台灣血脂與血糖異常的成年人飲食型態與血脂、血糖、肥胖及肝功能指數之相關性研究

Dietary patterns in relation to serum lipids and glucose, obesity, and liver function enzymes among adults with dyslipidemia and abnormal fasting blood glucose in Taiwan

林俐吟(Li-Yin Lin)

指導教授 ： 趙振瑞

臺北醫學大學/營養學院/保健營養學研究所/博士(2020年)

摘要

研究目的
高血脂症以及高血糖這兩種疾病和遺傳有相當的關連，若直系親屬裡有高血脂症或是高血糖的情況，會提高自身患有此兩種疾病的風險。除此之外，過去的研究也顯示，不良的飲食習慣例如攝取過多的碳水化合物、糖分、以及不好的脂肪，例如飽和脂肪和反式脂肪，容易增加高血糖及高血脂的發生率。目前大多研究都只擇一分析高血脂症病人的飲食型態或高血糖病人的飲食型態，尚未有研究同時將患有高血脂症及高血糖的族群做飲食型態的分析。此外，過去許多文獻也指出體脂肪及腰圍與胰島素阻抗性呈現正相關性，體脂肪偏高以及腰圍過粗都會提高罹患高血脂、高血糖、以及脂肪肝的風險。本研究預探討屏除遺傳因子的影響，探討同時有高血糖高血脂症成年人的飲食型態與體脂肪、腰圍、肝功能指數的相關性。

材料與方法

本實驗分析之資料庫來自於美兆健檢診所，資料收集起迄時間為2001年至2015年，共計15年，屬於橫斷面研究 (又稱現況研究)。第一篇及第二篇由765,064筆資料(2001年至2010年)篩選20歲至50歲同時有高血脂和空腹血糖異常的青壯年人，並排除有高血脂高血糖家族史者、 癌症病人、服用精神疾病藥物、抗甲狀腺藥物、抗病毒藥物、用類固醇、糖尿病或心血管疾病藥物的人。第三篇則是由377,124筆資料中(2001年至2015年)篩選35歲以上同時有高血脂和空腹血糖異常的成人，一樣排除有高血脂高血糖家族史者、 癌症病人、服用精神疾病藥物、抗甲狀腺藥物、抗病毒藥物、服用類固醇、糖尿病或心血管疾病藥物的人做為分析對象。本實驗屬於現況研究(橫向研究) 。分析項目有比較男女性參與者之基本資料包含年齡、 職業、 教育程度、 體重、 抽菸情形、體脂肪、腰圍、腰臀比、腰身高比、飲酒習慣、工作活動強度、過去病史及血液生化值包含空腹血糖、三酸甘油酯、總膽固醇、低密度膽固醇、高密度膽固醇、肝功能指數 (GPT, GOT, GGT)是否有差異。 同時本研究也比較男性女性參與者之奶類、蛋類與肉類、水產魚貝類、豆類及豆製品、蔬菜、水果、主食類、油炸食品及含糖飲料攝取量與體脂肪、腰圍、空腹血糖、三酸甘油酯、膽固醇、低密度膽固醇、高密度膽固醇、肝功能指數 (GPT, GOT, GGT)之相關性。

結果

第一篇研究顯示肉類速食型的飲食型態 (飲食中偏好油炸及加工食物、醬汁、含糖飲料、肉類、內臟、泡麵、蛋類、以及裹粉油炸的食物)與高血脂和空腹血糖異常病無直接關係。 以健康蔬果型為主的飲食型態(飲食中偏好蔬果、海鮮、黃豆製品、主食和麵粉類食物)與高血脂呈現負向關係，但與空腹血糖異常則是呈現正向關係。最後，奶類複合碳水化合物型的飲食型態(飲食中多奶製品、根部蔬菜、果醬、蜂蜜、以及全穀食物) 則與高血脂和空腹血糖異常呈現反向關係。

第二篇研究結果顯示，飲食型態接近西方飲食(油炸及加工食物、醬料、含糖飲料、蛋、果醬類、精緻糕點等等)的男女罹患一般肥胖、中央型肥胖及體脂肪過高的風險會增加。反之，飲食型態接近謹慎飲食(深色及淺色蔬菜、水果、奶製品、海鮮類、全穀類、麵粉及米製品等等)可以降低罹患一般肥胖、中央型肥胖及體脂肪過高的風險，但此結果只有在男性族群裡呈現顯著，在女性族群裡則不顯著。 另外，在兩性族群裡擁有較高高密度膽固醇的人可以降低罹患一般肥胖和中央型肥胖的風險。
反之，在兩性族群裡擁有較高三酸甘油酯和空腹血糖的人則會增加罹患一般肥胖和中央型肥胖的風險。在女性族群中，擁有較高低密度膽固醇會提高體脂過高的風險。此研究證明飲食型態與代謝的參數，肥
胖，以及體脂肪的相關性確實會受男女性別差異所影響。女性族群尤其需特別管控自身的三酸甘油酯指數，因為本研究顯示三酸甘油酯偏高的女性患有肥胖和體脂肪過高的風險是一般正常女性的三倍!

