修訂版全面飲食指標與慢性疾病危險因子及代謝症候群關係之探討
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Date
1993-01-01
Authors
李美璇
盧立卿
楊鳳玉
李孟璋
ee, Meei-Shyuan
Lyu, Li-Ching
Yang, Feng-Yu
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Abstract
全面飲食指標（ODI）是根據「每日飲食指南」及「國民飲食指標」發展出來的總體飲食品質指標，然ODI與慢性病危險因子之盛行率與發生率關係並不一致。本研究按飲食新建議修訂ODI為全面飲食指標修正版（ODI-R），增加醣類及肉類食物質的評價，減少膳食脂肪的量的影響。ODI-R共9大項，包括飲食指南分數（奶、蛋豆魚肉、蔬菜、水果和五穀根莖等五類食物攝取情形）、膳食脂肪表現（P/S比、膽固醇攝取）、飲食適量及飲食多樣性；其中「五穀根莖」及「蛋豆魚肉」附加品質評量，每項15分，其餘各10分，總分100分。繼以橫斷面與追蹤研究兩種設計，探討ODI-R與慢性病危險因子及代謝症候群的關係。研究資料為87年（橫斷面，50,060人，女性：51.7%）與87與91兩年（世代，4,131人，女性：51.5%）參加某健檢診所19-64歲、非素食會員之人體測量、生化檢查、膳食評估及抽菸、喝酒及運動等行為資料。主要發現如下： 1. ODI-R平均61.3分（範圍：17.3-95.3，SD：11.0，中位數：61.9），＞80%的人在51-80分之間；僅3.4%＞80分；女高於男（62.2 vs. 60.2）；年齡愈長愈高。ODI-R和熱量、醣類、膳食纖維、鈣質、維生素E和C呈正相關；與膽固醇和酒精呈負相關；與脂肪呈弱正相關。ODI-R可表現巨量及微量營養素的攝取；飲食品質愈佳者其生活型態愈健康。 2. 慢性疾病危險因子盛行率及追蹤四年發生率分別為：高血糖（3.3%、1.2%）、高血壓（13.4%、4.0%）、高尿酸（29.1%、16.2%）及高血脂（32.1%、7.8%）。DOH代謝症候群盛行率為14.7%（男：17.9%，女：11.6%）；隨年齡上升而上升，男性三年齡組為7.8%、17.8%及28.6%；女性前兩組遠低於男性（1.9%、6.6%），50-64歲組驟升至33.4%。從＜20歲到≧70歲之每十年盛行率分別為2.5、4.5、9.3、17.9、30.0、40.7、45.6，與美國相仿。四年追蹤發生率為5.9%（男：7.4%，女：4.4%）；女性更年期後陡升至13%。NCEP盛行率及發生率分別為10.4%（男：12.5%，女：8.4%）及4.6%（男：6.0%，女：3.3%）。 3. ODI-R與慢性病危險因子的橫斷面關係具性別差異。其與血糖、平均血壓關連不大；但對總膽固醇（Chol）、三酸甘油酯（TG）及尿酸有保護。男性最高之20%比最低者TG低15mg/dl（趨勢，p＜0.0001）；Chol低4mg/dl（趨勢，p＜0.0001）；尿酸結果類似。女性僅Chol與尿酸有保護作用。與ODI相比其趨勢相同，但強度及顯著性均增加。ODI-R愈高分對血脂與尿酸異常有顯著保護，最高五分位組血脂異常的機會是最低組之81％（趨勢，p＜0.0001）。飲食品質對男性代謝症候群之保護效果隨年齡增加而增強，兩個較長年齡組之最高分組罹患代謝症候群的危險是最低分組的70％（趨勢，p＜0.001）。不分齡趨勢更強（p＜0.0001），後四組較最低組有顯著較低的危險。女性僅最高齡組之最高分組有保護（OR=0.81），趨勢也僅及邊緣顯著（p = 0.078）。不分齡趨勢雖顯著但不強（p = 0.04）。將BMI從模式中去除後結果變得更顯著，且兩性差異不再。ODI-R較ODI更能解釋慢性病危險因子異常與代謝症候群盛行率，飲食品質愈佳盛行率愈低。 4. 世代分析：結果較橫斷面分析不明顯，女性在三個年齡層趨勢一致，以TG及Chol保護效應最大；血糖有趨勢但效應不大；血壓則無任何關連。男性則在各年齡表現凌亂，飲食品質對男性而言，對四年後的血壓及血清生化值幾乎完全無保護作用。女性的飲食品質呈現保護的效果，飲食品質最好的那一組有最低的OR，但僅血脂顯著；男性無任一項顯著。比較ODI-R最高分組與最低分組，女性之血糖異常、血壓異常、血脂異常、與尿酸異常發生之OR分別為0.48、0.56、0.50及0.82。血脂異常發生之危險，在控制了其他因素後，隨著得分愈高下降（趨勢，p＜0.05）。飲食品質對男性代謝症候群之發生沒有明顯效應，女性則有得分最高組有較低OR的趨勢（p＜0.01）。四年之追蹤研究結果，儘管強度不大，仍然指出若飲食的品質較佳，則後續會有三項及以上之代謝異常發生的機率會較低。這種保護效果對女性尤其顯著。 本研究的結果證明飲食品質愈佳，則不論是慢性疾病危險因子或代謝症候群的盛行率與發生率均較低，應該鼓勵民眾之日常飲食應該參照「飲食指南」及「飲食指標」的建議。
Background: Human being??s eating behavior is a complex and multi-dimensional phenomenon. The traditional single-food or single-nutrient approach cannot completely explain the actual relationship between the diet and the risk of disease. The food guides for Chinese in Taiwan developed by Department of Health comprises the recommended daily portions of the six major food groups. It aims to reduce the risk of major chronic disease and maintain overall health status of the people through balance diet. Little is known about the overall health effects of adherence to the guides. Objective: To evaluate a revision of the Overall Dietary Index called the Over Overall Dietary Index Revised (ODI-R). We tested whether the dietary quality indices related to the food guides derived from a simplified semi-food-frequency questionnaire would predict the impact of major chronic disease related risk factors and metabolic syndrome. Design: A total of 50,060 adults aged 19-64, including 24,161 men and 25,899 women who attended a periodic health check-up program in a private health check-up institute