc cdng bd va dugc ap dung rdng rai d nhiSu Qudc gia tren ThS gidi [1,4, 5]. Tuy nhiSn, vdi nhung hiSu biSt hien nay, nhu cau Ca phu thupc rat nhiSu vao miic hoat ddng thS luc, tinh trang dinli dudng, do tudi, gidi va chung tdc. a My va Canada, nhu cau Ca khuySn nghi eho ngudi trSn
' TS.BS, Vien Dinh Dirrvnt:
- CN - Vien Dinh Diranu
50 tuoi la 1200 mg/ ngay, trong khi nhu cau cho ngudi eiing do tudi dd d Phap la 900 mg/ngay, a Anh la 700 mg/ngay, va d Australia la 800 mg/ngay [6- 8].
Cd nhiSu phuang phap nghiSn ciru xae djnh nhu cau Ca nhu: xac djnh nhu cau bang each tinh tdng lugng Ca thai ra trong nudc tiSu va phan (phuang phap fractor- ial), phuang phap dua vao diSu tra djch tS hgc va phuang phap balance. Trong dd, phucmg phap balance dugc gidi khoa hgc chap nhan va su dung nhiSu han ca vi do ehinh xac va tinh kha thi cao [4]. Theo phucmg phap nay, nhu cau Ca trung binh d ngudi tmang thanh dugc xac djnh dua vao mdi tucmg quan hdi quy tuyen tinh giua lugng Ca an vao va can bang chuySn hoa Ca (Ca balance), theo dd nhu cau Ca dugc tinh la khau phan ma tai do lugng an vao va thai ra bang nhau (balance = 0) [1].
d Viet nam, ty IS lodng xuang d ngudi trudng thanh la 9%, tuang ddi cao so vdi cac nudc khac trong khu vuc [9]. Trong khi dd, khau phan Ca tmng binh d ngudi truang thanh van < 500 mg/ngay [10].
Nhu cau dinh dudng Ca da dugc Vien Dinh Dudng- Bd Y te khuyen nghj dua vao cac bang chirng khoa hgc dugc khuySn cao ciia Td chire Y tS ThS gidi va
tham khao vdi cac nudc khac trong khu vuc [11]. Cho dSn nay, van chua co nghiSn cuu ve nhu cau Ca d ngudi Viet Nam. Chinh vi vay, cac tac gia dd tien hanh nghiSn cim dS tim hiSu nhu cau Ca d phu nir da man kinh tir 55- 65 tudi, lira tudi cd nguy ca bj loang xuang cao, vdi hy vgng kSt qua nghiSn ciiu se gdp phan lam giau thSm cac minh chimg khoa hgc cua ban Nhu cau dinh dudng khuyen nghj cho ngudi Viet Nam.
II. MUC TIEU NGHIEN CLTU
Budc dau tim hiSu nhu eau Ca cua phu nii man kinh tir 55-65 tudi d ndng thdn.
III. PHUONG PHAP NGHIEN ClTU 1. Dja diem nghien ciru: xa Viet Hung, huyen Kim Thanh, tinh Hai Duong 2. Thoi gian trien khai: tir thang 11/2007 dSn thang 2/2008
3. Thiet ke nghien ciru:
ude tinh nhu cau Ca d ddi tugng dua vao lidn quan tuySn tdnh giira khau phan Ca va can bang chuySn hda Ca, vdi 2 muc khau phan Ca la 300 va 600 mg/ngay tuong ung vdi 2 giai doan nghidn cuu. Sir dung md hinh phan tich hdi quy tuyen tinh, nhu cau Ca dugc xac djnh la khau phan Ca ma d dd balance = 0 (HoTih IL
Khau ph-an Ca
Hinh 1. Lien quan tuyen tinh giira khau phan Ca va can bang chuyen hoa Ca
2 Giai doan nghiSn ciru dugc thiSt kS nhu sau:
- Giai doan 1: Ddi tugng dugc an kliau phan Ca khoang 300 mg/ngay trong 15 ngay theo thirc dan tinh toan san, dua vao bang Thanh phan Dinh Dudng cac thuc pham Viet nam nam 2000 [12].
* 10 ngay dau (thai gian thich iing): la thdi gian dS doi tugng thich ii-ng vdi khau phan Camdi.
