臺灣博碩士論文加值系統

背景：
齲齒是國小學童最常見的口腔慢性疾病。過去研究顯示礦物質鈣和磷及飲食攝取之鈣磷比，與齲齒經驗有關連性。然而目前營養素與齲齒之間相關性的文獻尚無明確定論，國內關於營養素的攝取與學童齲齒之間的研究資料仍有限，因此探討鈣、磷、鎂以及鈣磷比之攝取與國小學童齲齒間的關連性為重要課題。
研究目的：
本研究藉由全國營養健康調查資料，針對台灣地區國小學童分析其飲食中攝取鈣、磷、鎂以及鈣磷比與混合齒列齲齒之相關性探討。
研究方法：
本研究使用民國90-91年度「台灣地區第四次全國營養健康調查」之資料；共有2248位年齡介於6到12歲學童完成問卷調查和口腔檢查，其中包含了1196位男童以及1052位女童。此次調查採「分層多段隨機集束抽樣」法；口腔檢查是由三位受過口檢一致性訓練之牙醫師來執行（經過三次校正篩檢之後，其全口齲齒盛行率的 kappa 值為0.80到0.83）。其齲齒狀況則分別以恆牙齲齒指數DMFT index與乳牙齲齒指數deft index做為齲齒記錄。在問卷方陎是由受過訓練之訪員同時與學童及其家長進行家庭訪視；藉由24小時飲食回憶記錄得到學童每日鈣、磷、鎂攝取量，並且以飲食頻率問卷取得學童近一個月以來其甜食與含糖飲料之每週攝取次數。
結果：
研究中依照行政院衛生署於民國91年所公布之國人膳食營養素參考攝取量(Dietary Reference Intakes，DRIs)，將學童鈣、磷、鎂之攝取二分為足夠與不足夠兩組進行運算分析。結果顯示，每日攝取足夠鈣之學童比每日攝取鈣不足之學童有較低風險得到4顆以上乳牙齲齒指數 (OR=0.65, 95% CI=0.46-0.92, p=0.0152)，以及1-3顆恆牙齲齒指數 (OR = 0.65, 95% CI =0.48-0.89, p = 0.0073)。每日攝取足夠鈣和磷之學童其鈣磷比相較於每日攝取不足之學童有較低風險得到4顆以上乳牙齲齒指數 (OR = 0.41, 95% CI =0.24-0.70, p = 0.0013)，和 1-3顆恆牙齲齒指數 (OR = 0.47, 95% CI =0.30-0.75, p = 0.0016)，以及較低之機率得到4顆以上恆牙齲齒指數 (OR = 0.52, 95% CI =0.32-0.86, p = 0.0111)。
結論：
台灣國小學童鈣、磷、鎂攝取與齲齒生成之關連性當中，以鈣之攝取與學童齲齒間的相關性最為顯著；磷之攝取與齲齒間關聯性相較
之下則顯得較為薄弱；在鎂攝取方陎，經過調整干擾因子之後並未發現有任何顯著性相關性存在。而鈣磷比對於學童齲齒生成之影響比鈣、磷分別獨立對齲齒形成之相關來得更為顯著。

Background:
Nutritional factors are generally associated with several systemic diseases, gastrointestinal disorders, most cancers, as well as oral diseases. Dental caries has been the most common chronic oral disease in school children. Some epidemiological studies have revealed that subjects with relatively high calcium and phosphate in their plaque experience a correspondingly lower presence of caries. An investigation indicated that dietary calcium-phosphorus (Ca/P) ratio was strongly associated with caries development in human teeth. The purpose of this research was to investigate the associations among caries experience and intakes of Ca, P, Mg, Ca/P ratio, snacks and beverages in a cross-sectional study of elementary school children.
Study objectives:
Dental caries has been the most common chronic oral disease in school children. The micronutrient intake is one of the important factors related to caries development. This cross-sectional study used the database of the Nutrition and Health Survey in Taiwan Elementary School Children 2001-2002 (NAHSIT Children 2001-2002) to investigate the associations among caries experience and daily intake of Ca, P, Mg and Ca/P ratio of school children.
Methods :
A total of 2248 school children (1196 boys and 1052 girls) aged 6-12 years were randomly selected based on the “probabilities proportional to sizes” (PPS) approach. Each participant received a dental examination and the caries status was recorded by a dentist. Food frequency data and 24-hour dietary recalls were collected by trained interviewers during a household questionnaire interview.
Results:
The daily intake of minerals was dichotomized into 2 groups according to the Taiwanese Dietary Reference Intakes (DRIs). The daily intake of sufficient Ca was significantly associated with lower risk of deft index above 4 (OR=0.65, 95% CI=0.46-0.92, p=0.0152) and DMFT index 1-3 (OR = 0.65, 95% CI =0.48-0.89, p = 0.0073). It was found that Ca/P ratio proved to be a significant predictor for school children with deft index above 4 (OR = 0.41, 95% CI =0.24-0.70, p = 0.0013), DMFT index from 1-3 (OR = 0.47, 95% CI =0.30-0.75, p = 0.0016), and DMFT index above 4 (OR = 0.52, 95% CI =0.32-0.86, p = 0.0111).
Conclusion:
Daily Ca intake plays the most effective role in prevention of school children caries between daily Ca, P and Mg intake, and the dietary Ca/P ratio seems more important than Ca and P separately in dental caries of school children.

