個人與學校脈絡因素對青少年血脂之多層次效應

A Multilevel Epidemiological Study of Blood Lipids for Junior High School Students

邱詩詒(Shih-Yi Ciou)

指導教授 ： 李建宏

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2010年)

摘要

血脂的組成為總膽固醇、HDL-C、LDL-C和三酸甘油脂，為代謝症候群的重要成分因子，同時也是心血管疾病的危險因子。學校周圍的飲食和運動環境，可能會影響青少年的的飲食型態及運動習慣。本研究為探討影響青少年血脂之危險因子，以及了解青少年在血脂的分佈上是否有學校的聚集性。
本研究為一橫斷式研究，以多步驟分層抽樣方法，隨機抽取高雄市、屏東縣以及台東縣共36間國中青少年參與本研究，共收集2739位(回應率72.4 %)青少年之血液資料，並透過人體測量學以及問卷資料蒐集到各體層次的資料。在學校層次的資料蒐集，則調查學校內運動設施、飲食提供和健康促進活動，以及調查校外300公尺和600公尺的飲食數量和運動場地。
在一般迴歸分析中，學童攝取較多的蔬菜可顯著減少3.2 mg/dL的總膽固醇與2.1 mg/dL的LDL-C，而攝取較多的奶類則會顯著增加2.8 mg/dL的總膽固醇和2.6 mg/dL的LDL-C。在多層次迴歸分析中，國中青少年血脂皆有顯著的學校聚集性，血脂的變異有6.1%~30.5%可歸因於學校的脈絡現象。其中學校每年舉辦超過2次的健康促進活動，可顯著減少青少年9.2 mg/dL的總膽固醇值和5.7 mg/dL的LDL-C值。而校外300公尺有較多的運動場地數，可以顯著增加4.6 mg/dL的HDL-C濃度。
本研究發現，青少年血脂除了受個人的飲食以及運動習慣外，學校以及學校周圍環境皆可能對青少年血脂造成影響，若學校能多舉辦健康促進活動，學校周圍社區也能提供較多運動設施以及良好的飲食環境，則能對青少年血脂有正向的影響。

關鍵字

HDL-C ； LDL-C ； 總膽固醇 ； 三酸甘油脂 ； 多層次迴歸分析

並列摘要

Blood lipids comprising high- (HDL), low-density lipoprotein (LDL), total cholesterols (TC) and triglycerides (TG) are imperative elements of metabolic syndrome and are important risk factors for cardiovascular diseases. Fast-food restaurants are staking out locations within easy walking distance of schools, exposing students to poor-quality foods. Factors that determine the level of blood lipids may be involved in individual variables and school-level features. We designed a scheme with multilevel sampling and subject recruitment to study such concerns among junior-high school students in Taiwan.
This study was a cross-sectional study. A total of 2739 adolescents from 36 different urbanization-level of schools participated in this study and offered blood samples (response rate, 71%). Individual factors including dietary habits, physical activity, free time activity and anthropometry examinations were collected. Food-related providers/ shops and sport facilities around the schools within 300m and 600m were video-taped and counted. Blood lipids levels are the primary outcomes. We used multilevel regression models to evaluate multilevel effects on these outcomes.
In the multiple linear regression analysis, it showed that total cholesterols and LDL-C were negatively associated with vegetable intake, but were significantly positive with milk intake. In multilevel regression analysis, blood lipids were all related to age, gender, body fat and specific dietary factors. About 6.1-30.5% of blood lipids differences between adolescents were associated with school-level variations.
High-density of Athletic field within 300m of the schools、health promotion activities and urbanization-level where the school located significantly contributed to school-level discrepancy. Our results emphasize the significance of building up individual- and school-level approaches to decrease high-level of blood lipids for adolescents.

並列關鍵字

high-density lipoprotein (HDL) ； low-density lipoprotein (LDL) ； total cholesterols (TC) ； triglycerides (TG) ； multilevel ； school contexts

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