探討不?袗?鋼鐵廠男性員工新陳代謝症候群之盛行率及相關危險因子

Prevalence and Determinants of Metabolic Syndrome Among Male Stainless Steel Factory Workers

顏簡美珠(Jean Mei-Chu Yen)

指導教授 ： 王榮德

共同指導教授 ： 杜宗禮(Chung-Li Du)

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.02907

摘要

研究目的：針對不?袗?鋼鐵廠男性員工之健康檢查結果進行分析，探討員工新陳代謝症候群盛行率與作業環境因素之相關性，並統計各影響因素之風險比，以作為未來健康管理策略之參考。
研究方法：自94.7.1.至94.9.30期間收集某不?袗?鋼鐵廠908位男性員工之健康檢查資料及健康行為問卷調查結果進行分析。個人基本資料包括年齡、教育程度、婚姻狀況、以及運動情況，和吸菸、喝酒、嚼檳榔等不利健康行為；工作史包括年資、工作內容、是否輪班、特別危害健康之作業類別；健康檢查項目則截取新陳代謝症候群定義項目，包括BMI、血壓、血糖、血脂肪之空腹檢查結果及是否服用降血壓、降血糖藥。針對研究對象基本資料、工作史及健康檢查結果進行描述性分析，並針對影響新陳代謝症候群盛行率的各項變因，調整年齡、教育程度、婚姻、運動情況、吸菸、喝酒、嚼檳榔等變項之影響，以探討員工新陳代謝症候群與高溫或噪音之作業別、以及是否輪班等作業環境因素之相關。交叉分析以t-test, ANOVA, Chi-square及Fisher’s exact test為主，採用Logistic regression統計影響新陳代謝症候群的各相關因素之風險比。
研究結果：研究對象平均年齡為34.8(±5.8)歲，其中未輪班者474人，有輪班但輪班作業少於6年者148人，輪班作業大於6年者286人，接受噪音作業特殊健檢者692人，接受噪音及高溫作業特殊健檢者116人。健檢結果BMI大於27者佔22.7%(206人)，在不同作業環境的員工之間並無顯著的差異，但有嚼檳榔者的調整後風險比是不嚼檳榔者的3.03倍；收縮壓≧130mmHg 者或舒張壓≧85mmHg 者或有服降壓藥但血壓正常者共佔39.5%(359人)，在不同作業環境的員工之間並無顯著的差異；高密度脂蛋白(HDL-C)低於40mg/dl者佔14.9%(135人)，每月喝酒1-2次以上者的調整後風險比僅為不喝酒者的0.51倍，有嚼檳榔者的調整後風險比是不嚼檳榔者的2.35倍；空腹血糖值≧110mg/dl者或有服降血糖藥但血糖正常者佔24.6% (223人)，年齡與輪班工作是高血糖的風險因子。與年齡小於30歲者相比，年齡在30-39歲者和年齡大於40歲者的調整後風險比分別是1.97倍、4.73倍，與沒輪班者相比，輪班時間少於6年者和輪班時間大於6年者的調整後風險比分別是2.38倍、1.54倍；空腹三酸甘油脂≧150mg/dl 者佔36%(327人)，年齡、吸菸以及嚼檳榔都是三酸甘油脂過高的風險因子。與年齡小於30歲者相比，年齡在30-39歲者和年齡大於40歲者的調整後風險比分別是是1.87倍、2.29倍，每日吸菸量10支以上以及嚼檳榔的調整後風險比分別是1.7倍、3.21倍。以上五種危險因子中包含三項或以上而符合新陳代謝症候群診斷者佔19.2%(174人)，嚼檳榔和輪班工作是罹患新陳代謝症候群的風險因子。有嚼檳榔者的調整後風險比是不嚼檳榔者的3.21倍，輪班時間大於6年者的調整後風險比是沒輪班者的1.59倍。
討論：本研究結果顯示鋼鐵廠男性員工其新陳代謝症候群盛行率明顯較國內同年齡層之男性高，是未來廠內健康管理及職廠健康促進的重要議題。嚼檳榔是肥胖、高密度脂蛋白(HDL-C)過低、空腹三酸甘油脂過高、以及陳代謝症候群的風險因素。而輪班工作是新陳代謝症候群和血糖過高的重要風險因素，如何協助輪班工作者建立健康的生活型態以降低新陳代謝症候群的風險是未來衛教工作努力的目標。
本研究的限制如下：員工的職場噪音暴露在本研究中以是否符合「噪音特殊危害勞工健康檢查」作為標準，並沒有個人暴露劑量之長期記錄。輪班與否以及輪班年數以自填問卷當時填答是否有輪班工作為依據，缺乏過去曾輪班但當時已不再輪班者的資料。由於國內「勞工健康保護規則」明定高血壓患者不宜從事高溫作業，心血管疾病患者不宜從事噪音作業，因此本研究結果無法排除健康者效應。

