第2型糖尿病病人營養素攝取，牙周狀況以及血糖控制相關性之研究

Relationships among nutrient intake, periodontal status and glycemic control in type 2 diabetes mellitus.

許玉恒(Yu-Heng Hsu)

指導教授 ： 黃純德

共同指導教授 ： 黃孟娟(Meng-Chuan Huang)

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士班/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00065

摘要

背景：目前已有許多研究證實牙周病是糖尿病患血糖控制差的危險因子，而糖尿病也是牙周病惡化的原因之一，營養素攝取可能同時或分別為牙周疾病和糖尿病的相關因子，但是營養素攝取與糖尿病患臨床血液生化值和牙周狀態之間的關係卻很少被談論。
研究目的：飲食中營養素攝取與糖尿病患牙周狀態(CPITN)及其血糖控制之交互關係。及飲食中營養素攝取在糖尿病患不同血糖控制狀態(A1C)與牙周狀況(牙周治療需求指數)(CPITN)的相關性。
研究方法：本研究為一個橫斷面研究，收案時間自2006年8月至2007年4月為止，在高雄醫學大學附設中和紀念醫院新陳代謝科收集同意參加本研究的糖尿病患211人，進行口腔檢查、基本資料及飲食問卷（包括：24小時的飲食回憶，食物頻率問卷及營養補充品）的訪視紀錄，進而分析之間的關係。
結果：研究發現糖尿病患的牙周狀況(CPITN)與血糖控制狀況(Glycosylated Hemoglobin A1C(簡稱A1C))有顯著相關性(p=0.0403)。維生素E α-TE(mg)攝取量在牙周良好組(CPITN≦2) 5.8mg，顯著高於牙周不良組(CPITN≧3) 4.6mg (p=0.0329)。進一步利用複線性迴歸，在調整性別、年齡、教育程度、身體質量指數、熱量後，分析維生素Eα-TE取量分組(＞75百分位，比≦75百分位)對CPITN相關於-0.4的CPITN變化量，此變化量具統計上顯著性意義(p=0.0410)。血糖良好組(A1C≦7.5)的糖尿病患，其醣類攝取佔熱量比為53.1%，顯著低於血糖不良組(A1C＞7.5)的57.2% (p=0.0119)。血糖良好組在脂肪攝取量和佔熱量比，為58.4g，32.5%，是顯著高於血糖不良組的49.4g和28.5% (p值分別為0.0387, 0.0069)。血糖良好組在N-3脂肪酸攝取量(C20-C22 N-3脂肪酸)0.9g，顯著高於血糖不良組的0.5g (p=0.0434)。在複線性迴歸分析中，調整性別、年齡、教育程度、身體質量指數、熱量後，醣類和脂肪攝取每增加10g，對A1C變化量達統計上顯著相關(分別，p=0.0297, p=0.0484)；再加上調整煙、酒、檳榔，醣類攝取每增加10g，對A1C變化量達統計上顯著相關(p=0.0442)。N-3脂肪酸攝取＞75百分位比≦75百分位在複線性迴歸分析中，調整性別、年齡、教育程度、身體質量指數後，對A1C變化量達統計上顯著相關(p=0.0053)；再加上調整煙、酒、檳榔，N-3脂肪酸攝取＞75百分位，比≦75百分位對A1C變化量，其相關係數為-1.14，仍然達統計上顯著相關(p=0.0021)。結論：本研究調查發現，糖尿病患牙周良好組中維生素E攝取量較高。飲食中調整熱量後，降低醣類或增加脂肪攝取量與糖化血色素降低有相關性。在血糖控制良好組可發現N-3脂肪酸攝取量較高。增加魚類尤其是深海魚攝取頻率與總膽固醇、三酸甘油酯及低密度膽固醇呈現統計上顯著的負相關，具降低糖尿病患心臟血管疾病危險因子的保護作用。