* 5 ngay sau la thdi gian thu thap mau:
doi tugng van an khau phan nhu tren.
Ngoai ra, phan va nudc tiSu 24 gid se dugc thu thap dS djnh lugng Ca.
Giai doan 2; Ddi tu-gng an khau phan Ca khoang 600 mg/ngay trong 15 ngay, trong do ciing cd 10 ngay thich img khau phan va thdi gian 5 ngay thu thap mau.
Gida 2 giai doan la thdi gian nghi 2 tuan, ddi tugng an vdi khau phan an thudng IS tai gia dinh [4].
4. Doi tu-gng va cd mau:
TiSu chuan chpn ddi tugng:
Phu nir 55 - 65 tuasi, da man kinh 5 nam, tu nghuyen tham gia nghiSn cu'u
BMI trong hr 18.5 den 23, cd 1-2 con, ty trgng xuang >1503 m/s.
Khdng uong thudc anh hudng dSn chuyen hoa Ca/ cac ehS pham chua Ca trong vdng
1 thang tru-dc khi nghiSn ciru. ' Khau phan Ca trong 3 thang qua tir 300-
400 mg/ngay.
TiSu chuan loai trir:
* Co 1 trong eac benh: xa gan, viSm loet da day - ta trang, cao huySt ap, viem dai trang, benh vS than, sdi than.
* Hay bj tao bon.
Cd mau: 12 ngirdi [theo Uenishi va CS,TLTKsd4].
Sau khi cong 15% ddi tugng bo eudc,
cd mau nghiSn cu-u du tinh la 14 ngudi.
Cach chgn mau: Cac phu nii tii' 55- 65 tudi trong cimg 1 thdn do dugc mdi tham gia kham sang Ipc dS lira chgn 14 ddi tugng du tieu chuan vao nghiSn cu-u, 5. Phuo'ng phap tien hanh nghien cii-u va ky thuat ap dung:
5.7. Khdm de sang lpc, tuyen chpn doi tup'ng tham gia nghien cdu
Phdng van thong tin chung vS tuoi, trinh dp van hda, nghS nghiep, sd con, dnh trang kinh nguyet, tiSn sir benh tat...
Thu thap sd do nhan trac: can nang, chieu cao, BMI. ., ,-, ;,, „, „..,,.,
Do ty trgng xuang bang phuang phap siSu am djnh lugng qua xuong got chan. Xac djnh ddi tugng bj loang xuang khi chisd SOS < 1503 m/s
Danh gia khau phan chung bang phuang phap hdi ghi 24 gid qua, trong 3 ngay khdng liSn tiSp.
Danh gia kliau phan Ca trong 3 thang qua bang phuang phap hoi ghi ban djnh lugng (SQFFQ).
5.2. Phdn tich hdm lucmg Ca trong nuoc uong cua dia phuang: Bdng phuang phaspquangpho hdp thu nguyen tu (AAS)
5.3. Lap thuc dan cho cdc hita dn de dat duac 2 muc khau phdn Ca xdp xi 3()0mg/
ngdy vd 600mg/ ngdy, co tinh den luang Ca tii' nudc uong vd nuac sd siing de che bien mon dn. Cdc gid tri dinh duang khac cua thuc dan ( ndng luang, protid, lipid, glucid) twang duang vai lurmg dn thuang ngdy cua chinh cdc doi tuang nghien ciru.
5.4. Trien khai nghien cdu:
5.4.1. Cho doi tuang an che do dn co kiem sodt:
Trong moi giai doan nghiSn ciru, ddi brgng duge cung cap cac bua an mien phi trong 15 ngay (3 bua/ ngay), tai 1 dja
diSm an tap trung, dudi su giam sat cua can bd Vien Dinh Dudng. Ddi Urgng dugc ySu cau khdng an bit eu thirc an, nudc uong gi khac ngoai Ca trong khau phan hang ngay:
5.4.2. Lay mint de phdn tich hdm luang Ca trong khau phdn hdng ngdy:
Hang ngay, vdi mdi biia an, cae nghiSn ciru viSn dSu chuan bj 15 xuat an nhu nhau (14 xuat cho ddi tugng, 1 xuat luu). Xuat thu- 15 cua 3 biia trong ngay dugc gom lai, trdn dSu va nghiSn nho bang may xay thuc pham. Sau khi xay nhd, 50g thii-c an dugc cho vao lg cd nap kin, bao quan trong ngan da tu lanh va hang tuan dugc ehuySn vS Vien Dinh Dudng bao quan d - 20 dp C cho den khi phan tich Ca.