致謝……………………………………………………………………I
中文摘要………………………………………………………………II
英文摘要………………………………………………………………V
第一章 緒論
第一節 研究背景…………………………………………………1
第二節 研究目的…………………………………………………4
第二章 文獻探討
第一節 乳製品與齲齒之相關探討……………………………….5
第二節 鈣與齲齒之相關探討…………………………………….10
第三節 磷與齲齒之相關探討…………………………………….11
第四節 鎂與齲齒之相關探討…………………………………….13
第五節 鈣磷比與齲齒之相關探討……………………………….14
第三章 材料與方法
第一節 研究對象………………………………………………….17
第二節 研究設計………………………………………………….17
第三節 研究工具………………………………………………….19
第四節 統計分析………………………………………………….22
第五節 研究架構………………………………………………….26
第四章 研究結果
第一節 樣本基本資料……………………………………………27
第二節 不同齲齒指數之營養攝取量狀況………………………28
第三節 齲齒指數與營養攝取之相關性…………………………30
第四節 低、中、高等攝取量與齲齒指數之迴歸模式…………31
第五節 足夠的鈣、磷、鎂攝取量和鈣磷比與齲齒指數間之迴歸模式………………………………………………………..31
第六節 每日鈣攝取量與鈣磷比之分布狀況…………………….33
第七節 不同鈣攝取量和鈣磷比組別與齲齒指數間之迴歸模式..34
第五章 討論
第一節 甜食與含糖飲料攝取與齲齒指數之相關性……………..36
第二節 鈣的攝取與齲齒指數之相關性…………………………..38
第三節 磷的攝取與齲齒指數之相關性…………………………..40
第四節 鎂的攝取與齲齒指數之相關性…………………………..42
第五節 飲食鈣磷比與齲齒指數之相關性………………………..43
第六節 鈣攝取量和鈣磷比組別與齲齒指數之相關性…………..45
第七節 研究限制…………………………………………………..46
第六章 結論與建議
第一節 結論………………………………………………………..47
第二節 建議………………………………………………………..47
參考文獻
英文文獻…………………………………………………………...49
中文文獻…………………………………………………………...51
網站資料…………………………………………………………..52
表格目錄
表1：不同性別、年齡、父母教育程度其齲齒情況分佈頻率……..53
表2：鈣、磷、鎂、甜食、含糖飲料的攝取量在不同乳牙齲齒指數組別之帄均值比較…………..……………………………………………54
表3：鈣、磷、鎂、甜食、含糖飲料的攝取量在不同恆牙齲齒指數組別之帄均值比較………………………………………………………55
表4：鈣、磷、鎂、甜食、含糖飲料的攝取量在不同乳牙齲齒指數組別之帄均值比較………………………………………………………56
表5：鈣、磷、鎂、甜食、含糖飲料的攝取量在不同恆牙齲齒指數組別之帄均值比較………………………………………………………57
表6：鈣、磷、鎂、甜食、含糖飲料攝取與乳、恆牙齲齒指數間之相關係數(r) ………………………………………………………………58
表7：鈣、磷、鎂、甜食、含糖飲料其低、中、高等攝取量（頻率）
與乳牙齲齒指數之迴歸模式…………………………………………59
表8：鈣、磷、鎂、甜食、含糖飲料其低、中、高等攝取量（頻率）與恆牙齲齒指數之迴歸模式…………………………………………60
表9：每日足夠的鈣、磷、鎂攝取量和鈣磷比與乳牙齲齒指數間之迴歸模式…………………………………………………………………61
表10：每日足夠的鈣、磷、鎂攝取量和鈣磷比與恆牙齲齒指數間之迴歸模式………………………………………………………………62
表11：每日鈣攝取量與鈣磷比變項之分布狀況…………………...63
表12：不同鈣攝取量以及鈣磷比組別與乳牙齲齒指數間之迴歸模式……………………………………………………………………….64
表13：不同鈣攝取量以及鈣磷比組別與恆牙齲齒指數間之迴歸模式……………………………………………………………………….65
Table 1：Prevalence of caries status in different gender, age and education level of parents groups…………………………………………………66
Table 2：Means of dietary intake of Ca, P, Mg, snack, beverage and groups of deft index in primary teeth. ……………………..…………..67
Table 3：Means of dietary intake of Ca, P, Mg, snack, beverage and groups of DMFT index in permanent teeth. ………………………..….68
Table 4：Means of dietary intake of Ca, P, Mg, snack, beverage and groups of deft index in primary teeth. …………………………..……..69
Table 5：Means of dietary intake of Ca, P, Mg, snack, beverage and
groups of DMFT index in permanent teeth. …………………..………..70
Table 6：The Pearson correlation coefficients (r) between the intake of Ca, P, Mg, snack, beverage and caries index………………………………..71
Table 7：Odds ratios of caries by tertile of daily Ca, P and Mg intake, weekly snack and beverage intake in primary teeth. …………………...72
Table 8：Odds ratios of caries by tertile of daily Ca, P and Mg intake, weekly snack and beverage intake in permanent teeth. ………………...73
Table 9：Odds ratios of caries by DRI of daily Ca, P, Mg and Ca/P ratio intake in primary teeth. ………………………………………………....74
Table 10：Odds ratios of caries by DRI of daily Ca, P, Mg and Ca/P ratio intake in permanent teeth. ………………………………………………75
Table 11：Distribution of daily Ca intake and Ca/P ratio………………..76
Table 12：Odds ratios of caries by groups of daily Ca and Ca/P ratio intake in primary teeth………………………………………………….77
Table 13：Odds ratios of caries by groups of daily Ca and Ca/P ratio intake in permanent teeth……………………………………………....78
附錄：飲食頻率問卷………………………………………….…….....79

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