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)於2007年出版「食物、營養、身體活動和癌症預防」，對民眾提出身體肥胖度、身體活動、高能量密度食物、植物性食物、動物性食物、加工製品、酒類攝取及膳食補充劑八項建議，探討國人遵行狀況，與癌症預防之相關。
本研究設計為世代研究，將第一次國民營養健康狀況變遷調查(1993-96)及第二次國民營養健康狀況變遷老人調查(1999-2000)串連至2006年癌症登記檔、健保資料庫及2008年死亡登記檔，確定個案罹癌狀況。以Cox proportional hazard 模式，評估相對風險 (hazard ratios, HR) 及95%信賴區間。
結果兩世代平均追蹤各為11.2及5.93年，每千人年中各有7.02及22.4人罹患癌症，校正性別、年齡層、地區層別、教育程度、抽菸及嚼食檳榔，30-64歲國人遵循加工製品建議，罹癌危險與未遵循者相比，顯著降低0.62倍(95% CI:0.15-0.97)，考慮八項建議相互影響情形下，同時放入模式中，發現在其他建議遵循相同下，加工製品達建議者，可顯著降低30-64歲國人總癌症63%罹癌危險 (95%CI:0.15-0.95)，而65歲以上老人可顯著降低罹患消化道及腹膜器官癌症危險(HR:0.22, 95%CI:0.07-0.70)。因此，建議遵循WCRF/AICR建議維持良好飲食及生活型態，可達到預防癌症效果。

In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published “Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective” It suggests that body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, processing preparation, alcoholic drinks, and dietary supplements can contribute to the incidence of cancer. The present study has examined the association between compliance with WCRF/AICR recommendations and cancer incidence in Taiwanese.
Datasets used for analysis were the Nutrition and Health Survey in Taiwan (NAHSIT 1993-1996), and Elderly Nutrition and Health Survey in Taiwan (NAHSIT Elderly, 1999-2000). Participants’ cancer incidence data were obtained from the Cancer Registry (up to 2006), National Health Insurance Research Database (up to 2006), and National Death Certification data (up to 2008). Cox proportional hazards regression models was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI).
The means of follow-up years were 11.2 in NAHSIT 1993-1996 and 5.93 in NAHSIT Elderly, the crude cancer incidence rates were 7.02 per 1000 person-years and 22.4 per 1000 person-years respectively. After adjustment for gender, age, region, education, smoking status, and betel nut chewing, the subjects aged 30-64 years who adhered to the processing preparation recommendation in WCRF/AICR had a hazard ratio for cancer incidence of 0.62 (95%CI:0.15-0.97). We also adjusted for the eight recommendations, and found that compliance with processing preparation recommendations had a significantly reduced overall cancer risk (HR:0.37, 95% CI:0.15-0.95) and malignant neoplasm of digestive organs and peritoneum (HR:0.22, 95% CI:0.07-0.70) respectively in NAHSIT 1993-1996 and NAHSIT Elderly. In conclusion, adherence to WCRF/AICR recommendations to maintain healthier dietary patterns and life styles can prevent cancer in adult population.