5.4.3. Liiy mdu de dinh luarig Ca trong phdn Vao trudc bii-a an dau tiSn cua ngay thir 11, mdi ddi tugng dugc an 1 g chat danh dau Cannine( chat co mau dd, khdng tham gia cac qua trinh chuySn hda trong ea the). Khi trong phan ciia ddi tugng xuat hien mau do eua carmine thi bat dau lay mau, phan bai phan c6 mau do tro vS trudc dugc loai bd. Phan ciia ddi tugng tiSp tuc dugc thu thap trong nhii-ng ngay tiSp theo. DSn ngay thu- 15, sau biia an cudi ciing, mdi doi tugng lai dugc an lg camiine,'kSt thiic lay mau khi phan cd mau do'carmine, phan bai phan co mau do duge trd vS sau duge Idai bd.
Toan hd mail phart cua ddi tupng trong 5 ngay dugc luu giir d nhiet dp phdng, trong cae hop kin cii daiah code ciia tirng ddi tugng (mdi ddi tugng cd 5 hop trong 5 ngay), Khi mau phan trong ca 5 ngay da dugc thu thap xong, toan bd mau trong 5 hop cua mdi ddi tugng dugc gom lai, nghiSn va trdn dSu, khoang 50g phan dugc hiy vao Ig cd nap day kin, chuySn ve ViSn Dinh Dudng, bao quan d nhiet do -
20 do C cho dSn khi phan tich.
5.4.4. Ldy mdu dc dinh luang Ca trong nuac tieu
Mau nude tieu 24h dugc thu thap ngay sau khi doi tugng udng carmin lan thir nhat klioang 2 gid (ySu cau ddi bi-gng dl dSu het trudc khi udng cannin) cho dSn hSt dSm ngay thir 15. Vdi dung cu lay mau chuySn biet (san xuat tai Nhat), sau mdi lan di tiSu, 1/50 lugng nudc tiSu se dugc luu lai. Ddi tugng cd thS mang theo diing cu bSn ngudi ca ngay va dem. Sau mdi ngay, dung cu nay dugc giri lai cho nghiSn ciiu viSn de lay mau nude tiSu, luu giij va phan tich. Nudc tiSu cua mdi ddi tugng dugc
luu giu trong 1 lg riSng (danh dau ngay va code). Nudc tiSu dugc bao quan bang dung djch acid HCL 6N. (20 - 30 ml cho mgt mau nudc tiSu 24 gid), de d nhiet do 5-8 dp C.
Nudc tiSu 5 ngay ciia tii-ng ddi tugng do dugc gom lai, trdn dSu, lay 50ml vao lg cii nap day kdn va chuyen vS Vien Dinh Dudng, bao quan d nhiet do - 20 do C cho dSn khi phan dch.
5.4.5. Theo doi vd gidm sdt:
Theo ddi lugng nudc udng, trgng lugng ca thS, trgng lugng phan va nudc tieu hang ngay, cac biSu hien bat thucmg vS sue khoS cua ddi tugng trong qua trinh nghiSn cim. Trgng lugng ca thS dugc can vao budi sang, liic ddi
Giam sat che do an ciia cac ddi tugng trong sudt qua trinh nghiSn cu-u.
Hoat dgng the luc cua ddi tugng trong sudt thdi gian nghiSn cim dugc giil- nguyen theo thudng IS.
5.4.6. Phdn tich Ca trong thirc dn, phdn vd nudc tieu:
Mau thiic an, phan va nudc tiSu dugc
vd CO hoa bang axit HN03 trudc khi phan tich. Sau khi vo ca hoa, mau dugc djnh lugng Ca bang phuang phap AAS.
5.4.7. Phuang phdp uac tinh nhu cdu Ca:
Can bang chuySn hda Ca (balance Ca)
dugc ude tinh dua theo phuang trinh sau:
Balance Ca = khau phAn Ca - lug-ng Ca thai ra
Lugng Ca thai ra = Lugng Ca trong phan + lugng Ca trong nude tiSu
(khau phan Ca- lugng Ca trong phan)
Ty IS hap thu Ca (%) = x 100
Sir dung mo hinh hdi quy tuySn tinh dS ude tinh nhu cau Ca (Calcium require- ment) dua vao 2 miic khau phan 300 va 600 mg/ ngay, tham khao phuang phap cua Jackman va CS [4, 13].
