台灣素食與代謝風險：糖尿病與非酒精性脂肪肝

背景:素食含有較低的飽和脂肪酸與血鐵質，及較高的纖維及植物生化素，這些可能影響幾個糖尿病致病機轉，然而目前很少研究探討亞洲素食飲食型態對糖尿病的影響。目的: 了解台灣素食飲食對糖尿病發生率及其相關代謝危險因子，包含肪肝、代謝症候群、及葡萄糖代謝異常的影響。方法: 慈濟健康研究於 2007–2009 年之間招募了4625 名慈濟志工，其中約1/3 為素食者，2/3 為葷食者。所有參予者在大林慈濟醫院進行完整的健康檢查，並接受問卷訪問基本資料、疾病及健康史、生活型態、與飲食。並於2010–2012 及2013–2016 年追蹤疾病狀況及飲食改變。參予者每三年被邀請回醫院作追蹤檢查。從沒回來接受追蹤檢查者以郵寄問卷追蹤。結果: 台灣素食飲食除了不含肉類及魚類，也包含較高的黃豆、蔬菜、全榖、堅果種子，其與較低的代謝症候群(以ATP III 定義: OR: 0.84, 95% CI: 0.70 – 1.00; 以International Federation of Diabetes 定義: OR: 0.62, 95% CI: 0.49 – 0.77)，較低的脂肪肝(OR: 0.79, 95% CI: 0.68, 0.91)，以及較低的肝臟纖維化有相關性。在平均5 年的追蹤期間，有183 名糖尿病新案例，與葷食者比較且校正可能干擾因子後，長期素食者與葷食轉素食者大幅降低糖尿病風險，危險率分別為HR: 0.52 (95% CI: 0.37, 0.73)及HR: 0.43 (95% CI: 0.28, 0.66)。結論: 台灣素食飲食與較低的代謝危險因子及非酒精性脂肪肝有相關性，同時對糖尿病的發生有保護效果。增加植物性蛋白質、全穀、及堅果種子可能有助代謝相關疾病。

關鍵字

糖尿病；非酒精性脂肪肝；代謝症候群；素食；前瞻性世代追蹤研究

並列摘要

Background: Vegetarian diets contain lower levels of saturated fat and heme iron, and higher levels of fiber and phytochemicals, which may ameliorate several underlying pathophysiological pathways of type 2 diabetes. However, the effect of Asian vegetarian diets on diabetes has not been carefully investigated. Aim: To examine whether a Taiwanese vegetarian diet affects incidence of diabetes and its related metabolic risk factors, including fatty liver, metabolic syndrome, and impaired glucose metabolism. Methods: The Tzu Chi Health Study recruited 4625 devoted Buddhist volunteers of the Buddhist Tzu Chi Foundation, with 1/3 vegetarians and 2/3 nonvegetarians. All participants received a health examination and were interviewed on basic demographics, medical history, diet (through a validated food frequency questionnaire) and lifestyle at the Buddhist Dalin Tzu Chi Hospital from 2007 to 2009, and followed from 2010 to 2012, and from 2013 to 2016. Participants were invited back for follow-up health examinations every 3 years. Those who never returned for follow-ups were sent a follow-up questionnaire to assess their diet and disease conditions. Results: Taiwanese vegetarian diets were characterized by higher intake of soy, vegetables, whole grains, nuts and seeds, and avoidance of meat and fish. This dietary pattern was associated with lower risk of metabolic syndrome (Adult Panel Treatment III definition, OR: 0.84, 95% CI: 0.70 – 1.00; International Federation of Diabetes definition, OR: 0.62, 95% CI: 0.49 – 0.77), nonalcoholic fatty liver (OR: 0.79, 95% CI: 0.68, 0.91) and liver fibrosis. In the 5-year (median) follow-up, 183 incident cases of diabetes were identified. Long-term vegetarians and the converted (nonvegetarians converted to vegetarians) experienced lower risk of diabetes, HR= 0.52 (95% CI:0.37, 0.73) and HR = 0.43 (95% CI: 0.28, 0.66), respectively, when compared with the nonvegetarians. Conclusion: Taiwanese vegetarian diet was inversely associated with cardiometabolic risk factors, nonalcoholic fatty liver, and risk of developing diabetes. Increasing consumption of plant protein, whole grains, seeds, and nuts may improve cardiometabolic health.

並列關鍵字

diabetes ； nonalcoholic fatty liver ； metabolic syndrome ； vegetarian diets ； prospective cohort study

參考文獻

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台灣素食與代謝風險：糖尿病與非酒精性脂肪肝

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