臺灣博碩士論文加值系統

世界癌症研究基金會(World Cancer Research Fund, WCRF)與美國癌症研究所(American Institute for Cancer Research, AICR)系統回顧大型流行病學研究及實驗性證據的結果，於2007年發表「食物、營養、身體活動和癌症預防」報告，提出身體肥胖度、身體活動、飲食及膳食補充劑等八項防癌建議。該八項建議除預防癌症外，亦需預防或至少不危害其他慢性疾病。為驗證其對慢性疾病之影響，本研究使用世代研究法，探討這八項建議與30-64歲國人糖尿病、高血壓及高血脂症發生情形。以1993-1996年國民營養狀況變遷調查之30-64歲受訪者構成研究世代，串連健保資料庫及全國死亡登記檔，以確認受訪者於追蹤期間新發生糖尿病、高血壓及高血脂症的狀況。使用Cox proportional-hazards model進行分析，以危害比(hazard ratio, HR)及95%信賴區間(confidence intervals, CI)呈現。個案追蹤時間的中位數為13.0-13.5年，每千人年中約有12.6人發生糖尿病、29.1人發生高血壓、13.4人發生高血脂症。經校正可能的干擾因子後，符合BMI＜24.0者及腰圍正常(男性＜90公分；女性＜80公分)者，與兩項皆不符合者相比，其發生糖尿病、高血壓、高血脂症的風險為0.22 (95% CI: 0.14-0.33)、0.55 (95% CI: 0.47-0.64)及0.38 (95% CI: 0.21-0.69)。將研究對象遵循WCRF/AICR建議之總得分(範圍為0至17分)依分布分成5組(≦8分、9分、10分、11分、≧12分)比較，得分11分、≧12分者，其發生糖尿病的風險分別為≦8分者的0.45倍(95%CI: 0.30-0.67)及0.33倍(95%CI: 0.14-0.82)，且隨著得分越高，發生風險越低(趨勢檢定p=0.013)。結果指出WCRF/AICR建議對國人糖尿病、高血壓及高血脂症的發生不造成危害；且八項建議中，又以維持正常身體肥胖度之建議，對此三個疾病最具顯著保護；而達建議之總得分11分以上者，對於糖尿病的預防具有顯著效果。

The World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) used systematic literature reviews and the criteria for grading the evidence to comprehensively judge many epidemiological studies and experimental evidence, and then published “Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective” in 2007. It makes eight recommendations for cancer prevention, including ones to do with body fatness, physical activity, food and dietary supplements. The Panel recognized that recommendations are also made in relation to other diseases and took these into account in formulating those for cancer prevention. We, therefore have examine the association between compliance with WCRF/AICR recommendations and risks of diabetes mellitus, hypertension and hyperlipidemia incidences in 30-64 years Taiwanese. The databases used in the analyses were, firstly, the Nutrition and Health Survey in Taiwan (NAHSIT 1993-1996). Secondly, participants’ chronic diseases incidence status was obtained by linkage of NAHSIT to the National Health Insurance and, thirdly, to the National Death Certification database. Cox proportional- hazards models with person-years of follow-up as the time variable were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI). During medians follow-ups of 13.0-13.5 years, the incidence densities of diabetes mellitus, hypertension and hyperlipidemia were 12.6, 29.1 and 13.4 per 1000 person-years. The combined effects of body mass index (BMI; kg/m2) and waist circumference were examined. After adjusting for potential confounders, the participants with a combination of BMI <24.0 and normal waist circumference (men <90 cm; women <80 cm), compared with those in the BMI ≥24.0 group with abnormal waist circumference (men ≥90 cm; women ≥80 cm) had lower risk of diabetes mellitus (HR=0.22, 95% CI: 0.14-0.33), hypertension (HR=0.55, 95% CI: 0.47-0.64) and hyperlipidemia (HR=0.38, 95% CI: 0.21-0.69). After adjusting for potential confounders, a score for the WCRF/AICR recommendations (range: 0-17) was associated with a significant reduction in risk of diabetes mellitus, compared with the highest ( ≥12) group and the lowest ( ≤8) group (HR: 0.33; 95% CI: 0.14-0.82; p for trend=0.013). In conclusion, WCRF/AICR recommendations did not increase the risks for diabetes mellitus, hypertension or hyperlipidemia. Of eight recommendations, maintaining normal weight was the most significant factor for prevention of these chronic diseases. WCRF/AICR recommendations total scores ≥11 points were significantly associated with a reduction in risk of diabetes mellitus.

正文目錄 I
表目錄 IV
圖目錄 VI
附錄目錄 VII
中文摘要 VIII
Abstract X
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 WCRF/AICR「食物、營養、身體活動和癌症預防」建議及定義 4
壹 身體肥胖度 5
貳 身體活動量 5
參 高能量密度食物及飲料 6
肆 植物性食物 6
伍 動物性食物 6
陸 含酒精飲料 7
柒 保存、加工及製作 7
捌 膳食補充劑 7
第二節 臺灣慢性疾病現況及其影響因素 9
壹 臺灣慢性疾病現況 9
貳 慢性疾病之影響因素 12
第三節 WCRF/AICR建議與慢性疾病之相關研究 18
壹 身體肥胖度 18
貳 身體活動量 18
參 高能量密度食物及飲料 19
肆 植物性食物 20
伍 動物性食物 21
陸 含酒精飲料 22
柒 鹽及醃製食品 22
捌 膳食補充劑 23
第四節 總結 25
第三章 研究問題與假設 26
第一節 研究問題 26
第二節 研究假設 26
第四章 研究材料與方法 27
第一節 研究架構 27
第二節 研究對象 28
第三節 研究工具 30
壹 問卷資料 30
貳 體檢資料 31
參 全民健保資料庫及全國死亡登記檔 32
第四節 研究流程 35
壹 糖尿病 35
貳 高血壓 35
參 高血脂症 36
第五節 量化WCRF/AICR建議 40
壹 身體肥胖度 40
貳 身體活動量 41
參 高能量密度食物及飲料 41
肆 植物性食物 43
伍 動物性食物 44
陸 含酒精飲料 45
柒 保存、加工及製作 45
捌 膳食補充劑 46
玖 WCRF/AICR建議之總得分 46
第六節 資料處理與統計方法 47
壹 追蹤時間 47
貳 描述性統計 48
參 推論性統計 48
第五章 結果 49
第一節 30-64歲國人慢性疾病之發生情形 49
第二節 影響國人慢性疾病之因素 50
壹 基本人口學 50
貳 生活型態 51
參 疾病史及體檢資料 52
第三節 遵循WCRF/AICR建議與慢性疾病發生之相關性 53
壹 WCRF/AICR八項建議中各細項之探討 53
貳 WCRF/AICR八項建議中項目符合度之探討 57
參 WCRF/AICR八項建議之綜合探討 59
第六章 討論 62
第一節 國人慢性疾病之發生情形 62
第二節 影響國人慢性疾病發生情形之因素 63
壹 基本人口學 63
貳 生活型態 66
參 疾病史與體檢資料 68
第三節 WCRF/AICR建議與國人慢性疾病發生之探討 69
壹 身體肥胖度 69
貳 身體活動量 70
參 高能量密度食物及飲料 71
肆 植物性食物 74
伍 動物性食物 77
陸 含酒精飲料 78
柒 鹽及醃製食品 80
捌 膳食補充劑 81
玖 整體建議 82
壹拾 量化後之量表 83
第四節 本研究之優點與研究限制 86
壹 研究優點 86
貳 研究限制 87
第七章 結論 88
第八章 參考文獻 89

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