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« 日産婦シンポジウム 「妊娠と栄養・代謝」② 1/2 | メイン | 息抜き。 »

2006年05月05日

前回の続きで、日産婦シンポジウム「妊娠と栄養・代謝」の2つ目の演題、「妊娠女性・若年女性における葉酸栄養状況とその効果に関する研究」を要約します。


目的は、「わが国におけるNTD(神経管閉鎖障害)抑制に向けた葉酸栄養状況の問題点を抽出すること」ということです。ちょっと小難しいかもしれません。

葉酸とNTDについては前回のログをお読みください。



1 非妊娠女性において、血清葉酸・ホモシステイン値濃度を測定し、食事中の葉酸摂取量との相関、およびMTHFR(後述)の遺伝子多型との関連、葉酸サプリメント内服による濃度の変化を検討した。


(結果)非妊娠女性においてはMTHFR677-塩基多型により、血清葉酸・ホモシステイン濃度に格差が見られるが、葉酸サプリメントの投与(400μg/day)により格差改善の効果が認められた

非妊娠女性の食事からの葉酸摂取量は平均316μg/dayと良好であった。しかし葉酸摂取量と血清葉酸濃度の相関は弱く、非妊娠女性の場合、食事内容の改善では血清葉酸濃度の改善→NTDの抑制が期待できないことを示唆する。


 

2 同様の検討を妊娠中期の女性に対して実施。


(結果)妊娠中期女性の食事からの葉酸摂取量は十分でなく、平均275μgにとどまった。しかし食事内容と血清葉酸濃度・ホモシステイン濃度との相関は非妊婦より良好。妊娠(中期)女性では必ずしもサプリメントに頼らなくとも、食事指導による(血清葉酸濃度の)改善の余地がある考えられる。(*カッコ内は矢崎の補足)


3 妊娠女性にアンケートを実施し、厚生省の勧告を知っていたか、サプリメントを使用したかを調査し、背景因子との関連を検討。


(結果)妊娠前から妊娠初期に掛けて葉酸サプリメントを使用していた妊娠女性は13.5%に過ぎず、ここ数年著名に増加したとは言い難い。背景因子の解析では、もともとサプリメント類を使用する習慣のない女性の使用率が特に低率であることが注目される。



以上は配布資料の文章をほぼそのまま書いたものなので、わかりやすくなるよう解説してみます。


MTHFRMethylene Tetrahydrofolate Reductase)とは、10-メチレンH葉酸から5-メチルH葉酸への過程に作用する酵素で、この遺伝子に多型(異常が起きたりすること)があることが知られています。この遺伝子の異常があると、MTHFRの活性(利き方)が低下し、葉酸の活性型である5-メチルH葉酸の産生が減少します。それによりアミノ酸の一種であるホモシステインからメチオニンへの代謝が障害され、血中ホモシステイン濃度が高まり、NTD(神経管閉鎖障害)が引き起こされると言われています。

(しかしNTDの発生は多因子的なものであり、葉酸摂取のみで予防できるものではありません)


これはつまり、「体質によって葉酸の血中濃度が低くなりやすい人、すなわちNTDの発生率が高くなりやすい人がいる」、と言うことを意味します。


この遺伝子の異常を持たない女性、1つ持っている女性、2つ持っている女性では、葉酸・ホモシステインの血中濃度に差がありました。しかし、葉酸サプリメントを投与すると、各群とも葉酸濃度は上昇し、その差はなくなりました。

これは体質的に葉酸が低くなりやすい人でも、葉酸サプリを摂れば血中濃度はきちんと上昇するので、NTDの予防効果が期待できる、と言うことを意味します。


食事と血清葉酸濃度を調べた結果では、妊娠してない女性の場合、食事に気をつけても葉酸濃度は上がらない、=NTDの予防効果は期待できない、ということが示唆されます。

それに対して妊娠中期の妊婦では、食事に気をつければ葉酸濃度は上がるので、サプリメントを摂らなくても食事指導によって血中濃度の改善は期待できるようです。おそらく妊娠すると食事からの葉酸の吸収が良くなるのでしょう。