during the year of 1998, were eligible for the cross-sectional analysis. For the follow-up incidence analyses, those who attended both tests (1998 and 2002), the size of the sample were 4,131(women: 51.5%). Measures: Information of personal characteristics, lifestyle related factors, such as smoking, alcohol drinking etc., and dietary data from a simplified semi- quantitative food frequency questionnaire was ascertained as part of a self- administered questionnaire completed by the examinees upon registration for health check-up. The major chronic disease risk factors were the values of the serum specimen collected during check-up, those included fasting glucose, blood lipids and uric acid. SBP and DBP were also accounted. Prevalence and incidence of the metabolic syndrome were defined by both NCEP ATP III and DOH criteria. Results: 1. The mean ODI-R score for the 1998 sample was 61.3 of a possible 100-point score. ODI-R was positively correlated with intake of other important measures of diet quality (e.g., total calories, dietary fiber, calcium and vitamin C) and negatively correlated with cholesterol and alcohol. Those who have high ODI-R score with more healthful life-style. 2. The prevalence and incidence after 4-year follow-up were hyperglycemia (3.3%, 1.2%), hypertension (13.4%?B4.0%), hyperuricemia (29.1%?B16.2%), hyperlipidemia (32.1%?B7.8%), respectively. Prevalence and incidence as defined by DOH were 14.7% (men: 17.9%, women: 11.6%) and 5.9% (men: 7.4%, women: 4.4%). The prevalence increased from 7.8% among participants aged 19-29 to 28.6% for participants aged 50-64, respectively. Four-year follow-up metabolic syndrome incidence was 5.9%, and up to 13% for women aged 50-64. Prevalence and incidence as defined by NCEP were 10.4% (men: 12.5%, women: 8.4%) and 4.6% (men: 6.0%, women: 3.3%). 3. In the cross-sectional analysis, sex-specific results were found. ODI-R showed substantial protective effects in total cholesterol and triglyceride, less in uric acid and no association with blood glucose and mean blood pressure. The blood triglyceride level was 15 mg/dl lower in the men with the highest quintile ODI-R score comparing the those who with the lowest quintile (p for trend < 0.0001). The protective effects of ODI-R were limited to total cholesterol and uric acid in females. Compared to ODI, ODI-R demonstrated same pattern in protection in those chronic risk factors but larger magnitude and significance. The ORs of the DOI-R fifth quintile contrasted to the lowest quintile were both 0.81 for the risk of hyperlipidemia and hyperuricemia in men. (p for trend < 0.0001). Those who with the highest quintile of ODI-R
Background: Human being??s eating behavior is a complex and multi-dimensional phenomenon. The traditional single-food or single-nutrient approach cannot completely explain the actual relationship between the diet and the risk of disease. The food guides for Chinese in Taiwan developed by Department of Health comprises the recommended daily portions of the six major food groups. It aims to reduce the risk of major chronic disease and maintain overall health status of the people through balance diet. Little is known about the overall health effects