以病例對照研究探討痛風之飲食及生活型態危險因子

Abstract

此項研究以營養流行病學研究法,針對國人痛風之生活形態病因探討的病例對照研究設計。研究於民國八十七年十一月至八十八年七月間,在台北市立和平醫院痛風門診招募痛風患者,並在同一醫院招募或經由患者人際網絡招募相同種族、性別及年齡層之非痛風患者為控制組。志願者為年齡30-60歲、居住於台北縣市、中等社經地位及家中有電話可聯絡者。研究者以直接面對面訪談方式(約90分鐘),收集了231位志願者的飲食歷史(包括食物頻率問卷及24小時回憶法)、活動量及型態(包括工作、休閒及家務活動)、抽煙歷史、疾病歷史、家族病史、用藥情形、體重歷史等標準化資料,並對志願者做血壓、皮脂厚度及體圍之測量。本研究的主要假說為:高脂、高蛋白的飲食型態為導致痛風病因的主要飲食因子,而肥胖歷史及運動型態可能為重要的痛風危險因子。初步分析72位患者及72位非患者資料顯示︰痛風病例組有較低的教育程度、水果和蔬菜攝取頻率較低、吃魚時會連皮吃的頻率較高(P<0.05)。此外、病例組比對照組血壓較高、腰圍、臀圍、三頭肌皮脂厚度皆較高(P<0.05)。由24小時回憶法所獲得的營養素攝取量顯示,植物性蛋白質、膳食纖維、葉酸、鈣及鐵質在對照組攝取量比病例組高。由食物頻率問卷所得每千大卡長期營養素攝取量發現痛風組攝取較低的葉酸、較高的酒精。由對數回歸分析發現提高攝取膳食纖維(OR=0.63,CI=0.38-1.05)、鐵質(OR=0.51,CI=0.30-0.87)、維生素C(OR=0.55,CI=0.33-0.93)、維生素A(OR=0.63,CI=0.38-1.05)、維生素B2 (OR=0.59,CI=0.35-0.99)、及葉酸(OR=0.54,CI=0.32-0.90)可降低罹患痛風的危險。針對研究主要假說及各變相交互作用之分析將會繼續進行。

The aim of this matched case-control study is to explore potential dietary and other lifestyle risk factors including smoking, education, physical activity and medication use in the development of gout. This study proposed an ad hoc hypothesis that a high fat, high protein diet is associated with gout. We recruited volunteers from the Gout Clinic in Taipei Municipal Ho-Ping Hospital and also acquired their friends to be healthy controls. Total 109 male female cases and 122 controls between November 1998 to July 1999 were interviewed in person, the average interview time was about 90 minutes. Information on diet history (including a 24-hour recall and a food frequency questionnaire), physical activity history (including work, leisure time and housework activities), smoking history, family medical history, and duration of certain diseases obtained by structured questionnaires with trained interviewers. The preliminary analyses for 92 male cases and 92 sex-age matched controls showed that cases had significantly lower education levels, lower frequencies for fruit and vegetable consumption and higher frequency for fish skin. In addition, cases had higher blood pressures, higher waist and hip circumferences and higher tricep skinfolds. Nutrients consumption from 24-hour recalls showed vegetable protein, dietary fiber, folic acid, calcium and iron intakes were higher in controls than the cases. Moreover, folic intake was significantly higher, but alcohol intake was lower in controls than the cases by food frequency questionnaire (p<0.05). We found high consumption of dietary fiber (OR=0.63, CI=0.38-1.05), iron (OR=0.51, CI=0.30-0.87), vitamin C (OR=0.55, CI=0.33-0.93), vitamin A (OR=0.63, CI=0.38-1.05), vitamin B2 (OR=0.59, CI=0.35-0.99) and folic acid (OR=0.54, CI=0.32-0.90) had reverse associations with gout. The inter-relationships between anthropometric measures, medical status and diet warrant further investigation.