飲食模式與第2型糖尿病風險的關係:台灣具代表性的世代研究

Association between dietary patterns and the risk of type 2 diabetes mellitus: a representative cohort study in Taiwan

林蓉(Rong Lin)

指導教授 ： 簡國龍

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(2021年)

https://doi.org/10.6342/NTU202103323

摘要

研究背景與目的:
飲食模式是第2型糖尿病的一個重要且可調整的危險因子。本研究利用1)事前被證實的飲食指引或指標，2)事後用統計方法得到的飲食模式，探討飲食模式與發生第2型糖尿病風險之間的關係以及找出潛在的修飾因子。
方法:
本研究是一個具全國代表性的世代追蹤研究，資料的來源為2001年至2015年進行的台灣三高主題資料庫中的數據。排除已知有糖尿病的受試者，共有4705名受試者符合納入條件。飲食攝取量的評估是一份有20組食物的飲食頻率問卷。本研究共使用9種飲食模式，其中包括地中海飲食指引、得舒飲食指引以及替代性健康飲食指標-2010以及3個由主成分分析、3個由偏最小平方迴歸分析而得的飲食模式。透過飲食頻率問卷計算每位參與者在這9種飲食模式中的得分。利用Cox比例風險模式來評估每種飲食模式中分數高低的4組的糖尿病風險比(hazard ratio)以及95%信賴區間，並且根據性別、年紀、身體質量指數做分層分析。
結果:
本研究在中位數5.28年的追蹤下，調整可能的干擾因子後，只有地中海飲食與第2型糖尿病風險有顯著的相關，在地中海飲食中得最高分的參與者與最低分相比，減少26％糖尿病風險。（調整後的HR: 0.74, 95% CI:0.60, 0.91)。此外，身體質量指數是一個顯著的修飾因子。
結論:
研究顯示高度依從地中海飲食習慣可以降少罹患第2型糖尿病風險，特別是體重過重的族群。

關鍵字

糖尿病 ； 飲食模式 ； 地中海飲食 ； 主成分分析 ； 偏最小平方迴歸分析

並列摘要

Introduction:
Dietary pattern is an important modifiable risk factor for diabetes. This study used 1) a priori-defined dietary pattern 2) a posterior-derived dietary pattern to explore the relationship between dietary patterns and type 2 diabetic risk, and to identify potential effect modifiers.
Methods:
Participants were enrolled from a nationwide cohort study from data of the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia database. The dietary intake was assessed by a food-frequency questionnaire containing 20 food groups. For dietary patterns assessment, we chose 1) the Mediterranean diet (MED), 2) the Dietary Approaches to Stop Hypertension diet, and 3) the alternative Healthy Eating Index-2010, three principal component analysis derived dietary patterns, and three partial least-squares regression derived dietary patterns. Multivariable adjusted hazard ratios and 95% confidence intervals by Cox proportional hazards regression analysis with subgroup analysis were performed.
Results:
During a median follow-up time of 5.28 years, only the MED showed a significant association with the diabetic risk after multivariate model regression. Participants having the highest MED scores had a 26% reduction of diabetic risk compared to those with 0-3 scores, adjusted HR: 0.74, 95% CI:0.60, 0.91. BMI was a significant effect modifier (P for trend 0.008).
Conclusion:
The highest adherence to the MED was associated with a lower risk of diabetes, especially in the overweight Taiwanese population.

並列關鍵字

Dietary patterns ； type 2 diabetes mellitus ； Mediterranean diet ； principal component analysis ； partial least-squares regression

參考文獻

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