Cognitive Impairment and Limited Dietary Diversity or Physical Inactivity Are Conjoint Precursors of Incident Diabetes More So in Elderly Women than Men

認知功能障礙伴隨單調飲食或缺乏運動是老年女性而非男性罹患糖尿病的前導因子

Li-Li Xiu ； Mark L Wahlqvist ； Meei-Shyuan Lee ； Rosalind Chia-Yu Chen ； Duo Li

《Asia Pacific Journal of Clinical Nutrition》 22卷4期 (2013/11) Pp. 635-645

https://doi.org/10.6133/apjcn.2013.22.4.20

摘要

已有研究發現患有糖尿病的老人易發生認知功能障礙，對於患有認知功能障礙的老人是否更易發生糖尿病，也就是老人糖尿病和認知功能障礙發生是否存在雙向性影響，目前不可知。本研究的目的為觀察患有認知功能障礙的老人是否更容易發生糖尿病。以參與1999－2000年臺灣老人營養和健康調查中1493位年齡超過65歲，且沒有糖尿病的老人為研究對象，追蹤8年，研究糖尿病發生率和認知功能的關係。認知功能障礙和糖尿病的發生率以Cox比例風險迴歸模型來分析。結果發現有認知功能障礙的女性其糖尿病發生率顯著提高，但在男性中沒有觀察到這樣的結果。以正常認知功能組做為參照組，在校正年齡，性別，種族和個人行為之後，認知功能障礙老年女性二型糖尿病風險比值（HR）為2.43（95%信賴區間：1.27－4.63），男性為1.55（95%信賴區間：0.48－5.07）。在分別校正年齡，種族，個人行為和經濟狀況，飲食品質，身體活動功能，運動，空腹血糖值，身體質量指數，腰圍及中臂肌圍等可能影響糖尿病發生的變數後，性別差異和風險比顯著性仍然存在。在女性中，上述共變數對糖尿病的發生存在顯著交互作用。飲食品質差及少運動，會增加認知功能障礙老年女性患糖尿病的風險比。

關鍵字

認知功能障礙 ； 第二型糖尿病 ； 飲食 ； 運動 ； 身體組成

並列摘要

OBJECTIVES: To establish whether elderly people with impaired cognition are at greater risk for the development of type 2 diabetes. DESIGN: Prospective population-based cohort study. SETTING: The Elderly Nutrition and Health Survey in Taiwan (NAHSIT Elderly). PARTICIPANTS: One thousand and four hundred ninety-three diabetes-free people ≥65 years were followed for incident diabetes in relation to cognitive status for up to 8 years. MEASUREMENTS: The association between cognitive impairment and diabetes incidence was analyzed with Cox proportional hazards models with exclusion of people who had diabetes within one year of cognitive function assessments. RESULTS: Cognitively-impaired women, but not men, had increased diabetes incidence density (DID). Age, gender, ethnicity and personal behavior adjusted hazard ratios (HR) and 95% confidence intervals (CI) for type 2 diabetes with normal cognition as referent were 2.43 (95% CI: 1.27-4.63) for women and 1.55 (95% CI: 0.48-5.07) for men. These gender differences and the HR significances remained with adjustments for age, ethnicity, financial status, dietary quality as a dietary diversity score, physical function, physical activity, fasting glucose, indices of body composition, body mass index, waist circumference, mid-arm muscle circumference, perceived and mental health status. There were extensive significant interactions with the covariates in women. CONCLUSION: Cognitive impairment in later life is associated with greater risk of type 2 diabetes in women and considerable potential risk enhancement.

並列關鍵字

cognitive impairment ； type 2 diabetes ； dietary ； physical activity ； body composition

參考文獻

Tu SH, Chen C, Hsieh YT, Chang HY, Yeh CJ, Lin YC et al. Design and sample characteristics of the 2005-2008 Nutrition and Health Survey in Taiwan. Asia Pac J Clin Nutr. 2011;20:225-37.

Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care. 2009;32:287-94. doi: 10.2337/dc08-1296

Di Carlo A, Baldereschi M, Amaducci L, Maggi S, Grigoletto F, Scarlato G et al. Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. J Am Geriatr Soc. 2000;48:775-82.

Croxson SCM, Jagger C. Diabetes and cognitive impairment - a community-based study of elderly aubjects. Age Ageing. 1995;24:421-4. doi: 10.1093/ageing/24.5. 421

Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes--systematic overview of prospective observational studies. Diabetologia. 2005;48:2460-9. doi: 10.1007/s00125-005-0023-4