Nhu cau Calci khuySn nghi (RDA) dugc ude tinh theo phuang trinh sau [4, 14]:RDA = Calcium requirement x 1,2 6. Xu- ly va phan tich so lieu
Sd lieu khau phan va cac thuc don dugc tinh toan bang phan mSm ACCESS, vdi ca sd dii- lieu la Bang Thanh phan Dinh dudng thuc pham Viet Nam nam 2000.
Xu- ly sd lieu bang phan mSm SPSS. Phan dch hdi quy tuySn tinh se dugc sir dung dS ude tinh nhu cau calci.
IV. KET QUA NGHIEN ClTU
Sau khi sang lgc, 14 ddi tugng du tiSu chuan da dugc mdi tham gia nghiSn ciru.
Trong sudt qua trinh nghien cuu, tat ca cac ddi tugng deu tuan thii dung cac ySu cau do nghien cim dat ra: khong an bat cu thuc an hoac nudc uong nao khac ngoai cac bira an dugc cung cap, cac hoat dgng thS luc van giii- nhu thudng IS, thuc hien diing quy trinh My mau phan va nudc tiSu theo hudng dan. Hang ngay, tat ca cae ddi tugng dSu an hSt khau phan an dugc cung cap va khong cd doi brgng nao gap phai van dS bat thudng ve sire khde.
Khau phan Ca
Bang L Dac diem chung cua doi tirong khi bat dau nghien ciru
Bien so Mean ± SD
Tuoi (nam) 58 i 3,8 Chieu cao (cm) ' ' ' 154,5±1,6 Can nang (kg) 47.1 ±3,4 BMI 19,8 ± 1,3 Khau phan canxi trong 3 thang 346,8 ± 40,5 qua (mg/ngay)
Ty trong xuong (m/s) 1521,9±18,1
KSt qua d Bang 1 cho thay: tudi trung binh ciia doi tugng la 58 (tudi). Can nang tmng binh la 47,1 ± 3,4 (kg). Khau phan Ca trung binh ciia ddi brgng trong 3 thang trudc khi triSn khai nghiSn cuu la 346.8 ± 40.5 (mg/ngay).
Bang 2. Dac diem khau phan cua doi tu-07ig (PP hoi ghi 24h cjua trong 3 ngdy)
Gia trj dinh duong Nang luong (Kcal) Protein
Tong s6(g) Protein dong vat(g) Lipit
Tong so (g)
Lipit dong vat/ Lipit long so (%) Chat khosing
Ca (mg) Fe(mg) Vitamin
.\(nicg) Carotene (mg) Vlt, D(mcg)
%Nang luyng tir:
Protein l.ipit (jiuxit
Mean ± SD 1813 ± 232,1
56,0 t 2 1 , 6 29 i 18,5 25,3 ± 11,3 52,8 ± 17,8 377,5 ± 134
12,9 ± 7,8 0,19 r(),94 4,7 r 3,9 0,28 r 0,55
12,3 12,9 74,X
KSt qua o Bang 2 la mo ta vS khau phan chung cua ddi tugng, vdi nang lugng khau phan trung binh la 1813 ± 232,1 Kcal/ ngay, khau phan protid va lipid tong so tuang img la 56,0 ± 21,6 g/ ngay va 25,3 ± 11,3 g/ ngay. Dang chii y la nang lugng khau phan cua cac ddi tugng chii ySu dSn tii' glucid, vdi ty IS nang lugng do Protid: Lipid: Glucid cung cap tuang ung la 12,3%: 12,9%: 74,8%.
Ba thuc dim cho miie Ca xap xi 300 mg/
ngay va 3 thue dan cho mirc Ca xap xi 600 mg/ ngay da dugc thiSt kS vdi gia trj nang lugng, glucid, protid va lipid gan tuang duong vdi md ta d Bang 2 de dam bao khau phan thuc nghiem dugc da dang hda va gan gidng vdi khau phan thudng IS cua ddi tugng.
