父母親心血管代謝危險因子之隔代效應及學童生活型態因子與青少年代謝症候群之相關研究

Association of trans-generational effect of parental cardio-metabolic risk factors and pediatric lifestyle factors with adolescent metabolic syndrome

李純瑩(Chun-ying Lee)

指導教授 ： 李建宏

高雄醫學大學/健康科學院/公共衛生學系環境暨職業安全衛生博士班/博士(2017年)

摘要

代謝症候群是指多個心血管危險因子聚集的現象，容易出現在肥胖者且有較高的發生第二型糖尿病及心血管疾病的風險。文獻指出，肥胖之青少年同樣容易出現心血管危險因子聚集的現象，而心血管疾病的早期病變「動脈粥狀硬化」可起始於孩童時期，宜早期介入。本研究目的在於探討可能父母親代謝症候群相關疾病、父母親肥胖、及青少年生活型態危險因子對青少年心血管危險因子聚集狀態的效應，以作為降低心血管疾病風險之介入。研究方法採隨機集束抽樣調查，在2007-2009年高雄縣市、屏東縣及台東縣地區之國中生，收集學童問卷、身體指標及血液檢查，同時收集家長問卷調查進行分析。統計方法採依變項的資料型態，將連續性、二分類或三分類別，分別使用線性複迴歸分析(multiple linear regression)、二元羅吉斯迴歸分析(binary logistic regression)以及多項式羅吉斯迴歸分析(multinomial logistic regression)，並且評估可能的潛在干擾因子加以控制。進一步分析與代謝症候群相關的危險因子兩兩交互作用於代謝症候群的風險效應。統計檢定顯著水準設為P-value < 0.05。本研究共2727名青少年參與（回應率約72.1%）。結果顯示，根據不同的操作型定義，南台灣青少年代謝症候群盛行率約為1.4%-11.9%。其中符合代謝症候群定義者大多為過重/肥胖者以及為胰島素阻抗狀態。無論採用何種代謝症候群定義，過重與肥胖以及胰島素阻抗狀態與代謝症候群有獨立的顯著相關。父母親有高血壓、糖尿病史或為肥胖者，或是青少年飲用含糖飲料、有較長與的使用螢幕時間、或較低體能活動，皆與青少年代謝症候群風險上升有關。其中，「父母親肥胖」與「青少年使用較長的螢幕時間」與青少年代謝症候群的相關性，可能透過青少年肥胖的中介效應而產生關聯。在交互作用分析中，「父母親有糖尿病史」且「青少年為肥胖者」在青少年代謝症候群的風險產生相加的效應；而「青少年飲用含糖飲料」與「青少年肥胖」在青少年代謝候群的風險則產生相乘的效應。過重/肥胖的青少年不飲用含糖飲料及有較多的體能活動者，其代謝症候群的風險較低。本論文分析結果建議，未來可針對高風險族群，如父母親為肥胖、高血壓或糖尿病患者，進行以家庭為基礎的生活型態介入，包括體重控制、增加體能活動及降低含糖飲料攝取等。此研究可以做為未來介入性研究建構有效的青少年改善心血管危險因子介入模式的基礎。

關鍵字

代謝症候群 ； 心血管代謝危險因子 ； 青少年 ； 肥胖

並列摘要

Clustering of cardio-metabolic risk factors within individual, named metabolic syndrome (MetS), is commonly seen among obese people and has been known to be associated with increasing risks of type 2 diabetes and cardiovascular diseases in adults. Metabolic syndrome also can be seen among obese youth. Atherosclerosis, the underlying cause of cardiovascular disease, can develop early in childhood. Early identification and intervention could be beneficial for prevention of cardiovascular disease. The purpose of the study was to investigate the effects of parental cardio-metabolic disease, overweight/obesity and pediatric lifestyle factors on the clustering of cardiovascular risk factors among adolescents. Representative adolescents (n = 2727; age, 12–16 years) were randomly recruited through multistage stratified sampling from 36 schools in Southern Taiwan. Adolescent and parent surveys were conducted in schools and participant homes, respectively. Their demographic factors, diet patterns, and physical, anthropometric, and clinical parameters were collected and analyzed. Multiple linear regression, binary logistic regression and multinomial logistic regression were used for analyzing the prevalence ratio of a risk factor for metabolic syndrome after adjusting for potential confounding factors. Additive and multiplicative interaction effects between parameters on risk of MetS were examined, a p-value < 0.05 was considered statistical significant. The results showed that prevalence of MetS in adolescents were 1.4%-11.9%, according to the definition used. Obesity and insulin resistance were independently associated with MetS in adolescents. Adolescents whose parents were overweight/obese, or with diabetes and hypertension, adolescents with low physical activity level, long screen time and high sugar-sweetened beverage intake were associated with increased risk of MetS. The adolescent BMI accounted for a majority of the effects of parental overweight/obesity and adolescent long screen time on the risk of adolescent MetS. A significantly additive synergistic effect on MetS was observed among overweight/obesity adolescents with parental T2D. The risk of sugar-sweetened beverage consumption was multiplicatively enhanced among adolescents with overweight/obesity. Overweight/obese adolescents who did not consume sugar-sweetened beverage or had higher level of physical activity was associated with a lower risk of MetS compared with overweight/obese adolescents who consume more sugar-sweetened beverage and with low physical activity. Our results suggest that multifaceted intervention including control of sugar-sweetened beverage consumption and increase physical activity among high risk family with obese adolescents and parental T2DM should be prioritized.

並列關鍵字

metabolic syndrome ； cardio-metabolic risk factors ； adolescents ； obesity

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