台灣地區成人與老人鐵營養與貧血狀況及其影響因子之研究

Status of Iron Nutrition and Anemia and Their Associated Factors in Taiwanese Adults and Elderly

王瑞蓮(Jui-Line Wang)

指導教授 ： 蕭寧馨

國立臺灣大學/生命科學院/微生物與生化學研究所/博士(2005年)

https://doi.org/10.6342/NTU.2005.02593

摘要

本研究之主要目的是評估台灣地區男女兩性成人與老人之鐵營養與貧血狀況，並篩選其重要影響因子。樣本取自兩個調查資料：（1）「82年-85年國民營養健康狀況變遷調查」﹙NAHSIT 1993-1996﹚之19-64歲成人，計有男性886人及女性1017人，共計1903人。（2）「台灣地區老人國民營養健康狀況調查」（NAHSIT 1999-2000）之65歲以上居家老人，完成問卷資料與鐵營養指標分析者，計有男性724人及女性703人，共計1427人。缺鐵評估採用多指標模式，以血紅素、運鐵蛋白飽和度及鐵蛋白濃度三項。預測模式與影響因子之篩選採用多元逐步迴歸分析及邏輯式迴歸分析。
結果可見，缺鐵率方面：男性輕度缺鐵率為0.1 %、19-50歲女性8.6 %、51-64歲女性6.2 %，男性老人2.3 %、女性老人1.4 %。男性缺鐵貧血率為0.1 %、19-50歲女性6.8 %、51-64歲女性1.3 %，男性老人2.5 %、女性老人2.0 %。男性總缺鐵率為0.2 %、19-50歲女性15.4 %、51-64歲女性7.5 %，男性老人4.8 %、女性老人3.4 %。貧血率方面：男性為6.6 %、19-50歲女性25.2 %、51-64歲女性16.0 %，男性老人19.5 %、女性老人18.8 %。女性是缺鐵、也是貧血的主要危險群，尤其是停經前女性。
鐵營養方面，多元逐步迴歸分析結果，血清鐵蛋白濃度的迴歸公式分別為：
19-50歲女性：血清鐵蛋白濃度對數值＝3.62－0.83×(是否有月經)－0.11×(月經天數)＋0.52×(是否規律使用補充劑)－0.001×(飲食維生素C量)＋0.02×(年齡)＋26.97×(飲食鐵密度)＋0.06×(血液維生素狀況)－0.16×(生產次數)＋0.03×(BMI; Body Mass Index)；51-64歲女性：血清鐵蛋白濃度對數值＝2.69＋0.03×(年齡)－1.21×(是否有月經)＋0.001×(飲食維生素C量)＋0.09×(血液維生素狀況)＋0.06×(BMI)；男性：血清鐵蛋白濃度對數值＝4.55＋0.07×(血液維生素狀況)＋0.001×(酒精攝取量)＋0.01×(海鮮與肉類攝取頻率)；女性老人：血清鐵蛋白濃度對數值＝1.59＋0.01×(年齡)－0.01×(血液葉酸濃度）＋0.10×(營養資訊）＋0.41×(血液肌酸酐濃度)＋0.34×(白蛋白濃度)＋0.01×(肌酸酐排除速率)；男性老人：血清鐵蛋白濃度對數值＝4.15－0.01×(年齡)＋2.33×(腰臀比)＋0.91×(ETKAC; Erythrocyte transketolase activity coefficient)－1.44×(EGRAC; Erythrocyte glutathione reductase activity coefficient)－0.02×(血液葉酸值)－0.04×(飲食血基質鐵量)－0.03×(飲食粗纖維量)＋0.001×(飲食維生素C量)。升高缺鐵風險的因素分別是：19-50歲女性有月經者、教育程度高、年齡大；51-64歲女性為BMI<18.5；男性老人為飲食鐵密度高。降低缺鐵風險的因素分別是：19-50歲女性為BMI大、水果攝取頻率高、酒精攝取≧3 g；51-64歲女性為月經週期天數長；男性老人為BMI大。
貧血方面，多元逐步迴歸分析結果，血紅素濃度的迴歸公式分別為：19-50歲女性：血紅素濃度＝10.83＋0.43×(鐵蛋白濃度)＋0.03×(水果攝取頻率)；51-64歲女性：血紅素濃度＝11.92＋0.46×(鐵蛋白濃度)－0.29×(血液維生素狀況)；女性老人：血紅素濃度＝10.61－0.04×(年齡)＋0.10×(BMI)＋0.96×(白蛋白濃度)－0.80×(血液肌酸酐濃度)＋0.23×(血清鐵蛋白濃度)－0.04×(飲食血基質鐵)；男性老人：血紅素濃度＝9.26－1.26×(血液肌酸酐濃度)＋0.88×(白蛋白濃度)＋0.06×(BMI)＋0.03×(飲食肉類攝取)－0.01×(生肉/煙燻肉/茶/咖啡攝取頻率)－0.01×(飲食指南分數)＋0.77×(ETKAC)－0.01×(年齡)。升高貧血風險的因素分別有：19-50歲女性為缺鐵；51-64歲女性為缺鐵與血液維生素狀況佳；女性老人為缺鐵與血液肌酸酐濃度高；男性老人為缺鐵。降低貧血風險的因素分別有：19-50歲女性為水果攝取頻率高；51-64歲女性為抽煙者；女性老人為BMI高與血液白蛋白濃度高；男性老人為BMI高與肌酸酐排除數率高。
本研究結果顯示，男女兩性成人與老人的鐵營養狀況都會受飲食因素的影響；此外，停經前女性還受個人生理特性的影響。老人則受個人生理特性與慢性疾病的影響。男女兩性成人與老人貧血的主要影響因素是缺鐵以及飲食與營養因素，老人的貧血還受個人生理特性與慢性疾病的影響。因此，改善個人微量營養素之充足程度有助於降低國人的缺鐵與貧血問題，此外若能針對性別與年齡特質提供進一步的保健防治措施，例如停經前婦女的個人生理問題的調理，老人慢性疾病的良好控制等，成效將可更為顯著。

