우유와 노인건강 Improving the General health and Well-being of Older People Minseon Park Department of Family Medicine, SNUH

목차 1. 노인 영양 2. 동물성 식품과 영양소 3. 동물성 식품과 건강 심혈관질환 암 비만, 당뇨, 대사증후군 골다공증 예방

연령계층별 고령인구 2013 고령자 통계, 사회통계국 통계기획과

To live healthier

고령자의 영양 생리 기능 저하, 소화기능 저하, 치아 불량 은퇴 이후 경제적인 어려움, 노년기 우울증  노년기 영양섭취 불량  노년기 영양섭취 불량  면역력 감소 신체활동 감소 질병 이환의 증가 윤성하, 우리나라 노인의 영양 섭취 현황, 질병 관리본부

노인의 1일 에너지, 단백질 섭취비율(%) (2010, 11 국민건강영양조사) Insufficient energy intake< 75% 이하 other nutrient intake> estimated AR Excess energy intake>125% 이상 sodium intake > 2000 mg other nutrient > tolerable UI

한국인의 부족 및 과다 영양소 (65세이상 남녀) 영양소 평균 섭취량 mg 권장량 mg 권장량 비율 % 칼슘 511393 (2001 2011국민건강영양조사) 영양소 평균 섭취량 mg 권장량 mg 권장량 비율 % 칼슘 511393 700 54-61 리보플라빈 (B2) 1.090.9 1.5(남) 1.2(여) 51-62 비타민 A (여성) 568584 RE 700RE 54 철분 11.3 (여) 12.3 (남녀) 16 79 비타민 C 123 83 mg 70 165 염분 (소금) 11.6 9.6gm 5gm 이하 116

목차 1. 노인 영양 2. 동물성 식품과 영양소 3. 동물성 식품과 건강 심혈관질환 암 당뇨 골다공증 예방

영양소 닭고기 (살코기) 돼지고기 (목살) 소고기 (등심) 60 1인 1회 섭취량 (g) 30 40 에너지 (kcal) 69 108 115.5 지방 (g) 0.8 5.8 6.75 단백질 (g) 14.4 12.2 12 칼슘 (mg) 6.6 6 13.2 철 (mg) 0.7 3.8 2.7 비타민 A (RE) 28.2 4.2 비타민 B2 (mg) 0.13 0.06 0.12 나트륨 (mg) 34.8 64.8 265.2 87% water, 4-5 % lactose, 3-4% protein or fat 농촌진흥청

우유와 영양소 Average nutrtioinal composition of whole, low fat, skim milk 87% water, 4-5 % lactose, 3-4% protein or fat Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013

목차 1. 노인 영양 2. 동물성 식품과 영양소 3. 동물성 식품과 건강 암 심혈관질환 비만, 당뇨, 대사증후군 1. 노인 영양 2. 동물성 식품과 영양소 3. 동물성 식품과 건강 암 심혈관질환 비만, 당뇨, 대사증후군 근감소증, 골다공증 예방

65세 이상 사망원인 및 사망률 1 위 2 위 3 위 4 위 5 위 2000 암 (929.7) 뇌혈관질환 (785.3) (단위 : 인구 10만명당 명)   1  위 2  위 3  위 4  위 5  위 2000 암 (929.7) 뇌혈관질환 (785.3) 심장질환 (358.9) 당뇨병 (218.4) 만성하기도질환 (209.1) 2010 (882.4) (409.4) (344.0) (153.1) 폐렴 (127.6) 2011 (847.8) (381.1) (361.2) (155.4) (143.2) 2012 (852.9) (372.9) (367.1) (166.4) (163.0) 남자 (1,287.3) (400.0) (371.6) (196.7) (188.8) 여자 (550.6) (363.9) (354.1) (152.3) (145.4) 자료: 통계청 ,사망원인 통계,

성별 주요 암종 발생분율:2012 자료: 중앙암등록 통계,2012

연령군별 암발생순위 남녀전체:2012 (단위 : 인구 10만명당 명) 자료: 중앙암등록 통계,

주요암종별 연령 표준화 발생율 추이:1999-2012 (단위 : 인구 10만명당 명) 자료: 중앙암등록 통계,

체질량 지수 및 암종별 발생 Lancet. 2014 Aug 30;384(9945):755-65. doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13 Lancet 2014 Aug 30;384 (9945):755-65 . doi: 10.1016/S0140-6736(14)60892-8

체질량 지수 및 암종별 발생 : per BMI change of 1 kg/m2 (AICR vs KCPS 1992-2006) Lancet. 2014 Aug 30;384(9945):755-65. doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13 Int J Cancer 2008; 123:1892-1896

동물성식품과 암 Heme Iron from Meat and Risk of CRC Good vs Bad ? Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013 Not clear  not the effect of a single food and nutrients in its origin and development insulin like growth factor (IGF-1) increased risk of breast, prostate CA ? fat content excess fat: energy source for cancer cell bladder, breast androgen and estrogen production in prostate and breast Lactose -> galactose : ovary Calcium  impairs vitamin D synthesis : prostate Cancer prev Res 2011: 4(2): 177-184

Red meat, processed meat 과 대장암 Good vs Bad ? Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013 Not clear  not the effect of a single food and nutrients in its origin and development insulin like growth factor (IGF-1) increased risk of breast, prostate CA ? fat content excess fat: energy source for cancer cell bladder, breast androgen and estrogen production in prostate and breast Lactose -> galactose : ovary Calcium  impairs vitamin D synthesis : prostate Recommendation by AICR; less than 500 g/week of red meat, avoid processed meat Cancer prev Res 2011: 4(2): 177-184

유제품과 대장암 Good vs Bad ? Not clear  not the effect of a single food and nutrients in its origin and development Moderate milk consumption Ca, folate, Vit D Ca -anti proliferative through its role in secondary bile acids and ionized FA colorectal cancer risk Crit Rev Food Sci Nutr. 2014;54(9):1167-79. doi: 10.1080/10408398.2011.629353.

