- 學位論文
台灣版健康飲食評量指標(Alternate Healthy Eating Index for Taiwan, AHEI-T)與第2型糖尿病之人體測量值、血糖、 血壓及血清脂質相關性探討
Association between Alternate Healthy Eating Index for Taiwan (AHEI-T) and anthropometry, blood sugar, blood pressure and serum lipid profile among type 2 diabetes mellitus patients
摘要
根據行政院衛生署於2009年公布的「2008國人十大死因」資料顯示，糖尿病位居於第五位，而其併發症如：心血管疾病、腦血管疾病及腎臟疾病則分別位居於第二、三和十位。研究指出良好的飲食習慣可以降低第2型糖尿病患者併發症的發生，飲食指標是一種評估飲食品質的工具，替代健康飲食指標（Alternate Healthy Eating Index, AHEI）是其中一種評估工具，其與慢性疾病的發生之間存在著顯著的負相關，本研究參考台灣每日飲食指南提出台灣版健康飲食評量指標（Alternate Healthy Eating Index for Taiwan, AHEI-T）並用於評估第2型糖尿病之飲食。研究目的：針對第2型糖尿病患者，利用 AHEI-T 評估飲食品質，並探討 AHEI-T 與其人體測量值、血糖及血脂控制良好之相關性。實驗設計與方法：本研究為一追蹤研究(Follow-up study)，受試者為20歲以上之第2型糖尿病患者，排除罹患肝硬化、腎衰竭及癌症之患者。研究收集受試者的人體測量學資料、血糖值、血壓值及血脂質值。利用24小時飲食回憶法進行收集飲食資料，以台灣版健康飲食評量指標評估飲食。結果：實驗基準期共招募196位第2型糖尿病患者，平均年齡為62.1 ± 11.2歲，每日熱量攝取為1387 ± 463大卡。受試者平均 AHEI-T 分數為45.5 ± 10.2。經邏輯氏迴歸分析發現， AHEI-T 只與餐後血糖控制良好的比率間具有顯著的正相關。餐後血糖達到良好控制的百分比經年齡、性別及熱量校正的勝算比得，AHEI-T分數的最高分位較最低分位，OR為3.38，顯示 AHEI-T 分數較高的第2型糖尿病患者有較高的 PC-sugar 達標率。追蹤到第6個月後剩下113位受試者完成24小時飲食回憶法，比較受試者前後飲食差異、AHEI-T及AHEI分數均沒有顯著變化，利用基準期的AHEI-T分數之中位數（AHEI-T分數：47.0）區分出AHEI-T高分組（AHEI-T分數 ≥ 47.0）及AHEI-T低分組（AHEI-T分數 < 47.0），比較組別間受試者人體測量值、血糖、血壓及血脂質值之變化則得，AHEI-T高分組較AHEI-T低分組於餐後血糖、三酸甘油酯、高密度脂蛋白膽固醇、三酸甘油酯與高密度脂蛋白膽固醇比及低密度脂蛋白膽固醇與高密度脂蛋白膽固醇比均有顯著改善的情形。結論：針對第2型糖尿病患者的研究顯示：利用 AHEI-T 評估其飲食，AHEI-T 與餐後血糖達到良好控制的比率具有顯著正相關。而3個月及6個月的追蹤實驗則證實AHEI-T分數較高的受試者於餐後血糖及血脂質皆有改善。
並列摘要
According to the 2008 top ten leading death in Taiwan which reported by Department of Health, Executive Yuan. R.O.C. Diabetes was the fifth and its complications as heart disease, cerebrovascular disease and kidney disease were second, third and tenth respectively. A good dietary habit might reduce onset of complications in type 2 diabetes patients. Diet index is a tool to assess diet quality. Alternate Healthy Eating Index (AHEI) is one of them and had been found associated to the incidence of chronic disease negatively. We provided Alternate Healthy Eating Index for Taiwan (AHEI-T) according to the Taiwan daily dietary guidelines to assess dietary of type 2 DM patients. Aim: To investigate the association between AHEI-T and good control of glycemic and lipid profile among type 2 DM patients. Study design: This was a cross-sectional and follow-up study. Participants were type 2 DM patients with over 20 years old. The following data were collected including: Anthropometric data, glycemic, blood pressure and lipid profile. Dietary data were collected used 24h dietary recall. AHEI-T was analyzed after that. Values are expressed as N, percentage or Mean ± SD. SAS 9.1 was used to perform data analysis, correlation test, regression, odds ratio and two-way repeated measures ANOVA were used, when p < 0.05 was considered as significant. Result: There were totally 196 type 2 DM patients involved. They were 62.1 ± 11.2 years old and daily intake was 1387 ± 463 kcal. For AHEI-T score, they got 45.5 ± 10.2 and found it was positively associated to the good control of PC-sugar after logistic regression analysis. AHEI-T score was then divided into quartiles for calculating odds ratio. We found that good control of PC-sugar was found positively associated to AHEI-T score (Q4 vs Q1) under age, sex and energy adjusted model with an odds ratio = 3.38. It showed the higher AHEI-T score, the higher rate of good control in PC-sugar. Finally, there were 113 paticipants finished 24h dietary recall after 6 months follow-up. There were no significant differenet in dietary data, AHEI-T score and AHEI score between baseline and 6 months. We separated paticipants into 2 groups (High AHEI-T score: AHEI-T score ≥ 47.0; Low AHEI-T score: AHEI-T score < 47.0) according to the median of AHEI-T score (AHEI-T score = 47.0) found in the baseline of this study in order to compared difference in anthropometric, glycemic, blood pressure and lipid profile between baseline, 3 months and 6 months follow-up. High AHEI-T score group was found improved in PC-sugar, TG, HDL-C, TG/HDL-C and LDL-C/HDL-C compared to Low AHEI-T score group during 6 months of follow-up. Conclusion: For the type 2 diabetes patients, baseline data showed AHEI-T score was positively associated to good control of PC-sugar; 3 and 6 months follow-up study found High AHEI-T score group had improved in glycemic and lipid profile compared to Low AHEI-T score group.