Bang 3. Kgt qua phan tich ham lu-ong Ca trong khau phan tai l.abo
Thu-c don
Ham luo-ng Ca trong khau ph3n (mg/ ngay) Giai doan 1 Giai doan 2 Thuc don A (n = 5) 327,6 ±15,7 605,6 ±7,7 Thu-c dem B (n = 5) 306,1 ±21,2 595,8 ±6,7 Thuc dan C (n = 5) 317,6 ±8,8 605,8 ±13,4
Chung(n=15) 317,1 ± 18,1 602,4±10,1 Sd lieu duac trinh bay a dcing mean i SD
Ket qua phan tich ham lugng Ca trong khau phan hang ngay cung cap cho doi tugng dugc thS hiSn d Bang 3. KSt qua phan tich da chimg minh: khau phan Ca danh gia true tiSp bang phuang phap phan tich raau thuc pham cung cd gia tri gan tuong duang vdi khau phan ude tinh dua vao Bang thanh phan dinh dudng thuc pham Viet nam nam 2000 [12].
Bang 4. Can bang chuyen hoa Ca ciia doi tu-ong nghien cu-u
Khau phan Ca (mg/ ngay) Lu'Cfng Ca trong phan (mg/ ngay) Lirgng Ca trong nuac tieu (mg/ ngay) Can bang chuyen hoa = an vao- thai ra Luong Ca hap thu (mg/ ngay) Ty le hip thu Ca (%)
(mg/ ngay)
Giai doan 1
317,1 ±18,1 309,7 ±95,2 150,3 ±36,4 -130,0± 101,6
20,2 ± 95,2 6,1 ±28,8
Giai doan 2
602,4 ± 10,1 498,2 ± 193,6
146,0 ±53,7 -10,1 ±203,6 136,1 ± 193,1 21,4 ±30,5 Sd lieu duac trinh bdv d dang mean ± SD hode %
KSt qua a Bang 4 eho thay: lugng Ca tmng binh thai ra trong phan cua ddi tugng d giai doan 1 va giai doan 2 mang img la: 309,7 ± 95,2 mg/ ngay va 498,2 ± 193,6 mg/ ngay. Trong khi do, lugng thai ra a nudc tieu it ban, d giai doan 1 la 150,3 ± 36,4 mg/ ngay va d giai doan 2 la
146,0 ± 53,7 mg/ ngay. Ty IS hap thu Ca o giai doan 1 (6,l%o) thap ban giai doan 2 (21,4%). DiSm dang chu y la: can bang ehuySn hda Ca d ca 2 giai doan dSu cd gia tri am (-130,0 ± 101,6 mg/ ngay d giai doan 1 va -10,1 ± 203,6 mg/ ngay a giai doan 2).
KSt qua phan tich theo md hinh hdi quy tuySn tinh dugc minh hga d Hinh 2, theo do can bang chuySn hda Ca bang 0 khi khau phan Ca dat 625 mg/ ngay. Nhu vay, nhu cau Ca (calcium requirement) ciia doi tugng dugc ude tinh la 625 mg/ ngay. Tii-
ket qua do, nhu cki khuySn nghi (RDA) vS Ca cho phu nir sau man kinh tir 55- 65 tudi a nong thon dugc ude tinh theo phuang phap cua K. Uenishi va CS [4,
14] la: 625 x 1,2 = 750 (mg/ ngay).
625 mg
, /
•t-
300mg
, X y ,y
y"' 600mg
Kh'^u ph'^Ti C-^lm\
X
Hinh 2. U oc tinh nhu cau canxi ciia doi tuong
Thay doi ve cdn ndng:
can nang tmng binh cua ddi tugng da tang tir 47,1 kg (trudc can thiep) ISn tdi 47,5 kg (sau giai doan 1) va 47,8 kg (sau giai doan 2), Su thay ddi can nang tii- thdi diSm tru-dc nghiSn ciiu dSn thdi diem kSt thue nghiSn cuu la khdng cd y nghia thdng kS,
V. BAN LUAN
Phuang phap balance (xac djnh nhu cau thdng qua can bang chuySn hda trong ca thS) da dugc chirng minh la cd dp chinh xac va tinh kha thi cao trong cac nghiSn cim ve nhu cau cac chat dinh dudng [4]. Ly tuang nhat la ap dung 3 diSm tuang iing vdi 3 mirc khau phan dS xac djnh nhu cau cua co thS vdi 1 chat dinh dudng (liinh 1).