關鍵字

國民營養健康狀況變遷調查 ； 台灣地區老人國民營養健康狀況調查 ； 輕度缺鐵 ； 缺鐵性貧血

並列摘要

The thesis was aimed to assess the iron status and anemia of both female and male adults and elderly and their associated factors in Taiwan, using data collected in the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 and the Elderly NAHSIT 1999-2000. The sample analyzed included 703 women and 724 men aged between 19 and 64 years and 1202 elderly men and 1152 elderly women aged 65 years and older. Iron status was assessed using a multiple factor model including serum ferritin, transferrin saturation and hemoglobin. Factors and models associated with iron deficiency and anemia were analyzed with multiple logistic regression and stepwise regression.
The prevalence of iron deficient erythropoiesis was 0.1 % in adult men, 8.6 % in women aged 19-50 years, 6.2 % in women aged 51-64 years, 2.3 % in elderly men and 1.4 % in elderly women. The prevalence of iron deficiency anemia was 0.1 % in adult men, 6.8 % in women aged 19-50 years, 1.3 % in women aged 51-64 years, 2.5 % in elderly men and 2.0 % in elderly women. The prevalence of anemia was 6.6 % in adult men, 25.2 % in women aged 19-50 years, 16.0 % in women aged 51-64 years, 19.5 % in elderly men and 18.8 % in elderly women.
The regression formula for serum ferritin concentration were: for women aged 19-50 years: log (ferritin)=3.62- 0.83×(menstruating or not)- 0.11×(days of menstruation period)+ 0.52×(regular supplement user or not)- 0.001×(Vitamin C intake)+ 0.02×(age)+ 26.97×( dietary iron density)+ 0.06×(blood vitamin status)- 0.16×(parity)+ 0.03×(BMI; Body Mass Index)；for women aged 51-64 years: log (ferritin)=2.69+ 0.03×(age)- 1.21× (menstruating or not)+ 0.001×(Vit.C intake)+ 0.09×(blood vitamin status)+ 0.06×(BMI); for adult men: log (ferritin)=4.55+ 0.07×(blood vitamin status)+ 0.001×(alcohol consumption)+ 0.01×(frequency of seafood and meat consumption)；for elderly women: log (ferritin)=1.59+ 0.01×(age)- 0.01×(serum folate) +0.10×(nutrition information) +0.41×(serum creatinine)+ 0.34×(serum albumin)+ 0.01×(CrCl; Creatinine clearance); for elderly men: log (ferritin)=4.15- 0.01×(age)+ 2.33×(waist-hip-ratio)+ 0.91×(ETKAC; Erythrocyte transketolase activity coefficient)- 1.44×(EGRAC; Erythrocyte glutathione reductase activity coefficient)- 0.02×(serum folate)- 0.04×(heme iron intake)- 0.03×(dietary fiber)+ 0.001×(Vit.C intake). Factors associated with increased iron deficiency risk were: menstruating, education years>12 and increased age for 19-50-year women; BMI<18.5 for 51-64-year women; increased dietary iron density for elderly men. Factors related to decreased iron deficiency risk were: increased BMI, high frequency of fruit consumption and alcohol intake≧3 g for 19-50-year women; days of menstruation cycle for 51-64-year women; increased BMI for elderly men.
The regression formula for serum ferritin concentration were: for 19-50-years women: hemoglobin=10.83+ 0.43×(serum ferritin)+ 0.03×(frequency of seafood and meat consumption); for 51-64-year women: hemoglobin=11.92+ 0.46×(serum ferritin)- 0.29×(blood vitamin status); for elderly women: hemoglobin=10.61- 0.04×(age)+ 0.10×(BMI)+ 0.96×(serum albumin)- 0.80×(serum creatinine)+ 0.23×(serum ferritin)- 0.04×(heme iron intake); for elderly men: hemoglomin=9.26- 1.26×(serum creatinine)+ 0.88×(serum albumin)+ 0.06×(BMI)+ 0.03×(meat intake)-0.01×(frequency of raw meat/smoked meat/tea/coffee consumption)- 0.01×(dietary guideline score)+ 0.77×(ETKAC)- 0.01×(age). Factors related to increased anemia risk were: iron deficiency for 19-50-year women; iron deficiency and better blood vitamin status for 51-64-year women; iron deficiency and increased serum creatinine for elderly women; iron deficiency for elderly men. Factors related decreased risk were: increased frequency of fruit consumption for 19-50-year women; smoking for 51-64-year women; BMI and increased CrCl for elderly men.

並列關鍵字

Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 ； Elderly NAHSIT 1999-2000 ； iron deficient erythropoiesis ； iron deficiency anemia

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