- 學位論文
中老年人飲食型態與代謝症候群危險性
The Relationship between Dietary Pattern and the Risk of Metabolic Syndrome in Middle-aged and Older Adults
摘要
代謝症候群的特徵為一系列的心血管疾病危險因子，包括血壓升高、血脂異常、血糖異常和腹部肥胖，而代謝症候群會增加罹患心血管疾病、第二型糖尿病和全因死亡率的風險。根據1993-1996年及2005-2008年兩次台灣國民營養健康狀況變遷調查(Nutrition and Health Survey in Taiwan, NAHSIT)的結果顯示，成人代謝症候群盛行率快速增加，且隨著年齡增加代謝症候群之盛行率越高。多項研究顯示相較於單一營養素或食物，飲食型態更能預測疾病風險或死亡率。本研究使用NAHSIT 2013-2016中所收集之45歲以上中老年樣本為對象，除了一般描述性分析之外，利用因素分析(factor analysis)將飲食頻率問卷(food frequency questionnaire, FFQ)中眾多食物項目濃縮成「飲食型態」變項，並計算各飲食型態分數，最終使用1088人以邏輯式迴歸(logistic regression)分析來探討中老年飲食型態與代謝症候群之危險性。分析結果發現中老年代謝症候群總盛行率高達46%。由因素分析歸納出五種主要飲食模式，包括高蛋白質、高脂肪、高糖飲食型態、魚類及海產飲食型態、蔬菜及豆類飲食型態、全穀、水果、乳製品及堅果類飲食型態以及調味、發酵及醃漬飲食型態。於單變量分析發現蔬菜及豆類飲食型態(0.688, 0.489-0.966)和全榖、水果、乳製品及堅果類飲食型態(0.575, 0.407-0.814)、年齡(1.029, 1.017-1.041)、BMI(1.456, 1.382-1.535)、睡眠時間大於8小時(1.424, 1.084-1.870)、坐著時間(1.046, 1.002-1.093)、目前仍有(1.760, 1.198-2.587)及過去曾抽菸(1.719, 1.262-2.341)、過去曾飲酒(2.400, 1.326-4.345)皆為代謝症候群顯著關聯因子；各變項於複迴歸模型相互調整後可觀察到女性(1.516, 1.052-2.183)、年齡(1.047, 1.031-1.062)、BMI(1.500, 1.417-1.588)、目前仍有(2.513, 1.484-4.257)及過去曾抽菸(1.604, 1.025-2.511)會增加代謝症候群風險，而睡眠時間少於6小時(0.513, 0.302-0.871)會降低代謝症候群風險。本研究結果顯示蔬菜及豆類飲食型態和全穀、水果、乳製品及堅果類飲食型態皆可降低代謝症候群風險，而除了性別、年齡等不可改變因素之外，BMI、飲食模式及生活型態等因子的調整可能有助於降低代謝症候群之風險。
並列摘要
Metabolic syndrome is characterized by a cluster of various risk factors associated with the development of cardiovascular disease, including elevated blood pressure, dyslipidemia, hyperglycemia and abdominal obesity. Metabolic syndrome increases not only the risks of cardiovascular disease and type 2 diabetes but also the all-cause mortality. According to the results of the two Nutrition and Health Surveys in Taiwan (NAHSIT 1993-1996 NAHSIT 2005-2008), the prevalence rates of metabolic syndrome increased rapidly, and the prevalence increased with age. Several studies demonstrated that dietary intake play some roles in predicting disease risk or mortality, yet the effects of overall diet, as examined by dietary patterns, may be more important than individual foods or nutrients. In the present study, the data of 1088 adults aged 45 years and older, collected in NAHSIT 2013-2016, were analyzed to investigate the relationship between dietary patterns, specific lifestyle factors and the risk of metabolic syndrome in middle-aged and older adults. The food frequency questionnaire data were analyzed by factor analysis to generate dietary patterns, and the scores for each dietary pattern were calculated for the subsequent regression analyses. The results showed that prevalence rate of metabolic syndrome was 46%. Five main dietary patterns were derived from factor analysis, including “high in protein, fat sugar”, “fish seafood”, “vegetable soybean”, “whole grain, fruit, dairy nuts” and “seasoned, fermented pickled”. The results of univariate models showed that “vegetable soybean” dietary pattern, “whole grain, fruit, dairy nuts” dietary pattern, age, BMI, more than 8 hours of sleep, sitting time, current or former smokers and former drinkers were significantly associated with metabolic syndrome (OR=0.688, 0.575, 1.029, 1.456, 1.424, 1.046, 1.760, 1.719 2.400, respectively). After reciprocal adjusting in the multiple regression model, being females, advanced age, higher BMI, and current or former smokers would increase the risk of metabolic syndrome (OR=1.516, 1.047, 1.500, 2.513 1.604, respectively), whereas less than 6 hours of sleep seemed to reduce the risk of metabolic syndrome (OR= 0.513). In conclusion, the results of the current analysis showed that the dietary patterns of “vegetable soybean” and “whole grain, fruit, dairy nuts” appeared to reduce the risk of metabolic syndrome. In addition to diet, strategies for better protection against metabolic syndrome should include the maintenance of healthy body weight and lifestyle.