健康飲食攝取狀態與糖尿病腎病變相關性之研究

Association Between Healthy Dietary Pattern and Risks of Diabetic Nephropathy

章慧如(Huei-Ru Jhang)

指導教授 ： 黃孟娟

高雄醫學大學/醫學院/醫學研究所/碩士(2010年)

摘要

背景 第2型糖尿病病患，若有微量白蛋白尿或巨量白蛋白尿的情形，會增加罹患心血管和腎臟衰竭的危險性。此外，除了血糖和血壓控制，攝取飽和脂肪酸會增加胰島素阻抗和發炎反應，可能會造成腎功能惡化；而攝取富含抗氧化劑之食物，因其具有抗發炎和抗氧化的功能，可能具延緩第2型糖尿病患者腎臟功能惡化之效果。本研究針對體內紅血球脂肪酸之濃度，和各種不同食物頻率的攝取量，探討糖尿病腎病變與糖尿病之間的危險性。
材料與方法 本研究為橫斷面研究，受試者為第2型糖尿病患502人，與糖尿病腎病變患者278人（包含微量和巨量白蛋白尿），進行紅血球脂肪酸成分分析和飲食頻率問卷訪視。
結果 糖尿病腎病變組之紅血球細胞膜上的飽和脂肪酸濃度顯著高於糖尿病組(39.42±0.92 wt% vs. 39.25±0.85 wt%, P = 0.019)，而n-3多元不飽和脂肪酸之濃度與糖尿病人有無罹患腎病變並無相關性，增加攝取新鮮蔬菜（>2份/天vs.≦2份/天）與降低糖尿病腎病變的風險有顯著的相關性（蔬菜：OR = 0.59, 95% CI = 0.43 - 0.81, P=0.001）。經校正年齡、性別、罹病年數、教育程度、高血壓、A1c，糖尿病患若體內總飽和脂肪酸/總多元不飽和脂肪酸比例較高者，腎病變的風險較高（≦ 0.92 vs. > 0.92, aOR=1.79, 95% CI = 1.23-2.58, P=0.002）；若每天攝取蔬菜的份數大於2份者，罹患糖尿病腎病變的風險為攝取蔬菜小於2份者的0.63倍（95% CI = 0.44-0.91, P=0.015）。
結論 本研究顯示飲食中減少攝取飽和脂肪酸、增加攝取多元不飽和脂肪酸，以及每天蔬菜攝取2份以上，皆有較低的糖尿病腎病變風險。故增加健康飲食型態的攝取，可能有助於降低第2型糖尿病腎病變之風險。

關鍵字

糖尿病腎病變 ； 健康飲食型態 ； 蔬菜 ； 飽和脂肪酸 ； 多元不飽和脂肪酸

並列摘要

Background: Microalbuminuria or Macroalbuminuria are known to increased risks of cardiovascular and renal failure in type 2 diabetes patients. Besides blood glucose and hypertension control, dietary components, such as consumption of different classes of fatty acid and healthy food choices may be beneficial in slowing progression of renal function in type 2 diabetes.
Methods and Materials: This study aimed to examine associations between keep fatty acid concentrations as dietary exposure as well as consumption of various foods and risks of diabetic nephropathy. Subjects were categorized as diabetes only (n=502) or diabetic nephropathy (n=278).
Result: The type 2 diabetic patients with or without nephropathy had significant differences in erythrocyte saturated fatty acids (39.42±0.92 wt% vs. 39.25±0.85 wt%, P=0.019). Erythrocyte n-3 polyunsaturated fatty acids were not significantly different between diabetic patients with or without nephropathy. Increased consumption of fresh vegetable ( >2 servings/day vs. ≦2 serving/day) was associated with lower risk of diabetic nephropathy (vegetable: OR = 0.59, 95% CI = 0.43 - 0.81, P=0.001). After adjusting for confounding factors (age, gender, disease duration, education, hypertension, HbA1c), total saturated fatty acids/total polyunsaturated fatty acids ratio had higher risk of diabetic nephropathy (≦ 0.92 vs. > 0.92, aOR=1.79, 95% CI = 1.23-2.58, P=0.002). In contrast, consumption of vegetable >2 servings per day as opposed to ≦2 servings per day had lower risks (aOR=0.63, 95% CI = 0.44-0.91, P=0.015) of diabetic nephropathy.
Conclusions: Diets lower in saturates, higher in polyunsaturates and increased consumption of vegetables may be beneficial in lowering risks of diabetic nephropathy.

並列關鍵字

Diabetic nephropathy ； healthy dietary pattern ； vegetable ； saturated fatty acids ； polyunsaturated fatty acids

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