台灣版健康飲食評量指標與血液透析患者之 心血管疾病危險因子相關性探討

Relationship between Alternate Healthy Eating Index for Taiwan （AHEI-T）and cardiovascular disease risk factors in hemodialysis patients.

楊斯涵(Sz-Hang Yang)

指導教授 ： 楊淑惠

臺北醫學大學/公共衛生暨營養學院/保健營養學研究所/碩士(2011年)

摘要

美國腎臟病資料登錄系統 ( The United States Renal Data System, USRDS) 2010年提出，台灣末期腎臟病 (end stage renal disease, ESRD)的發生率及盛行率皆位居世界第一，且心血管疾病為其主要死亡原因，佔32–42%。ESRD患者罹患心血管疾病危險因子包括傳統性心血管疾病危險因子：糖尿病、高血壓；非傳統性心血管疾病危險因子：腎臟疾病引起之營養不良、氧化壓力、發炎、血脂異常；營養相關心血管疾病危險因子：蛋白質、熱量、葉酸、維生素B12攝取不足、飽和脂肪酸攝取過量，這些因子導致透析患者容易罹患心血管疾病。而飲食為主要造成心血管疾病的原因。McCullough等人於2002年提出替代健康飲食指標（Alternate Healthy Eating Index, AHEI）相較其他飲食指標能預測心血管疾病的風險，本研究室於2009年依據台灣飲食指標修改AHEI為台灣版健康飲食評量指標 （Alternate Healthy Eating Index for Taiwan, AHEI-T）。本研究目的：利用AHEI-T評估血液透析患者飲食品質，探討AHEI-T分數與心血管疾病危險因子相關性。受試者與方法：研究設計為橫斷型研究 (cross-sectional study) 及追蹤型研究 (follow-up study)。收集血液透析患者的基本資料、體位資料、心臟/胸廓比 (cardiothoracic ratio, CTR)、血壓、血液生化數值、透析品質及飲食資料，以AHEI-T飲食指標評值受試者飲食資料。數值以Mean ± SEM表示，以SAS 9.1進行統計分析，當p＜0.05時具統計上的意義。結果：共招募68位血液透析患者，其中男性35位、女性33位。平均年齡64.8 ± 1.7歲，平均透析歷史45.4 ± 6.2月。平均熱量攝取1367 ± 52卡、23.3 ± 0.9卡/公斤體重，AHEI -T分數平均32.5 ± 0.6分。經相關性分析及回歸分析發現， AHEI -T分數與SBP控制良好比率具顯著的正相關性。SBP控制良好比率經年齡、性別及熱量校正後分析勝算比得，AHEI -T分數最高分位與最低分位，勝算比為8.09，顯示AHEI -T分數較高的血液透析患者有較高的SBP達標率。追蹤期時比較受試者飲食、AHEI -T分數與基準期時的差異，則均無顯著變化，以基準期時AHEI -T第三分位分數為切點，分為AHEI-T高分組(≧34.3分)及低分組(＜34.3分)，比較體位資料、血壓、血液生化數值的變化得，AHEI-T高分組相較於AHEI-T低分組的TG有顯著改善的情形。分析AHEI-T分數及項目與CTR的相關性，經多因子校正後得，蔬菜分數與CTR呈顯著負相關性，且蔬菜攝取種類以低中鉀含量之蔬菜為主。結論：AHEI-T分數越高SBP與TG控制越良好，且蔬菜攝取量越多有保護CTR的效果，因此AHEI-T可做為台灣血液透析患者之飲食評量指標且AHEI-T分數越高，心血管疾病風險越低。

關鍵字

血液透析、台灣版健康飲食評量指標、心臟/胸廓比、心血管疾病

並列摘要

The United States Renal Data System (USRDS) 2010 reported that incidence and prevalence of end stage renal disease in Taiwan are the highest of the world. Taiwan Society of Nephrology proposed that cardiovascular disease (CVD) is the first cause of death of hemodialysis (HD) patients. CVD risk factors of end stage renal disease patients including traditional CVD risk factors: hypertension, diabetes mellitus; nontraditional CVD risk factors: chronic kidney isease-related malnutrition, oxidative stress, inflammation, dyslipidemia and nutrition-related CVD risk factors: insufficient protein and energy intake, high saturated fatty acid intake, insufficient folate and vitamin B12 intake. Diet is the main cause of CVD. AHEI, a dietary index predicted CVD risk better than the others . We, our labotary modified Alternate healthy eating index (AHEI) to Alternate healthy eating index for Taiwan (AHEI-T) according to Taiwan daily dietary guidelines in 2009. Purpose: To assess diet quality of HD patients with AHEI-T and to investigate the correlation between AHEI-T and the risk factors of cardiovascular disease. Subject and Method: This is a cross-sectional and follow-up study. We collected the following data: anthropometric data, cardiothoracic ratio (CTR),blood pressure, nutritional status, inflammation, lipid profile, blood sugar and dietary data. AHEI-T was used for evaluating dietary data. SAS 9.1 was used to perform data analysis and when p < 0.05 was considered as significant. Result: Sixty-eight HD patients were recruited, including 35men and 33women.The mean age was 64.8 ± 1.7 years old, dialysis vintage was 45.4 ± 6.2 months, energy intake was 1367 ± 52 kcal, 23.3 ± 0.9 kcal/kg body weight. For AHEI-T score, they got 32.5 ± 0.63 and found it was positively associated to the percentage of achiving good control to SBP after correlation and regression analysis. To divide subjects into tertiles according to AHEI-T score then calculate its odds ratio.We found that the percentage of achiving of good control of SBP was positively associated to AHEI-T score (T3 vs T1) under age, sex and energy adjusted model with an odds ratio 8.09. It showed the higher AHEI-T score, the higher rate of the percentage of achiving of good control of SBP.There were no significant difference in dietary data and AHEI-T score between baseline and follow-up. To devide subjects into 2 groups High AHEI-T score group (≥ 34.3), Low AHEI-T score group (< 34.3) according to tertile of AHEI-T score at baseline in order to compared difference in anthropometric, blood pressure, nutritional status, inflammation, lipid profile, blood sugar among baseline, month 1 and month 2. High AHEI-T score group had improved in TG level compared to Low AHEI-T score group in month 2. Analyzing correlation between AHEI-T components and CTR, found that vegetable score was negatively correlated to cardiothoracic ratio under multi- factors adjusted. And low and medium potassium vegetables were the main vegetable category. Conclusion: The higher AHEI-T score, the higher rate of percentage of achiving of good control in SBP and TG and the more vegetable intake the more CTR protection effect.Therefore AHEI-T could be a good dietary quality index for Taiwan HD patients’ and the higher AHEI-T score, the lower CVD risk.

並列關鍵字

hemodialysis, Alternate Healthy Eating Index for Taiwan, cardiothoracic ratio, cardiovalsular disease.

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