關鍵字

新陳代謝症候群 ； 作業環境危害 ； 輪班 ； 噪音 ； 高溫 ； 嚼檳榔

並列摘要

Objectives: With the aim to provide framework for workplace health management strategy, this study tried to identify the prevalence of metabolic syndrome among male workers in a stainless factory, and to analyze possible correlation between workplace hazards and metabolic syndrome.
Methods: We recruited 908 male subjects out of 1472 workers in a stainless factory into this study when they visited our hospital for annual health examination from July 2005 to September 2005. With written informed consents, participants were asked to fill out a standard questionnaire. Information of shift work, health behavior, and demographic data were collected. Workplace exposures to noise and heat were determined based on company records of exposure survey. Data on BMI (body mass index), blood pressure, fasting blood sugar, serum lipids profile, hypertension and diabetes were collected in annual health examination. Fisher’s exact test, t-test, ANOVA, and chi-square were used for analysis of correlation. The influencing factors such as age, education, marital status, regular leisure time physical activities, smoking, alcohol consumption, betel nut chewing, workplace hazards of noise, heat, and dust were explored for correlation with metabolic syndrome by multiple logistic regression.
Results: The mean age of study subjects was 34.8(±5.8) years. Among them 474 workers were in day time work, 148 workers were in shift work for less than 6 years, 286 workers were in shift work for more than 6 years, 692 workers exposed to noise hazard, 116 workers were exposed to both noise and high temperature hazards. The prevalence of obesity (BMI≧27) of study subjects was 22.7%(206), with no significant differences among the subgroups, but betel nut chewing was a strong risk with adjusted odds ratio of 3.03. The prevalence of high blood pressure (systolic ≧130mmHg or diastolic ≧85mmHg or under medication with normal BP) was 39.5%(359) , with no significant differences among the subgroups. The prevalence of low HDL-Cholesterol (＜40mg/dl) was 14.9% (135), with alcohol drinking more than 1-2 times a month as protecting factor, the adjusted odds ratio was 0.51 compared to nondrinker. Betel nut chewing was a strong risk for low HDL level with adjusted odds ratio of 2.35 compared to non chewer. The prevalence of high fasting blood sugar (≧110mmHg or under medication with normal blood sugar) was 24.6%(223). Age was a risk factor of high fasting blood sugar, comparing to workers aged less than 30 years old, the adjusted odds ratio of workers aged between 30-40 years old was 2.35, and the adjusted odds ratio of workers aged between 30-40 years old was 4.73. Shift work was a risk factor of high fasting blood sugar, comparing to day time workers, the adjusted odds ratio of workers on shift work for less than 6 years and more than 6 years was 2.38, and 1.54. The prevalence of high fasting Triglyceride (≧150mmHg) was 36% (327). Age was a risk factor of high fasting Triglyceride, comparing to workers aged less than 30 years old, the adjusted odds ratio of workers aged between 30-40 years old and more than 40 years old was 1.87 and 2.29. Smoking was a risk factor of high fasting Triglyceride, the adjusted odds ratio of daily smoker (>10 cigarette/day) was 1.7 compared to non smoker. Betel nut chewing was a strong risk for high fasting Triglyceride with adjusted odds ratio of 3.21 compared to non chewer. The prevalence of metabolic syndrome (workers with more than 3 risk factors) was 19.2%(174), betel nut chewing was a strong risk for metabolic syndrome with adjusted odds ratio of 3.21 compared to non chewer. The adjusted odds ratio of workers on shift work for more than 6 years was 1.59 compared to day time workers.
Discussion: The high prevalence of metabolic syndrome among subjects warrants recognition as key issue in workplace health promotion. Duration of shift work and betel nut chewing are strong determinants of risk for metabolic syndrome among male workers in stainless steel factory. Health promotion activity aiming at establishing healthy life style for employee working on shift should be a priority for health management.
There are several limitations of this study. Duration of shift work is measured by self administered questionnaire, there might be recall bias. Incomplete information was obtained concerning exposure to workplace noise more than one year prior to the health examination, use of personal protective devices, or noise exposure outside the occupational setting. Possibility of healthy workers’ effect could not be ruled out. To avoid labor dispute during the process for workers health management regarding workplace hazards, more comprehensive records for hazards exposure such as noise, high temperature and shift work will provide better discretion for decision making with evidence-based information.

並列關鍵字

metabolic syndrome ； shift work ； workplace ； noise ； heat ； betel nut chewing

參考文獻

1. Haffner SM. Risk constellations in patients with the metabolic syndrome: epidemiology, diagnosis, and treatment patterns. Am J Med 2006; 19(Supp1):S3–S9.

2. Reaven GM. Banting lecture 1988: role of insulin resistance in human disease. Diabetes 1988; 37:1595–1607.

3. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications: part 1: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation. Diabet Med 1998; 15:539–553.

4. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

5. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care. 2005 Jul;28:1769-1778.