- 學位論文
飲食攝取與生活習慣對多囊性卵巢症候群婦女葡萄糖代謝與荷爾蒙相關性之探討
Relationship of dietary intake and lifestyle to glucose metabolism and hormones in patients with polycystic ovary syndrome
摘要
多囊性卵巢症候群(polycystic ovary syndrome; PCOS)是生殖年齡婦女常見的內分泌疾病，其臨床表現與第2型糖尿病(Type 2 diabetes mellitus; Type 2 DM)類似，包括腹部肥胖、血脂異常及胰島素阻抗，未來罹患Type 2 DM及心血管疾病的風險也會增加，與胰島素阻抗相關之調控因子是當前研究重點。然而現今對於臺灣PCOS患者飲食與生活型態對葡萄糖代謝相關因子與荷爾蒙之相關性尚未清楚。故本研究目的是評估臺灣PCOS患者飲食攝取狀況(熱量、三大營養素佔總熱量比例、膳食纖維攝取量)及生活型態(運動、睡眠品質、生活壓力)，探討其與血糖及相關調節荷爾蒙與生殖相關荷爾蒙之相關性。 本研究於臺安醫院進行，受試者經篩選後共為67位21至45歲不孕症患者，依照1990年PCOS診斷標準分為PCOS組與非PCOS組，於月經來潮5天內行口服葡萄糖耐受試驗，測量空腹及餐後血糖、胰島素、血脂組成、生殖相關荷爾蒙、脂肪荷爾蒙、類胰島素生長因子-1、飢餓素及體位測量，並填寫三天飲食記錄、身體活動量紀錄、匹茲堡睡眠量表及壓力知覺量表。 研究結果顯示PCOS組性荷爾蒙結合球蛋白與促濾泡生長激素顯著低於非PCOS組(p < 0.05)，然而睪固酮、游離雄性素指標(free androgen index; FAI)、空腹及餐後胰島素、胰島素阻抗指數(homeostasis model assessment for insulin resistance; HOMA-IR)皆顯著高於非PCOS組(p < 0.05)。PCOS組總熱量攝取約為1700卡，三大營養素組成比例分別為醣類49 %、脂肪33 %、蛋白質18 %，膳食纖維攝取量約為12克。PCOS組熱量及脂肪佔總熱量比例皆較非PCOS組高，而醣類佔總熱量比例及膳食纖維攝取量較非PCOS組低(p < 0.05)。匹茲堡睡眠量表(大於5分表示睡眠品質較差)PCOS組平均分數為6.6分顯著高於非PCOS組的平均4.1分，壓力知覺量表PCOS組平均為24分也顯著高於非PCOS組的平均20分(p < 0.05)。 在PCOS組血糖控制與飲食及生活習慣因子相關性分析中發現，醣類佔總熱量比例與睪固酮呈正相關(r = 0.40, p < 0.05)，總熱量分別與空腹血糖、空腹胰島素及HOMA-IR指數呈正相關(r = 0.47, r = 0.31, r = 0.41, p < 0.05)，脂肪佔總熱量比例與餐後血糖呈正相關(r = 0.45, p < 0.05)。PCOS患者有運動習慣者(一週大於一次以上)不論是空腹或餐後胰島素及HOMA-IR指數皆顯著低於完全無運動習慣者。 PCOS患者性荷爾蒙調節失衡，男性荷爾蒙較高且有胰島素阻抗情形。總熱量攝取量為影響血糖控制之重要因素，熱量攝取越高，胰島素阻抗越嚴重，醣類與脂肪佔總熱量比例與男性荷爾蒙及餐後血糖呈正相關，培養運動習慣可降低胰島素濃度且改善胰島素阻抗情形。
並列摘要
Women with polycystic ovary syndrome (PCOS) have been considered to increase the risk of metabolic syndrome and cardiovascular disease. Patients with PCOS had clinical symptoms similar to type 2 diabetes mellitus like abdominal obesity, dyslipidemia and insulin resistance. The aim of the study was to discuss the relationship of dietary intake (total calories and three macro-nutrients, dietary fiber) and lifestyle (exercise, sleep quality, stress) to glucose metabolism and reproductive hormones in patients with PCOS. This study was approved by and conducted in accordance with the guidelines of the Taiwan Adventist Hospital Investigational Review Board, and all patients provided written informed consent. Sixty-seven patients aged 25 to 45 years and divided two groups according to diagnose with PCOS were recruited. A total of 31 patients with PCOS served as the study group, and the remaining 67 infertility patients constituted the non-PCOS group. Blood samples were collected after a 75-g oral glucose tolerance test, and the concentrations of serum glucose, insulin, lipids, reproductive hormones, adipocytokines, insulin-like growth factor-1 and ghrelin were measured. Anthropometric parameters were determined, dietary intake was assessed by 3-d dietary record and sleep quality was assessed by Pittsburg sleep quality index and stress was assessed by Perceived stress scale. There was significantly lower sex hormone binding globulin and follicle-stimulating hormone, and higher testosterone, free androgen index (FAI), serum insulin, insulin resistance. Total calories intake in PCOS group was about 1700 kcal, dietary intake for carbohydrate, lipid and protein was 49%, 33% and 18% of total calories and dietary fiber intake was about 12 g. Patients with PCOS had significantly higher calories and fat intake but fewer carbohydrate and dietary fiber intake than non-PCOS group. The Pittsburgh sleep quality index score which showed poor sleep quality with score over 5 of PCOS group was 6.6 significantly higher than non-PCOS group which mean score was 4.1. The Perceived stress scale score of PCOS group was 24 also significantly higher than non-PCOS group which mean score was 20. The Pearson correlation coefficient between glucose metabolism and dietary intake or lifestyle shows significant positive correlations between caloric intake and fasting serum glucose (r = 0.47, P < 0.05), fasting insulin (r = 0.31, P < 0.05), insulin resistance (r = 0.41, P < 0.05). Testosterone concentration was positively correlated with dietary carbohydrate intake (r = 0.40, P < 0.01). Postprandial glucose concentration was positively correlated with dietary fat intake (r = 0.45, P < 0.01). There was significantly lower fasting insulin, postprandial insulin and insulin resistance in PCOS group which had exercise habit before than which without any exercise habit. Therefore, women with PCOS impair glucose metabolism and imbalance sex hormone and had greater BMI, body fat and visceral fat mass as increasing caloric and fat intake. Patients with PCOS who need to improve glucose metabolism should be suggested calorie-restrict diet and adjust fat and carbohydrate percentage of energy, maintain exercise training as a habit.
參考文獻
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