しかしこの調査は妊娠1620の妊婦で行われたので、妊婦と言ってもNTDの発生に重要な妊娠7週以前ではどうなのか、ということは検討されていません。


最後のアンケート調査は、妊娠前から葉酸サプリメントを摂っていた妊婦は1割強に過ぎず、啓蒙活動は(ほぼ全く)功を奏していない、と言うことです。これはサプリメント自体がまだそれほど市民権を得ていない、ということも背景にあります。



以上をまとめると、

NTDを抑制する(=葉酸血中濃度を上げる)ためには、食事指導は有効でなく、妊娠前からのサプリメントによる葉酸の摂取が必要である

しかし、妊娠しそうな女性たちにおける認知度は低く、かつ葉酸摂取をサプリメントで徹底させることは限界がある

ということです。

 

現在の日本の葉酸栄養についての問題点が浮き彫りになった形です。



まあそうだよね、と言う結果ですが、データできちんと示されたと言う事実が貴重です。

ということは、諸外国のように葉酸を食品に強制添加するしかないでしょ、という話なわけです。

会場では、カップ麺などのジャンクフードに添加すべきである、という意見が出されました。栄養のことなど考えたこともない若い人たちに今さらジャンクフードを食べるなと言っても無理ですから、そうするべきだと私も思います。

しかし、そうするには国家の強制力が必要ですが、日本人の食文化が崩壊し、栄養欠乏による健康被害が起きているという問題は、現実には放置されていますから、このまま時間がたてはNTDの赤ちゃんはどんどん増えるでしょう。

多分アメリカ並みに健康水準が悪くならないと、政府は動かないでしょうね。そうでなくても緊急的に解決すべき問題が山積みですから…。


まあ健康に対する責任を政府だけに求めても仕方ないので、後は自衛するしかないです。

自分や家族の健康を守るのは、自分しかいないのですから、私たち一人一人が自分の健康に責任を持つことが必要ですよね。

蛇足ですが、「CSI:マイアミ」という犯罪捜査を題材にした米TVドラマで、被害者女性の血清葉酸濃度が高いことから被害者が妊娠していたことがわかり、犯人逮捕に結びついた、というエピソードがあったくらい、アメリカでは「妊娠=葉酸」なわけです。

大体においてアメリカは反面教師であるわけですが、こういうところは見習うべきだと思います。


というわけで、このブログを読んだ方で健康な(少なくともNTDでない)赤ちゃんが欲しい、と思っている方は、是非葉酸を、少なくとも1400μgはサプリメントで摂取して欲しい思います(上限はアメリカCDC1mgと言っています(医師の管理下にある場合を除く))。

葉酸が足りないと言うことはそれ以外のビタミンも足りてないはずなので、マルチビタミン・ミネラルで摂ることをお勧めします。(*ビタミンAは混合カロテノイドの形で摂るのが良いでしょう)

ちなみに、次の演題に出てきますが、タン白質もきちんと摂ることを強くお勧めします。


ではまた次回 ロケット

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Apple now has Rhapsody as an app, which is a great start, but it is currently hampered by the inability to store locally on your iPod, and has a dismal 64kbps bit rate. If this changes, then it will somewhat negate this advantage for the Zune, but the 10 songs per month will still be a big plus in Zune Pass' favor.

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原因不明の体調不良、月経前症候群、うつ症状、パニック障害、過食症、肥満…、あなたのその症状は、低血糖症が原因かもしれません!


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Optimal Health オプティマル・ヘルスとは、「最高の健康状態」を意味する言葉です。
「病気ではない」という消極的な意味での健康ではなく、エネルギーに満ちた快適な状態でいられること。
その人らしい人生を思う存分過ごすこと。
すべての患者様にOptimal Healthを得ていただくことが、私達の願いです。


未来の医者は薬を使わず、食事を重視し、病気の本来の原因を探し、予防するという、人間の基本を大切にして治療をするであろう。
トーマス・エジソン
(1847-1931)

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クリニック ハイジーア


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