正文目錄
正文目錄 I
表目錄 IV
圖目錄 V
附錄目錄 VI
中文摘要 VII
Abstract IX
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 台灣地區癌症現狀 4
第二節 罹患癌症之影響因子 5
壹.教育程度、社會經濟地位及居住地區 5
貳.抽菸 5
參.嚼食檳榔 6
肆.飲食及營養因素 6
伍.身體肥胖度 13
陸.身體活動量 17
第三節 世界癌症研究基金會 18
壹.第一版「食物、營養和癌症預防」建議 18
貳.第一版相關研究 19
參.第二版「食物、營養、身體活動和癌症預防」建議 20
第四節 總結 21
第三章 研究問題與假設 22
第一節 研究問題 22
第二節 研究假設 22
第四章 研究材料與方法 23
第一節 研究架構 23
第二節 研究對象 25
壹.國民營養健康狀況變遷調查1993-1996 (NAHSIT I) 25
貳.國民營養健康狀況變遷老人調查1999-2000 (NAHSIT II) 25
第三節 研究工具 27
壹.問卷資料 27
貳.體檢資料 27
參.癌症登記檔連結 (癌登檔) 28
肆.健保資料庫連結 28
伍.死亡檔資料連結 29
第四節 研究流程 30
第五節 WCRF/AICR 建議量化方法 32
壹.身體肥胖度 32
貳.身體活動量 32
參.高能量密度食物及飲料 (高能量密度食物) 33
肆.植物性食物 34
伍.動物性食品 34
陸.含酒精飲料 35
柒.保存、加工、製作 (加工製品) 35
捌.膳食補充劑 35
第六節 資料處理與統計方法 36
壹.追蹤時間 36
貳.描述性統計 36
參.推論性統計 37
第五章 結果 38
第一節 研究對象罹患癌症之情形 38
壹.國民營養健康狀況變遷調查1993-1996 38
貳.國民營養健康狀況變遷老人調查1999-2000 38
第二節 研究對象社會人口學背景及生活型態情形 40
壹.國民營養健康狀況變遷調查1993-1996 40
貳.國民營養健康狀況變遷老人調查1999-2000 41
第三節 研究族群遵循WCRF/AICR各項建議比例 45
第四節 遵循各建議內容與罹患癌症情形相關性 46
壹.八項建議各項討論 46
貳.多項建議合併討論 51
第五節 評估研究對象遵循狀況與罹癌狀況之關聯 53
壹.WCRF/AICR建議與不分部位癌症之關聯 53
貳.WCRF/AICR建議與消化器及腹膜惡性腫瘤之關聯 54
第六章 討論 56
第一節 研究對象罹患癌症之情形 56
第二節 研究對象社會人口學背景及生活型態情形 57
第三節 遵循WCRF/AICR建議與罹患癌症情形相關性 60
壹.體位 60
貳.身體活動 61
參.高能量密度食物及含糖飲料 61
肆.植物性食物 63
伍.動物性食物 65
陸.酒類攝取 65
柒.保存、加工、製作 66
捌.膳食補充劑 67
玖.WCRF/AICR整體建議 67
第四節 研究限制 69
第七章 結論 70
第八章 參考文獻 71

表目錄
表2-1.WCRF/AICR 於1997年發表第一版「食物、營養和癌症預防」建議 81
表2-2.WCRF/AICR 於2007年發表第二版「食物、營養、身體活動和癌症預防」建議 83
表 5-1.「1993-1996年國民營養健康狀況變遷調查」 30-64歲國人罹患癌症種類(n=3126) 85
表 5-2.「1999-2000年國民營養健康狀況變遷老人調查」65歲以上老人罹患癌症種類(n=1752) 86
表 5-3.「1993-1996年國民營養健康狀況變遷調查」 30-64歲國人是否罹患癌症風險之單變項分析(n=3126) 87
表 5-4.「1999-2000年國民營養健康狀況變遷老人調查」65歲以上老人是否罹患癌症風險之單變項分析(n=1752) 91
表 5-5.研究族群遵循WCRF/AICR各項建議比例 97
表 5-6.「1993-1996年國民營養健康狀況變遷調查」 30-64歲國人是否罹患癌症與WCRF建議符合情形-性別分層(n=3126) 98
表 5-7.「1999-2000年國民營養健康狀況變遷老人調查」65歲以上老人是否罹患癌症與WCRF建議符合情形-性別分層(n=1752) 110
表 5-8.「1993-1996年國民營養健康狀況變遷調查」 30-64歲國人WCRF各為變項 (n=3126) 122
表 5-9.「1999-2000年國民營養健康狀況變遷老人調查」65歲以上老人WCRF各為變項 (n=1752) 124
表 5- 10.「1993-1996年國民營養健康狀況變遷調查」 30-64歲國人WCRF各為變項罹患消化道及腹膜惡性腫瘤風險之分析a (n=2994) 126
表 5- 11.「1999-2000年國民營養健康狀況變遷老人調查」65歲以上老人WCRF各為變項罹患消化道及腹膜惡性腫瘤風險之分析a (n=1618) 128

圖目錄
圖4-1.研究架構 24
圖4-2.研究對象篩選納入之流程 31

附錄目錄
附錄 1.國民營養健康狀況變遷調查1993-1996年之飲食問卷 130
附錄 2.國民營養健康狀況變遷老人調查1999-2000年之飲食問卷 133

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