of adherence to the guides. Objective: To evaluate a revision of the Overall Dietary Index called the Over Overall Dietary Index Revised (ODI-R). We tested whether the dietary quality indices related to the food guides derived from a simplified semi-food-frequency questionnaire would predict the impact of major chronic disease related risk factors and metabolic syndrome. Design: A total of 50,060 adults aged 19-64, including 24,161 men and 25,899 women who attended a periodic health check-up program in a private health check-up institute during the year of 1998, were eligible for the cross-sectional analysis. For the follow-up incidence analyses, those who attended both tests (1998 and 2002), the size of the sample were 4,131(women: 51.5%). Measures: Information of personal characteristics, lifestyle related factors, such as smoking, alcohol drinking etc., and dietary data from a simplified semi- quantitative food frequency questionnaire was ascertained as part of a self- administered questionnaire completed by the examinees upon registration for health check-up. The major chronic disease risk factors were the values of the serum specimen collected during check-up, those included fasting glucose, blood lipids and uric acid. SBP and DBP were also accounted. Prevalence and incidence of the metabolic syndrome were defined by both NCEP ATP III and DOH criteria. Results: 1. The mean ODI-R score for the 1998 sample was 61.3 of a possible 100-point score. ODI-R was positively correlated with intake of other important measures of diet quality (e.g., total calories, dietary fiber, calcium and vitamin C) and negatively correlated with cholesterol and alcohol. Those who have high ODI-R score with more healthful life-style. 2. The prevalence and incidence after 4-year follow-up were hyperglycemia (3.3%, 1.2%), hypertension (13.4%?B4.0%), hyperuricemia (29.1%?B16.2%), hyperlipidemia (32.1%?B7.8%), respectively. Prevalence and incidence as defined by DOH were 14.7% (men: 17.9%, women: 11.6%) and 5.9% (men: 7.4%, women: 4.4%). The prevalence increased from 7.8% among participants aged 19-29 to 28.6% for participants aged 50-64, respectively. Four-year follow-up metabolic syndrome incidence was 5.9%, and up to 13% for women aged 50-64. Prevalence and incidence as defined by NCEP were 10.4% (men: 12.5%, women: 8.4%) and 4.6% (men: 6.0%, women: 3.3%). 3. In the cross-sectional analysis, sex-specific results were found. ODI-R showed substantial protective effects in total cholesterol and triglyceride, less in uric acid and no association with blood glucose and mean blood pressure. The blood triglyceride level was 15 mg/dl lower in the men with the highest quintile ODI-R score comparing the those who with the lowest quintile (p for trend < 0.0001). The protective effects of ODI-R were limited to total cholesterol and uric acid in females. Compared to ODI, ODI-R demonstrated same pattern in protection in those chronic risk factors but larger magnitude and significance. The ORs of the DOI-R fifth quintile contrasted to the lowest quintile were both 0.81 for the risk of hyperlipidemia and hyperuricemia in men. (p for trend < 0.0001). Those who with the highest quintile of ODI-R