臺灣博碩士論文加值系統

蔬食是一種以新鮮及低加工植物性食品為主，並減少肉、蛋及乳製品攝取的飲食型態。西方世代研究證實，蔬食有助於降低慢性疾病的發生。鑑於國人慢性疾病的攀升，加上蔬食與慢性疾病之研究多屬橫斷面分析，本研究藉世代研究法，釐清蔬食與慢性疾病及全死因之相關性。
本研究的研究材料取自「1993-1996年國民營養健康狀況變遷調查」(NAHSIT I)、「1999-2000年國民營養健康狀況變遷老人調查」(NAHSIT II) ，以及「2005-2008年國民營養健康狀況變遷調查」(NAHSITⅢ)三個二手資料庫。藉由三個年代之資料，比較成人及老人蔬食比例的增減。此外，將1993-1996及1999-2000年兩次營養調查資料，連結健保資料庫（至2006年）、癌症登記檔（至2006年）及死亡登記檔（至2008年），取得結果變項。以Cox比例風險迴歸，分析臺灣地區30歲以上國人，蔬食與慢性疾病發生及全死因死亡率之相關性。研究對象分為蔬食組(每日蔬菜總攝取≥3份，且肉類及蛋總攝取≤3份者)、菜少肉多組、菜多肉多組以及菜少肉少組。
分析結果顯示1993-1996年的成年人口蔬食比例為13.7%， 2005-2008年降至9.73%。1999-2000年至2005-2008年，老年人口蔬食比例則顯著增加11%。1993-1996之成年人口，女性、年長、低教育程度、低飲酒率、高體能活動者、患有高血壓者，蔬食比例較高；1999-2000之老年人口蔬食與性別、年齡、教育程度、抽菸與否、自覺健康狀況顯著相關。2005-2008年男性蔬食與低抽菸率顯著相關，其他變項則無顯著相關。蔬食女性低教育程度及高體能活動特質一致，但飲酒比率顯著升高。無論成人或老人，其蔬食的飲食品質皆有變佳的趨勢。
校正年齡後，比起參考組(菜少肉多組)，女性蔬食者罹患第2型糖尿病風險，顯著降低56% (95% CI: 0.20-0.98, p-value<0.05)；敏感度分析效益仍然顯著。蔬食者罹患任何型式骨折的風險與參考組無顯著差異，但女性自述為素食者，飲食型態屬於菜少肉少或菜多肉多者，可能具有較高的任何形式骨折風險。成年男性及老人蔬食雖無助於降低慢性疾病和死亡風險，但也無害於健康。

A plant-based diet may be defined as an eating pattern dominated by fresh or minimally processed plant foods and decreased consumption of meat, eggs and dairy products. Cohort studies in western countries confirm that a plant-based diet can reduce the incidence of chronic disease. There are also increased rates of chronic disease in Taiwan, reflected in many studies of cross-sectional design. We have used the cohort study design to clarify the purported associations between the plant-based diet and chronic disease as well as all-cause mortality.
Data used for analysis were those of three Nutrition and Health Surveys in Taiwan, namely: І (1993-1996), II (Elderly only, 1999-2000) and III (2005-2008). We compared the prevalence of plant-based diet usage in different surveys. In addition, Survey І and the Elderly Survey were linked to the National Health Insurance system, to the Cancer Registry and with the National Death Registry for outcome ascertainment. Cox proportional-hazards models were used to analyze the associations between plant-based diets, chronic disease and all-cause mortality. Participants were classified into four groups by their dietary intakes: 1) plant-based diet (defined as daily vegetable intake ≥3 servings, and intakes of meat and eggs ≤3 servings); 2) low vegetable and high meat and egg diet; 3) high vegetable, meat and egg diet; and 4) low vegetable, meat and egg diet.
Compared to the 1993-1996 survey, the plant-based diet prevalence of adults aged 31 to 64 years decreased around 4%. By contrast, the plant-based diet prevalence among elderly increased by about 11% from 1999-2000 to 2005-2008. In the Survey I, women, elders, those with lower education, non-alcohol drinkers, those with higher levels of physical activity, and those who were hypertensive, had more prevalent plant-based diet usage. For elderly who participated in the 1999-2000 survey, the plant-based diet was significantly correlated with gender, age, education level, smoking, and self-awareness of health. In NASHIT III, men who consumed a plant-based diet had a significantly lower smoking rate, while the corresponding women continued to be those with the lower education and higher physical activity levels, but had higher alcohol drinking rates than in the previous studies. The Overall Dietary Index Revised score revealed that the quality of the plant-based diet was better than in the past.
After adjustment for age, women who consumed a plant-based diet had a lower risk of type 2 diabetes (HR=0.44, 95% CI: 0.20-0.98, p-value <0.05). In sensitivity analyses this finding was unchanged. For men, there was no such association with diabetes. There were no significant associations between plant-base diet usage and fracture. However, if women considered themselves to be vegetarian, or had a dietary pattern high in vegetables, meat and eggs (group 3) or had one low in vegetables, meat and eggs (group 4), had a higher risk of fracture. Plant-based diet usage among adult and elderly men does not affect the incidence of chronic disease or all-cause mortality.

正文目錄 ...................................................................................................................................... I
表目錄 ...................................................................................................................................... III
圖目錄 ....................................................................................................................................... V
中文摘要 .................................................................................................................................. VI
Abstract ................................................................................................................................. VIII
第一章 緒論 .............................................................................................................................. 1
第一節 研究背景與重要性 .............................................................................................. 3
第二節 研究目的 .............................................................................................................. 3
第二章 文獻探討 ...................................................................................................................... 4
第一節 蔬食定義 .............................................................................................................. 4
第二節 蔬食者之營養議題 .............................................................................................. 6
第三節 美、英兩國蔬食研究發展 ................................................................................ 13
第四節 蔬食及慢性疾病之影響因素 ............................................................................ 16
第五節 蔬食與慢性疾病之相關 .................................................................................... 18
第六節 蔬食與死亡率之相關 ........................................................................................ 23
第三章 研究問題及假設 ........................................................................................................ 24
第一節 研究問題 ............................................................................................................ 24
第二節 研究假設 ............................................................................................................ 24
第四章 研究材料與方法 ........................................................................................................ 25
第一節 研究架構 ............................................................................................................ 25
第二節 研究對象 ............................................................................................................ 26
第三節 研究工具 ............................................................................................................ 28
第四節 資料處理 ............................................................................................................ 30
第五節 統計方法 ............................................................................................................ 55
第五章 結果 ............................................................................................................................ 56
第一節 蔬食人口比例及人口學特性 ............................................................................ 56
第二節 蔬食人口生理特質 ............................................................................................ 59
第三節 蔬食飲食內容 .................................................................................................... 61
第四節 蔬食與慢性疾病之相關 .................................................................................... 64
第五節 蔬食與死亡率之相關 ........................................................................................ 67
第六章 ...................................................................................................................................... 68
第一節 蔬食人口比例 .................................................................................................... 68
第二節 蔬食人口學特性 ................................................................................................ 69
第三節 蔬食人口生理特質 ............................................................................................ 73
第四節 蔬食飲食內容 .................................................................................................... 77
第五節 蔬食與慢性疾病之相關 .................................................................................... 79
第六節 蔬食與死亡率之相關 ........................................................................................ 84
第七節 研究優點與限制 ................................................................................................ 85
第七章 結論 ............................................................................................................................ 87
第八章 參考文獻 .................................................................................................................... 89

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