糖尿病病人飲食生物標記與糖尿病病人腎臟功能指標相關性之探討

The association between dietary markers and renal function indicators in type 2 diabetic patients

廖彥菱(Yen-Ling Liao)

指導教授 ： 黃孟娟

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2015年)

摘要

研究背景及目的 糖尿病腎病變是糖尿病常見的併發症，會造成醫療資源耗損及負擔。目前探討台灣人之各種飲食型態，飲食生物標記及與腎病變危險性之相關性研究較少。而本研究目的為：(1).探討飲食型態(飲食分數)與飲食生物標記之相關性。(2).以橫斷面研究探討760位第2型糖尿病病人，其血漿中飲食生物標記（葉酸(folate)、鐵蛋白(ferritin)及n-3 Long Chain Polyunsaturated Fatty acids(n-3 LCPUFA)）與腎臟功能不良之相關性。
材料與方法 本研究為橫斷面研究，受試者為760位第2型糖尿病病人，以因素分析方法將2008－2009年平均飲食頻率問卷區分為三種型態，取得其飲食分數及檢測血液中ferritin、folate及DHA/ n-3 LCPUFA。腎臟功能指標為(creatinine (Cr))及estimated glomerular filtration rate(eGFR))。
結果 folate與高脂肉類呈負相關(p trend <0.001)，與蔬菜魚類呈正相關(p trend =0.002)。而ferritin與高脂肉類飲食型態分數呈正相關(p trend<0.001)。 n-3 LCPUFA與高脂肉類及蔬菜魚類呈正相關(p trend <0.001)，而與中式小吃呈負相關(p trend <0.001)。故此研究所探討之飲食型態可部份反應體內飲食相關生物標記。folate與生化值之單變量分析結果顯示，隨著folate濃度上升，Cr濃度越低，但未達趨勢相關(p trend =0.157)。隨著ferritin濃度上升，Cr濃度越高，呈趨勢性正相關(p trend=0.003)。DHA/ n-3 LCPUFA與腎臟功能無相關性。而folate、ferritin及n-3 LCPUFA與eGFR則無顯著相關性。最後以多元線性迴規模式將所有飲食標記放入同一模式，在調整干擾因子後，發現folate與Cr有達到顯著的負相關（β= -0.035, p =0.038），而ferritin與Cr有邊緣性顯著正相關（β= 0.034, p =0.053）。在eGFR的部分，調整干擾因子後，發現folate與eGFR有達到邊緣性顯著的正相關（β=1.94, p =0.054），而ferritin與eGFR有邊緣性負相關（β= -1.58, p =0.129）。
結論 本研究之所使用飲食標記，多吃蔬菜和魚類飲食型態，體內folate及DHA/ n-3 LCPUFA濃度會上升，而多吃高脂高肉類的飲食，則體內ferritin會上升。此外，Folate及Ferritin似乎與糖尿病病人之腎臟功能不良有關。而飲食標記是否可以預測糖尿病腎功能發展需要進一步研究。

關鍵字

糖尿病腎病變 ； 飲食型態 ； 葉酸 ； 鐵蛋白 ； n-3多元不飽和脂肪酸

並列摘要

Background and aims. Diabetic nephropathy is common complications of diabetes, and has contributed to increased medical resources and costs. Few studies have explored relations between dietary patterns risks of diabetic complications such as diabetic nephropathy.. The purpose of this study is firstly (1) to investigate correlations between dietary patterns (dietary factor scores) and biomarkers (folate, ferritin and n-3 Long Chain Polyunsaturated Fatty acids (n-3 LCPUFA), secondly (2) to examine associations between these dietary biomarkers and renal function indicators in 760 patients with type 2 diabetes in a cross-sectional study.
Methods & Materials.Diabetic patients (n =760) were selected from a cohort participating in a diabetic control study Diabetes Management through Integrated Delivery System (DMIDS) in Taiwan during year of 2008-2009. Food-frequency questionnaires obtained during two consecutive years of 2008-2009 were used and three dietary patterns (fatty meat, vegetable and fish and traditional Chinese snack), were generated using factor analysis. Plasma levels of ferritin, folate and erythrocyte n-3 LCPUFA were measured. Creatinine (Cr) and(estimated glomerular filtration rate (eGFR) were used as renal function indicators.
Result. Folate appeared to correlate positively with fish and vegetable dietary pattern scores, and negatively with and fatty meat pattern scores, respectively (p trend<0.001). Ferritin correlated significantly with fatty meat pattern scores only (p trend<0.001). n-3 LCPUFA was positively associated with fatty meat as well as vegetables/fish (p trend <0.001), but negatively with Chinese snacks (p trend <0.001). Our results suggest that eating patterns in part contributed to changes of blood dietary biomarkers. In univariate analysis, folate correlated significantly with lower Cr (p=0.038) concentrations and marginally with higher eGFR (p=0.054).In contrast, ferritin was associated with higher Cr (p=0.054) and lower eGFR (p=0.129) at marginal significance。LCPUFA as well as DHA did not appear to be associated with any of renal function indicators. Upon adjustment for confounding factors, folate correlated significantly with lower Cr (p=0.038) and marginally with higher eGFR level (p=0.054).
In contrast, ferritin correlated with higher Cr (p=0.054) and lower eGFR (p=0.129) at marginal significance. LCPUFA as well as DHA did not correlated with renal function indicators.
Conclusions. Frequent consumption of fish and vegetable and fatty meat may be reflected by changes of blood folate and ferritin. These two blood bio markers also appeared to correlate with better and worsening of renal function indicators in type 2 diabetic patients. Prospective study is needed to explore association between dietary markers and renal function development in type 2 diabetic patients.

並列關鍵字

Diabetic nephropathy ； dietary patterns ； folic acid ； ferritin ； n-3 polyunsaturated fatty acids

參考文獻

1. Fung, T.T., et al., Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. American Journal of Clinical Nutrition, 2001. 73(1): p. 61-67.

2. Wild, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. 2004.

3. International Diabetes Federation. Global Burden: Prevalence and Projections, 2010 and 2030. 2009 [cited 2011 April 22]; Available from: http://www.diabetesatlas.org/content/diabetes-and-impaired-glucose-tolerance.

4. Chang, C.-J., et al., Epidemiologic study of type 2 diabetes in Taiwan. Diabetes Research and Clinical Practice, 2000.

5. Pan, W.H., et al., Prevalence and awareness of diabetes and mean fasting glucose by age, sex, and region: results from the Nutrition and Health Survey in Taiwan, 1993-1996. Diabetic Medicine, 2003. 20(3): p. 182-185.