Trong nghiSn ciru vS nhu cau Ca, phucmg phap su dung 2 diem tucmg iiTig vdi 2 mirc khiiu phan van dam bao tinh khoa hgc, neu diSm tuang ung vdi mire
khau phan cao nam gan sat vdi khau phan ude tinh, vi balance Ca cd liSn quan tuySn tinh vdi khau phan Ca [13]. Phuang phap sir dung 2 diSm ciing da dugc nhiSu nghiSn cuu tru-dc day sir dung va dugc chirng minh la kSt qua dang tin cay [4, 13]. Trong nghien cim nay, chiing tdi sir dung 2 mirc khau phan Ca la 300 va 600 mg/ ngay. KSt qua cho thay: nhu cau Ca ude tinli la 625 mg/ ngay, diang ung diSm gan sat vdi 600 mg/ ngay (Hinh 1). Vi vay, chiing toi tin rang ket qua ude tinh trong nghiSn ciru la tuong ddi sat vdi thue tS.
So vdi phu nii cung lira tudi a cac nudc khac, nhu eau Ca cua ddi tugng trong nghiSn cim nay thap han. Vdi ciing phuong phap sir dung, nhu cau Ca ciia phu nu- man kinh d 1 sd cdng ddng ngudi da triing la 900 mg/ ngay, o- phu nir Nhat ban la 788 mg/ ngay, trong khi dd nhu cau cua phu nir Viet nam la 625 mg/ ngay [4, 15]. KSt qua nay ddng thuan vdi kSt luan
cua nhung nghiSn cim trudc day la: nhu cau Ca khac nhau theo chiing tpc [8].
Ket qua vS lugng Ca dugc hap thu vao CO ths cung gan m-ang tu- nhu nghiSn ciru ciia K, Uenishi va CS trSn phu nij- Nhat ban ciing do tudi [4]. K. Uenishi su dung 2 muc khau phan Ca la 250 mg/
ngay va 850 mg/ ngay dS xac dinh nhu cau Ca. KSt qua so sanh cho thay: lugng Ca hap thu d mirc kliau phan Ca thap ciia ngudi Viet nam (20,2 mg/ ngay) ciing tuang duang vdi phu nfl- Nhat (21 mg/ngay), nhung d mirc khau phan Ca cao (136,1 mg/ ngay) thi cao ban ban so vdi phu nfl- Nhat (113 mg/ ngay). Day la bang ehiing chung td nhu cau Ca ciia ngudi Viet nam thap ban ngudi NTiat Ban vi diSm bao hda Ca thap ban.
"Nhu cau khuySn nghj" la mpt thuat ngii khac vdi "Nhu cau". Trong khi "nhu cau"
cua mdt chat dinh dudng vdi ca thS dugc ude tinh dua vao ca the thi "nhu cau khuyen nghj" duge sir dung dS khuySn nghj cho ca cdng ddng. Vi vay, "nhu cau khuyen nghj" thudng dugc ude tinh la gap 1,2 lan so vdi "nhu eau" [14]. Nhu cau khuySn nghj ve Ca cho 1 sd cdng ddng ngudi da trang la 1000- 1500 mg/
ngay vdi ngudi cao tudi la nCi. Nhu cau nay vdi ngudi Nhat ban cimg lua tudi la 946 mg/ ngay, trong khi ngudi Viet nam la 750 mg/ ngay. NSu tinh nhu cau theo can nang. vdi can nang trung binh ciia ddi tugng trong nghiSn ciru nay la 47,1 kg thi nhu cau Ca la 15,9 mg/ kg trpng lugng ca the. Nhu cau tinh theo can nang nay cung van thap han so vdi phu nfl- da trang (18,5 mg/ kg) va phu nfl- Nhat ban (18,1 mg/ kg) [4, 16, 17, 18]. So vdi Nhu cau khuySn nghj trong cuon "Nhu cau dinh dudng khuyen nghj cho ngudi Viet Nam" xuat ban nam 2007 thi ket qua ude tinh cua chunu tdi thap ban. Vi vay, can cd nhu-ng
nghiSn ciru tiep theo dS khang djnh ket qua nghien ciru nay va cd thSm sd lieu sat tiiuc vdi ngudi Viet nam.
