台灣老年人飲食型態與認知功能障礙之關聯研究

Association between Dietary Patterns and Cognitive Impairment in Taiwanese Elders

張凱婷(Kai-Ting Chang)

指導教授 ： 程蘊菁

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.10126

摘要

背景
台灣人口老化速度為世界第二。隨著人口快速老化，與老化相關的疾病(例如：認知功能障礙)成為重要的健康議題。認知功能障礙包含輕度認知功能障礙及失智症。過去探討營養素或單一食物與認知功能障礙研究的結果並不一致，而這些研究以西方國家的飲食型態為主，由於東西方飲食差異甚大，因此本研究旨在探討台灣老人之飲食型態與認知功能障礙之關聯。
方法
此研究為橫斷性研究，招募了566位於2011至2013年間參加臺大醫院老人健康檢查的65歲以上之老人。認知功能障礙使用蒙特利爾認知測試來評估(分數為0-30)。過去一年的飲食資料則用44項半定量的飲食頻率問卷收集。接著以主成分分析找出此族群的飲食型態，並用羅吉斯回歸模型用來探討飲食型態(將因素分數依人數分為三組)與認知功能障礙的關聯。同時對於可能的混淆因子進行分層分析，探討其如何影響飲食型態與認知功能障礙之關聯。
結果
傳統飲食型態(發酵食物和醃漬蔬菜)較高的二組，比起因素分數最低的一組，皆能顯著降低認知功能障礙的風險(第二組：調整後勝算比＝0.30-0.34，95%信賴區間＝0.16-0.59，第三組：調整後勝算比＝0.33-0.39，95%信賴區間＝0.18-0.67)。以年齡(< 75歲及 ≥ 75歲)或性別分層後，發現在傳統飲食型態較高的二組仍能降低認知功能障礙的風險(< 75歲，第二組：調整後勝算比＝0.29，第三組：調整後勝算比＝0.30，P趨勢＝0.006；≥ 75歲，第二組：調整後勝算比＝0.30，第三組：調整後勝算比＝0.40；女性：第二組：調整後勝算比＝0.25，第三組：調整後勝算比＝0.30；男性：第二組：調整後勝算比＝0.33，第三組：調整後勝算比＝0.40)。相反的，傳統飲食型態較高的二組只在沒有帶APOE e4遺傳半型的老人存有保護作用(第二組：調整後勝算比＝0.36，第三組：調整後勝算比＝0.38)，對於帶有APOE e4遺傳半型的老人，傳統飲食型態只在第二組有保護作用(調整後勝算比＝0.06)。此外，傳統飲食型態較高二組的保護作用只存在於有攝取營養補充品者(調整後勝算比＝0.31及0.33)。
在飲食習型態與可能的混淆因子，也就是年齡分組、性別、APOE e4狀態及營養補充品，對於認知功能障礙風險皆沒有交互作用存在。
結論
傳統飲食型態(發酵食物和醃漬蔬菜)顯著降低認知功能的障礙，但並未呈現劑量效應。且APOE e4狀態及營養補充品，似乎會影響傳統飲食型態與認知功能障礙的關聯性。台灣的飲食有別於西方的飲食，需要更多前瞻性且在中國族群的大型研究來證實本研究的發現。

關鍵字

認知功能障礙 ； 飲食型態 ； 醃漬蔬菜 ； 發酵食物

並列摘要

Background
Taiwan’s aging rate ranks the 2nd in the world. As population aging quickly, aging related health issue, e.g., cognitive impairment, becomes an important health concern. Cognitive impairment includes both mild cognitive impairment (MCI) and dementia. Previous studies showed inconsistent findings between nutrients or foods and cognitive impairment. These studies mainly focused on the western diet, which is different from the East on diet and the West are quite different. Therefore, this study was aimed to assess the relationship between dietary pattern and the risk of cognitive impairment in Taiwanese elders.
Material and Methods
This is a cross-sectional study. A total of 566 elders aged 65 or older were recruited from the annual elderly health checkup program, National Taiwan University Hospital, Taipei, Taiwan from 2011 to 2013. Cognitive impairment was assessed by Montreal Cognitive Assessment (MoCA, score range: 0 to 30). Diet information in the past year of recruited date was collected based on a 44-item semi-quantitative food frequency questionnaire. Principal component analysis was performed to identify dietary patterns. Logistic regression model was used to explore the association between dietary patterns (tertiled factor score) and cognitive impairment. Stratifications by potential confounders were performed to explore how they affected the association between dietary patterns and cognitive impairment.
Results
Higher tertiles of “traditional Chinese” dietary pattern (fermented foods and pickled vegetables) protected against cognitive impairment [T2: adjusted odds ratio (AOR) = 0.30-0.34, 95% confidence interval (CI) = 0.16-0.59; T3: AOR = 0.33-0.39, 95% CI = 0.18-0.67] as compared to the lowest tertile. No significant interaction was observed between dietary pattern groups and potential confounders (i.e., age groups, sex, APOE e4 status, and supplement use) on the risk of cognitive impairment. Stratification by age groups (< 75 and ≥ 75 years old) or sex showed similar protective effect in the higher tertiles of “traditional Chinese” dietary pattern (Age < 75, T2: AOR = 0.29, T3: AOR = 0.30, P for trend = 0.006; Age ≥ 75, T2: AOR = 0.30, T3: AOR = 0.40; women, T2: AOR = 0.25, T3: AOR = 0.30; men, T2: AOR = 0.33, T3: AOR = 0.40). Protective effect was found in higher tertiles of “traditional Chinese” dietary pattern among APOE e4 non-carriers (T2: AOR = 0.36, T3: AOR = 0.38), while protective effect was only observed in the 2nd tertile among APOE e4 carriers (AOR = 0.06). In addition, the protective effect of the higher tertiles of “traditional Chinese” dietary pattern was only observed in participants with supplement use (AOR = 0.31 and 0.33).
Conclusions
“Traditional Chinese” dietary pattern (fermented foods and pickled vegetables) protected against cognitive impairment but not in a dose-response relationship. APOE e4 status and supplement use seemed affect the association between “traditional Chinese” dietary pattern and cognitive impairment. Taiwanese diet is different from the western diet, larger prospective studies in Chinese population are needed to confirm our finding.

並列關鍵字

cognitive impairment ； dietary pattern ； pickled vegetable ； fermented food

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