關鍵字

牙周病 ； 糖尿病 ； 24小時飲食回憶法 ； 飲食頻率問卷 ； 營養素 ； 醣類 ； 脂肪 ； N-3脂肪酸 ； 維生素E

並列摘要

Background：The relationship between periodontal disease and diabetes mellitus is well established, and studies have shown that diabetes mellitus is the main reason for the worsening of periodontal disease. Nutrient intake may be one of the important factors affecting periodontal disease and diabetes mellitus; however, the relationship between nutrient intake, biochemical examination, and periodontal disease has rarely been discussed. The objective of this investigation was to examine the relationship between nutrient intake, biochemical examination and periodontal status in patients with diabetes mellitus.
Method：211 patients with diabetes mellitus were recruited from the Department of Endocrinology in Kaohsiung Medical University Hospital from April to August, 2006. Subjects were divided into two groups; diabetes-well-controlled (DWC) group and diabetes-badly-controlled (DBC) group. Periodontal status was evaluated by the CPITN index, the condition of nutritional intake was evaluated by a 24-hour diet record, and a questionnaire for food frequency as well as supplements. JMP was used for statistical analysis.
Results：The results showed that there was a statistically significant association between patients’ periodontal status(Community Periodontal Index of Treatment Needs, CPITN) and diabetes blood sugar control(hemoglobin A1c, A1C) (p=0.0403). Patients with better periodontal status (CPITN≦2) had higher vitamin E α-TE(mg) intake compared with those of poor periodontal status (p=0.0329). Using multiple regression analysis to adjust sex, age, education degree, body mass index(BMI) and kilocalorie. Vitamin Eα-TE intake to divide into 2 groups (＞75 percentile vs ≦75 percentile) for CPITN was change -0.4, the change was statistically significant. Patients in the DWC group had a lower percentage of carbohydrate intake 53.1%, compared with the DBC group 57.2%, the change was statistically significant (p=0.0119), the higher percentage of dietary fat intake and dietary fat intake was 58.4g and 32.5%, compared with the DBC group was 49.4g and 28.5% , the difference was statistically significant (p=0.0069 and p=0.0387, respectively), and the DWC group had higher n-3 fatty acid intake 0.9g compared with the DBC group 0.5g, the difference was statistically significant (p=0.0434). Using multiple regression analysis to adjust sex, age, education degree, BMI and kilocalorie. The carbohydrate and fat per intake to add 10g for A1C of change, the change was statistically significantly different (p=0.0297 and p=0.0484, respectively). N-3 fatty acid intake to divide into 2 groups (＞75 percentile vs ≦75 percentile) for A1C was change, the regression coefficient was a statistically significant difference (p=0.0053). another to accede to adjusting for smoking, alcohol and betel nut, N-3 fatty acid intake to divide into 2 groups for A1C was change, the regression coefficient -1.14 was a statistically significant difference (p=0.0021).
Conclusion: These findings diabetes mellitus patient with better periodontal status, higher vitamin E α-TE intake. To adjust kilocalorie, that lower dietary carbohydrate, increase dietary fat intake with lower A1C has correlation; DWC had higher n-3 fatty acid intake. To raise fish intake, especially deep sea of fish frequency of intake, with Total-Cholesterol, Triglyceride and Low density Cholesterol had negative coefficient, the coefficient was a statistically significant difference, that had to reduce the diabetes mellitus patient of cardiovascular diseases hazard factor. So that can protect the cardiovascular system.

並列關鍵字

periodontal disease ； diabetes mellitus ； 24-hour diet record ； food frequency questionnaire ； nutrition ； carbohydrate ； fat ； N-3 fatty acid ； vitamin E

參考文獻

1. Ackman, R. G., & Sipos, J. C. (1964). Flame Ionization Detector Response for the Carbonyl Carbon Atom in the Carboxyl Group of Fatty Acids and Esters. J Chromatogr, 16, 298-305.

2. Adler, A. I., Boyko, E. J., Schraer, C. D., & Murphy, N. J. (1994). Lower prevalence of impaired glucose tolerance and diabetes associated with daily seal oil or salmon consumption among Alaska Natives. Diabetes Care, 17(12), 1498-1501.

3. Al-Zahrani, M. S. (2006). Increased intake of dairy products is related to lower periodontitis prevalence. J Periodontol, 77(2), 289-294.

4. Amos AF, McCarty DJ, & Zimmet P. (1997). The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabete Med, 14 Suppl5, S1-85.

5. Andrew R, Skyrme-Jones P, O’Brien RC, Berry KL, & IT, M. (2000). Vitamin E supplementation improves endothelial function in type I diabetes mellitus: a randomized, placebo-controlled study. . J Am Coll Cardiol, 36, 94-102.