KSt qua nghiSn cfl-u cua chung tdi cho thay: ddi tugng dugc tang can sau thiTi gian 45 ngay tham gia nghien cfl-u mac du su tang can nay chua cd y nghTa thong ke. DiSu nay co thS do nghien ciru dugc tiSn hanh vao thdi gian ndng nhan d ndng thdn, va khau phan dugc cung cap mac du cd tong nang lugng, glucid, protid
\ a lipid gan tucmg duang vdi khau phan thudng IS nhung su day du liSn tuc ve khau phan an da dan dSn su tang can. Tuy nhiSn, thuc don dugc tinh toan trong nghiSn CUTI nay la bam sat vdi nhu cau khuySn nghj ve cac chat sinh nang lugng nSn nhu cau calci da ude tinh la cd thS ap dung dugc.
\ I . KET LUAN
Nhu cau calci cua phu nir man kinh tu 55-65 tudi e n«ng th«n dugc ude tinh trong nghiSn cfl-u nay la 625 mg/ ngay.
Nhu cau calci khuySn nghj cho phu nfl- man kinh tir 55-65 tudi e n«ng th«n la 750 mg/ ngay.
\ II. KHUYEN NGHI
can cd nhfl-ng nghien cuu vS nhu cau calci cho nhung nhom tudi khac nhau va o nhflng vflng dja ly khac nhau trSn toan ciuoe dS ddng gdp sd lieu sat thuc va phong phfl hon cho Bang Nhu cau Dinh dudng khuySn nghi cua ngudi Viet Nam.
TAI LIEU THAIVI KHAO
1. FAO/WHO (2002). .Calcium. In:
Human Vitamin and Mineral Re- quirement. Report of a Joint Expert Consultadon. FAO Rome: 151-171.
2, Heaney RP (2000), Calcium, dairy products and osteoporosis. J Am Coll Nutr, 2000.
3. Heaney RP (2002). The important of calcium intake for life long skle- tal Healtli. Calcif Tissue Int; 70: 70- 73 4. K.Uenishi, H. Ishida, A. Kamei, et
al (2001). Calcium Requirement Es- timated by Balance Study in Elderly Japanese People. Osteoporos Int ;
12; 858-863.
5. Commission of the European Com- munities (1993). Nutrient and En- ergy Intakes for the European Community. Reports of the Scien- tific Committee for Food (31st Se- ries). Office for Official Publications of the European Com- munities, Luxembourg.
6. Connie M Weaver (2000). Calcium requirements of physically active people. Am J Clin Nutr;72(suppl):579S-84S.
7. WHO (2003). Prevention and man- agement of osteoporosis. Technical Report Series, No. 921.
8. A. Prentice (2002). What are the Di- etary Requirements for Calcium and Vitamin D? Calcif Tissue Int;
70:83-88.
9. Vu Thi Thu Hien, Nguyen Cong Khan, Nguyen Thi Lam, Le Bach Mai, Shigeru Yamamoto, et al (2005). Determining the prevalence of osteoporosis and related factors using quantitative ultrasound in Vietnamese adult women. Am J Epidemiol; 161(9): 824-830.
10. Vien Dinh dudng, Bd Y te (2003).
Tdng DiSu tra dinh dudng 2000.
Nha xuat ban Y hgc. Ha Ndi.
11. Vien Dinh dudng, Bd Y te (1997).
Nhu eau dinh dudng khuySn nghj cua ngudi Viet Nam. Nha xuat ban Y hge. Ha Not.
12. Bd Y tS- Vien Dinh Dudng. 2000.
Bang Thanh phan dinh dudng thuc pham Viet nam. Nha xuat Y hgc. Ha Ndi.
13. Jackman LA, Millane SS, Martin BR, et al. Calcium retention in rela- tion to calcium intake and post- menarcheal age in adolescent females. Am J Clin Nutr
1997;66:327-33.
13. Health Promotion and Nutrition Di- vision, Health Service Bureau, Min- istry Health and Welfare.
Recommended dietary allowances for the Japanese, 5th revision.
Tokyo: Dai Ichi Shuppan, 1996.
14. Roberts PH, Kerr CH, Ohlson MA.
Nutritional status of older women. J Am Diet Assoc 1948;24:292-9.
