空氣及飲用水品質對代謝性症候群影響之社區研究

A community-based study on the association between metabolic syndrome and the quality of air and drinking water

陳佳琪(Jia-Chi Chen)

指導教授 ： 詹長權

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(2004年)

https://doi.org/10.6342/NTU.2004.02337

摘要

目的：透過收集社區民眾健康篩檢資料、空氣及飲用水品質資料，以瞭解空氣及飲用水品質與罹患代謝性症候群之關連。
方法：研究對象為2002年至2003年間來自二十四個分區曾參與社區性整合式健康篩檢模式之民眾，共有26166名。此二十四個分區之飲用水資料來源為1996年至2001年環保署八項飲用水品質抽驗資料，包括大腸桿菌群、總菌落數、濁度、亞硝酸鹽氮、硝酸鹽氮、硫酸鹽、硬度(碳酸鈣)、及pH值；另外從中選取其中八個有空氣品質監測的分區，共有民眾7566名，並收集環保署1993年至2001年五項空氣品質監測資料，包括二氧化硫、一氧化碳、臭氧、懸浮微粒（PM10）及二氧化氮。代謝性症候群採用亞洲版NECP ATP III之定義，統計方式採用一般線性混合型模式（Genralized Linear Mixed-effects Model），在校正了代謝性症候群之其他危險因子，包括固定效應性別、年齡、抽菸、飲酒、運動習慣、素食飲食習慣、主食份量、蔬菜份量、肉食份量、及BMI等變項，並以環境品質分區為隨機效應，分別探討空氣品質及飲用水品質各項目與罹患代謝性症候群之關連性。
結果：二十四個飲用水品質分區代謝性症候群之平均盛行率為19﹪，各區盛行率介於15﹪至34﹪之間，八個飲用水品質項目中，只有亞硝酸鹽氮、硫酸鹽、及硬度（碳酸鈣）三項與罹患代謝性症候群有正相關，亞硝酸鹽氮高濃度地區（5∼6μg/L）較低濃度地區（1∼3μg/L）之勝算比為2.22（95%信賴區間1.86~2.66）；硫酸鹽高濃度地區（38∼84mg/L）較低濃度地區（13∼32mg/L）之勝算比為1.34（95%信賴區間1.04~1.73）；總硬度高濃度地區（103∼224mg/L）較低濃度地區（24∼99mg/L）之勝算比為1.30（95%信賴區間1.00~1.68）。五個空氣品質項目中空氣品質中，只有二氧化硫及二氧化氮與罹患代謝性症候群有正相關，二氧化硫高濃度地區（4∼15ppb）較低濃度地區（2∼3ppb）之勝算比為1.90（95%信賴區間1.09~3.31）；二氧化氮高濃度地區（27∼29ppb）較低濃度地區（13∼23ppb）之勝算比為2.37（95%信賴區間1.75~3.23）。
結論：空氣品質中的二氧化硫及二氧化氮，以及飲用水品質中的亞硝酸鹽氮、硫酸鹽及總硬度中的碳酸鈣與罹患代謝性症候群有顯著正相關。目前環境品質與代謝性症候群之關係尚無其他研究探討，確切的劑量效應及生物機轉，需要進一步的研究來釐清。

關鍵字

飲用水品質 ； 代謝性症候群 ； 空氣品質 ； 一般線性混合式模型

並列摘要

Purpose: The purpose of this study was to investigate the association between metabolic syndrome and the quality of air and drinking water.
Method: Our study subjects included 26166 residents of 24 communities in Taiwan, who have participated in community-based integrated screen for multiple diseases during 2002-2003. The quality of drinking water in each community including total Coliform count、heterotrophic plate count、turbidity、nitrite、nitrate、sulfate、hardness(calcium carbonate), and pH value were obtained from routine monitoring of the Taiwan Environmental Protection Agency (TEPA) during 1996-2001. The air quality including sulfur dioxide, carbon monoxide, ozone, particulate matter, and nitric dioxide in 8 out of 24 communities were obtained from 8 TEPA’s air-quality monitoring stations during 1993-2001. There were 7566 residents in the 8 communities with air quality data. The Asian modified National Education Cholesterol Program Adult Treatment Panel Third defined the metabolic syndrome of screened population. Generalized Linear Mixed-effect models were used to investigate the association between metabolic syndrome and the quality of air and drinking water by adjusting gender, age, body mass index, smoking, drinking, exercise, and diet as fixed effects and the community as a random effect.
Result: The prevalence of metabolic syndrome averaged at 19%, ranging 15% to 34% among our 24 study communities. Among 8 water quality indices, only nitrite, sulfate, and calcium of hardness were found to be associated with metabolic syndrome. By comparing the residents in the areas of nitrite levels between 5 and 6μg/L, sulfate levels between 38 and 84 mg/L, and calcium levels of hardness between 103 and 224 mg/L to those in the area with nitrite levels between 1 and 3 μg/L, sulfate levels between 13 and 32 mg/L, and calcium levels of hardness between 24 and 99 mg/L, the adjusted odds ratios (95% confidence interval) were 2.22 (1.86 to 2.66) for nitrite, 1.34 (1.04 to 1.73) for sulfate, and 1.30 (1.00 to 1.68) for hardness, respectively. Among the 5 air quality indices, only nitric dioxide and sulfur dioxide were found to be associated with metabolic syndrome. By comparing the residents in the areas of nitric dioxide levels between 27 and 29 ppb, and sulfur dioxide levels between 4 and 15 ppb to those in the areas of nitric dioxide levels between 13 and 23 ppb, and sulfur dioxide levels between 2 and 3 ppb, the adjusted odds ratios (95% confidence interval) were 2.37 (1.75 to 3.23) for nitric dioxide, and 1.90 (1.09 to 3.31) for sulfur dioxide.
Conclusion：Environmental quality including nitric dioxide and sulfur dioxide in air, and nitrite, sulfate, and calcium of hardness in drinking water were significantly associated with increase in metabolic syndrome.

並列關鍵字

Generalized Linear Mixed-effect Model ； drinking water quality ； air quality ； metabolic syndrome

參考文獻

1Eric Chivian, Michael McCally, Howard Hu, Andrew Haines. Critical Condition: human health and the environment. Massachusetts Institute of Technology 1993; 34-39.

2Anderson HR. Air pollution and health I-IV: Health effects of air pollution episodes. Academic Press 1999; 461-482.

3Klea Katsouyanni. Ambient air pollution and health. Br Med Bull 2003;68:143-156.

5Dockery DW, Pope CA III, Xu X, et al. An association between air pollution and mortality in six US cities. N Engl J Med 1993;329:1753-1759.

6Pope CA III, Thun MJ, Namboodiri MM, et al. Particulate air pollution as a predictor of mortality in a prospective study of US adults. Am J Respir Crit Care Med 1995;151:669-674.