第三篇研究顯示，對於30歲以上的男女而言，高鹽高糖高脂肪飲食與肝功能指數異常並無直接相關性，而植物性飲食與肝功能指數異常亦無相關性。反之，高蛋白質飲食可降低患有天門冬胺酸轉胺酶素(GOT)偏高的風險，但僅限於男性。最後，乳製品早餐飲食型態可降低患有麩胺酸轉移酶 (GGT)偏高的風險，但僅限於男性。本研究顯示飲食型態與肝功能指數的相關性只有在男性族群裡才有顯著性，女性則幾乎沒有。

結論
本次研究結果證實，對於血脂和空腹血糖異常的族群來說，飲食型態確實對於預防及治療血脂異常和空腹血糖異常有一定的影響力。另外，男女間的差異也經證實會影響飲食型態和代謝參數、肥胖、體脂肪、以及肝功能指數之間的關係。最後，飲食型態與肝功能指數的關係僅在男性族群中較為顯著，在女性族群裡則不顯著。

關鍵字: 飲食型態，男女性差異，因素分析，血脂異常，空腹血糖異常，肥胖，肝功能指數。

關鍵字

飲食型態 ； 因素分析 ； 血脂異常 ； 空腹血糖異常 ； 肥胖 ； 肝功能指數

並列摘要

Background: Dietary patterns have been known to be related to risk factors for many chronic conditions such as dyslipidemia, hyperglycemia, cardiovascular disease, obesity, and liver disease. To the best of our knowledge, there hasn’t been any study investigating the relationships between dietary patterns with components of dyslipidemia and fasting plasma glucose and its related complications (i.e. obesity and liver disease) among adults with dyslipidemia and elevated fasting plasma glucose in Taiwan.

Methods: This cross-sectional study collected data from the Mei Jau International Health Management Institution in Taiwan from 2001-2010 for study one and two, and data from 2001-2015 for study three. A total of 13,609 subjects and 14,087 subjects aged between 20 and 50 years were chosen for study one and study two respectively for analysis. In study three, a total of 20,408 subjects aged 35 and above were selected for analysis.
Results: In the first study, higher scores of the meat-convenience dietary pattern (high intake of deep-fried and processed food, sauces, sugar-added beverages, meat and organ meats, instant noodles, rice or flour cooked in oil and eggs) had no association with components of dyslipidemia and abnormal FPG. Higher scores of the vegetables-fruits- seafood dietary pattern (high intake of vegetables, vegetables with oil or dressing, fruits, seafood, legumes, soy products, and rice or flour products) was inversely associated with hypercholesterolemia and positively associated with hyperglycemia. Higher scores of the dairy-complex carbohydrate dietary pattern (high intake of dairy products, milk, root crops, jam or honey, and whole grains) was inversely correlated with hypertriglycemia and low high-density lipoprotein cholesterol level. In the second study, both men and women in the highest quartile of the western dietary pattern had a significantly increased odds ratio of general obesity, central obesity, and high body fat. However, only male subjects in the higher quartiles of the prudent dietary pattern had a significantly decreased odds ratio of all indices of obesity. In addition, both men and women with higher high density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels had a significantly reduced odds ratio of general and central obesity. Higher low-density lipoprotein cholesterol (LDL-C) level was significantly associated with an increased odds ratio of high body fat, while higher TC level was significantly correlated with a reduced odds ratio of high body fat only in women. In the third study, gender difference appeared to exert significant influence in the association between dietary patterns and liver function enzymes. High-protein dietary pattern decreased the risk of having abnormal glutamic oxalocetic transaminanse (GOT) level in men only. Furthermore, dairy-breakfast pattern decreased the risk of having abnormal gamma-Glutamyltransferase (GGT) in men only. By contrast, the association between dietary patterns and liver function enzymes seemed to be non-significant in women at this time.

Conclusions: The results support that the dietary patterns appear to have a role in the prevention and management of dyslipidemia and abnormal FPG. Furthermore, there is a gender difference in the association of dietary patterns and metabolic parameters with obesity and body fat among young and middle-aged adults with dyslipidemia and abnormal FPG in Taiwan. Lastly, the effects of dietary patterns on liver function enzymes appear to be significant only in men.

Keywords: dietary patterns, factor analysis, dyslipidemia, abnormal fasting plasma glucose, obesity, gender difference, liver function enzymes, liver disease.

並列關鍵字

dietary patterns ； factor analysis ； dyslipidemia ； abnormal fasting plasma glucose ； obesity ； liver function enzymes

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