유제품과 대장암 Good vs Bad ? Not clear  not the effect of a single food and nutrients in its origin and development insulin like growth factor (IGF-1) increased risk of breast, prostate CA ? fat content excess fat: energy source for cancer cell bladder, breast androgen and estrogen production in prostate and breast Lactose -> galactose : ovary Calcium  impairs vitamin D synthesis : prostate Crit Rev Food Sci Nutr. 2014;54(9):1167-79. doi: 10.1080/10408398.2011.629353.

Red and processed meat 과 심혈관질환 Risk of CHD associated with 100 g serving per day of processed meat and 50g serving per day of processed meat Curr Atheroscler Rep 2012; 14 (6):512-524

Red and processed meat 과 뇌혈관질환 European Journal of Clinical Nutrition 2013; 67:91-95

유제품과 심혈관질환 Good vs Bad ?  CV protective Saturated fat 70% (palmitic, myristic, lauric FA)  cholesterol, LDL  CVD risk  Replace whole milk to low fat milk Minerals including Ca, Mg, K  20% reduction in hypertension incidence Direct inhibitory effect of casein induced peptide for ACE synthesis  Agt II (Engberink MF etal. Inverse association between dairy intake and hypertension: the Rotterdam study Animal Frontienr; 2014:4:8-15

우유와 심혈관질환 Good vs Bad ?  CV protective Saturated fat 70% (palmitic, myristic, lauric FA)  cholesterol, LDL  CVD risk  Replace whole milk to low fat milk Minerals including Ca, Mg, K  20% reduction in hypertension incidence Direct inhibitory effect of casein induced peptide for ACE synthesis  Agt II (Engberink MF etal. Inverse association between dairy intake and hypertension: the Rotterdam study) Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013

Meat 와 당뇨 Risk of CHD associated with 100 g serving per day of processed meat and 50g serving per day of processed meat Curr Atheroscler Rep 2012; 14 (6):512-524

유제품과 당뇨 low fat dairy product 섬취와 2형 당뇨 위험 Good vs Bad ? Dairy products consumption and risk of T2 DM: systematic review and dose-response meta-analysis PLoS One 2013; 8(9):e73965

우유와 당뇨 low fat dairy product 섬취와 2형 당뇨 위험 Good vs Bad ? Dairy products consumption and risk of T2 DM: systematic review and dose-response meta-analysis PLoS One 2013; 8(9):e73965

우유와 당뇨 Protective Ca, Mg  insulin sensitivity, glucose tolerance Whey proteins  excessive food intake weight gain Proteins  satiety, appetite control in gut hormones CCK, GLP1 ghrelin Conjugated linoleic acid (CLA) adiposity BP control, antioxidant, anti-inflammatory effect Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013

(노인성)근감소증

Age-Related Loss of Skeletal Muscle Mass (노화로 인한 근육량의 감소: 남자 VS. 여자) B: relationship between relative SM mass and age in men and women. Solid lines, regression lines. Note that slope of regression line is greater (P , 0.01) in men than in women. A: relationship between whole body SM mass and age in men and women.

Muscle Strength vs mortality (Anne BN et al. J Geron. 2006)

동물성 단백질 섭취와 근육량 감소 노년기 근육량 감소 저하 70-79세 노인 2066명을 대상 3년간 추적연구 시행 그림. 동물성단백질 섭취량에 따른 LM의 변화 그림. 동물성단백질 섭취량에 따른 aLM의 변화 *LM : 체중에서 지방의 무게 제함 *aLM : 팔,다리 부분의 체중에서 지방무게 제함 Gerontology 2009; 55: 707-713

우유와 골다공증 Protective Ca, other minerals  peak bont mass during growth Peptides and CLA  favorable actions in bond mass Bone matrix like high biological value proteins Vitamin C, D, K Copper, Zinc, Manganse High calcium absoption due to lactose, and Ca/P ratio Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013

우유의 건강위해 Lactose malabsorption: lack of β-galactosidase activity due ot sugar fermentation in colon  small amounts, throughout the day  adaptation Cow milk protein allergy: 2-7.5% neonatal period or during the first years of life due to whey protein, mainly β-lactoglobulin replace CMP for hydrolyzed or amino acid options or soy or rice formula anaphylaxis, cutaneous reactions with urticaria and edema respiratory episodes and GI distress Pereira PC, Milk nutritional composition and its role in human health, Nutrition 2013

1. 전체적으로 열량이 부족하지 않게, 열량, 동물성 단백질이 지나치게 부족  폐질환 위험성이 높아짐  연세드신 분 기침이 잦아질 때는 폐 CT 를 시행함 2. 제철식품을 다양하게

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