15. NIH consensus development panel on optimal calcium intake. Ophmal calcum intake. JAMA
1994;272:1942-8.
16. Heaney RP. Recommended calcium intakes revisited: round table. In:
Burckhardt P, Dawson-Hughes B, Heaney RP, editors. Nutritional as- pect of osteoporosis. Berlin Heidel- berg New York: Springer,
1998:317-25.
17. Food and Nutrition Board, Inshtute of Medicine. Dietary reference in- takes for calcium, phosphorus, mag- nesium, vitamin D. and fluoride.
Washington, DC: National Acad- emy Press, 1997:1 i 1-7.
SUMMARY
Study done in 2007- 2008 to estimate calcium requirement and recommended dietary allowance (RDA) for calcium in postmenopausal Vietnamese women aged from 55- 65 years, using calcium balance method. Total of 14 postmenopausal women participated in study. Each pardcipant was subjected to a low calcium intake (300 mg/ day) for 15 days. After an interval of 2 weeks, an other 15 days period was set with high calcium intake (600 mg/ day) for each subject. Calcium intake levels were calculated based on Vietnamese Food Composition Table published in 2000, Calcium content in intake, feacc and urine were analyzed by Atomic Absorption Spectrophotometer Cal- cium balance was calculated at each dose of calcium intake. Calcium requirement was estimated by linear regression between calcium intake and calcium balance. The results showed that daily calcium requirement was 625 mg in studied subjects. Recommended dietary allowance (RDA) for calcium is 750 mg per day in postmenopausal women aged from 55- 65 years in mral area. Further studies should be done to confirm our result and contribute fruitful data to Recommended dietary allowance (RDA) for Vietnamese people.
HIEU QUA CUA BO SUNG DO U O N G MILO D E N T I N H TRANG D I N H
D U O N G ,THE LlTC VA TRI LlTC CUA TRE EM 7 ^ TUOI T M HUYEN GIA BINH-BAC NINH
Nguyen Xuan Ninh', Nguyen Thanh Huffng^, Ddng Trudng Duy^, Phgm Thi Ngdn\ Gidp Binh Nga^, Duffng Dieu Hoa ^, Le Thi Hop'
Hieu qua eua do ucing MILO den dnh trang dinh dudng, boat dgng the luc, tri luc dugc danh gia tren tre em tieu hoc (ldp 2, 7-8 tuoi), tai huyen Gia Binh, Bac Ninh. Mdt nhom dugc uong 150 ml MILO/ngay (MILO. n=59); nhom chimg dugc uong 150 ml sira nguyen kem/ngay (CTR, n=59); 5 ngay/tuan, trong thdi gian 16 tuan. Cac test ve the luc (nang ta, chay 50m), ve tri lue (tap tmng nghe, nhin, xiic giac tay, phan tich) dugc danh gia khi bSt dau ciing nhu ket thuc nghien cuu.
Ket qud: Sau 16 tuan bo sung, nhdm tre uong MILO e6 sir tang can nang tot hon (l,8±0,8kg, p<0,05 so vdi l,4±0,8kg ciia CTR); tang so lan nang ta nhieu hon (5,8±3,1 lan, p<0,001 so vdi 3,4±2,1 lan cua CTR); chay 50m nhanh hon (10,4±0,7 giay, p<0,05 so vdi nhom CTR (10,8±1,0 giay). Tong so diem tmng binh cua 4 loai test tri luc cua nhdm MILO (303,1±34,1 diem) cao ban y nghia (p<0,001) so voi nhdm CTR (280,5±28,9); tac ddng ro ret nhai cua MILO lam tang so diem cua chi so tap tmng nghe-thinh luc (75,3x12,8 diem, p<0,001 so vdi 65,9±13,6 cua CTR) va test tap trung phan dch (78,7±12,2 diSm, p<0.()l so vdi 71,5±13,4 cua CTR). Ket ludn : MILO la do udng c6 tac dung tot tang cudng hoat dong the lire cung nhu mpt sd test ve tri luc cua tre em
hpc dudng. ' Tu- khoa , MILO, the luc. tri luc, tre em hoc dirang
' P( iS, TS - Vien Dinh duang - KS - Vien Dinh duong
^ Bo mon tam ly tieu hoc - Dai Hoc Su Pham Ha Noi