臺灣博碩士論文加值系統

背景：隨著台灣老年人口數的增加，老年人在其健康與長壽的飲食營養上所扮演的角色已引起諸多注意。在老化的過程中，生理上的、社會的變遷、慢性疾病的發展、藥物的使用及活動量的減少等等皆是導致老年人處於營養不良的危險因子。鐵的攝取與其營養狀況亦受到年齡、性別、收入和飲食型態的影響；故一般認為老年人普遍有鐵攝取不足及鐵缺乏的情形。為了評估老人之間其鐵質狀況與營養素攝取之間的相關性，因此本研究的目的在：1.調查台中地區老年人營養攝取的情況。2.分析此類族群的血液生化值及鐵營養狀況。3.比較健康與罹患慢性疾病老人之間其鐵質狀況與營養素攝取之間的差異。
方法：共有96名老人參與本研究。受測者分為4組 (28位健康男性、12位患慢性疾病男性、29位健康女性、27位患慢性疾病女性)。受測者需完成基本資料及醫療病史問卷的填寫，另外需完成24小時的飲食回憶記錄及食物頻率問卷調查。血液生化值的測量則包括血紅素(hemoglobin)、血比容(hematiocrit)、平均血球容積(mean cell volume)、血漿鐵質(plasma iron)及鐵蛋白(ferritin)、總鐵結合能力(total iron binding capacity)及轉運鐵蛋白飽合度(transferrin saturation)。體內鐵的貯存(iron stores)是根據血紅素、鐵蛋白及轉運鐵蛋白飽合度計算而得。
結果：發現所有組別中，其平均每日鐵攝取量均高於目前台灣的RDNA (10 mg)。鐵的攝取量與各種鐵質狀況的生化指標在各組中均無顯示其相關性。在兩性中健康與慢性病組別之間鐵質營養狀況並沒有顯著的差異；然而體內鐵的貯存與血漿鐵蛋白之間呈現顯著的正相關 (P<0.05)。兩位健康及一位患慢性病男性，兩位健康及三位患慢性病女性有缺鐵性貧血，因為血漿中的鐵蛋白濃度<12μg/L，且有一種或以上的其他異常鐵質狀況的生化指標。
結論：雖然健康和慢性病的老人都有足夠的鐵質攝取甚且高於RDNA，但是鐵質缺乏仍舊存於老年人口中，可能原因是鐵的生物利用率似乎因其他原因而受到限制。另外，在評估老年人的鐵值狀況，血漿鐵蛋白是很好的評估指標。

Background: Since the turn of the century, the age of the population in Taiwan has steadily increased. The role of dietary nutrition to maintain good health and long life has caught more attention. Aging is a multifaceted event that encompasses molecular, cellular, physiological, and psychological changes. Individual nutritional needs may thereby change in response to progressive loss of efficiency within organ systems. The iron intake and status are influenced by age、sex、income and the pattern of diet. Thus, elderly people are more likely than young adults to be at high risk of iron deficiency. The purposes of this study were: 1). To examine nutrient intakes of elderly people. 2). To assess the hematological parameters and iron status of elderly people. 3). To compare nutrient intakes and iron status of the elderly with chronic diseases to that of the healthy elderly.
Method: Ninety-six elderly (40males, 56 females) participated in this study, subjects were divided into four groups (28 healthy males, 12 males with chronic diseases, 29 healthy females, and 27 females with chronic diseases). Each subject completed a 24-h diet recall and food frequency questionnaire. Hemoglobin、 hematocrit、mean cell volume、plasma iron and ferritin、total iron binding capacity and transferrin saturation were measured. Body iron stores were calculated.
Results: The mean iron intake was higher than the current Taiwan Recommended Daily Nutrient Allowance of 10 mg in all groups. However, iron intake did not correlate with any iron status indicators in any study groups. There were no significant differences in iron status indicators between healthy and chronically-diseased groups. Body iron stores were correlated positively with plasma ferritin (p< 0.05). Two healthy males, one chronically-diseased male; two healthy females and three chronically-diseased females had iron deficiency anemia; they had anemic ferritin levels (< 12μg/L) and one or more other abnormal iron status indicators.
Conclusion: Although the elderly subjects had sufficient iron intake even higher than the RDNA, the bioavailability of iron might be limited to maintain body iron stores. A combination of plasma ferritin and other iron indices is recommended to determine the iron status in elderly subjects.

中文摘要------------------------------------------------ 1
英文摘要------------------------------------------------ 3
壹、緒言------------------------------------------------- 5
貳、文獻回顧--------------------------------------------- 7
(一).老年人的鐵缺乏與慢性疾病的關係 ------------------- 7
(二).鐵代謝的相關介紹--------------------------------- 8
一.鐵的飲食來源----------------------------------- 8
表一.100g食物鐵含量---------------------------- 10
二.鐵缺乏的影響----------------------------------- 11
三.鐵代謝的機制----------------------------------- 12
四.鐵的吸收機轉----------------------------------- 14
圖一.小腸細胞吸收鐵及轉移鐵的代謝-------------- 15
圖二.鐵的吸收與利用---------------------------- 17
五.血液生化值的評估------------------------------- 18
六.體內鐵貯存的評估------------------------------- 20
(三).鐵的建議量與其營養問題--------------------------- 22
參、研究目的--------------------------------------------- 24
肆、材料與方法------------------------------------------- 25
(一).研究設計---------------------------------------- 25
(二).研究進行時間------------------------------------ 25
(三).研究對象---------------------------------------- 26
(四).營養素攝取及鐵營養狀況的評估-------------------- 27
一.體位測量-------------------------------------- 27
二.飲食記錄與頻率問卷---------------------------- 28
三.血液樣本採集與分析---------------------------- 29
四. 統計分析------------------------------------- 30
伍、結果------------------------------------------------- 31
(一).受測者的特性------------------------------------ 31
(二).飲食攝取狀況------------------------------------ 32
(三).血液分析---------------------------------------- 33
(四).營養素攝取與鐵值狀況生化值的相關性-------------- 35
(五).體內鐵貯存-------------------------------------- 36
(六).鐵貯存與鐵質狀況指標值的相關性---------------------- 37
表格一.健康與患慢性病的老人的特性-------------------- 38
表格二.健康與患慢性病的老人的營養素攝取-------------- 39
表格三.各組中鐵的營養生化檢驗值---------------------- 40
表格四.營養素攝取與鐵質狀況參數的相關性--------------- 41
表格五.鐵貯存與鐵質狀況指標值的相關性----------------- 42
Figure 1. —A----------------------------------------- 43
Figure 1. —B----------------------------------------- 44
Figure 1. —C----------------------------------------- 45
Figure 1. —D----------------------------------------- 46
Figure 2各組中其體內鐵貯存的分佈情形------------------ 47
陸、討論------------------------------------------------- 48
柒、結論-------------------------------------------------- 55
捌、參考文獻---------------------------------------------- 56
玖、感言-------------------------------------------------- 66
附錄一.同意書--------------------------------------------- 67
附錄二.基本資料與飲食問卷--------------------------------- 68

1. Ahluwalia N, Lammi — Keefe CJ, Bendel RB, et al. Iron deficiency and anemia of chronic disease in elderly women：a discrimininant — analysis approach for differentiation. Am J Clin Nutr 1995; 61: 590-596.
2. Coenen JLLM, van Dieijen-Visser MP, van Pelt J, et al. Measurements of serum ferritin used to predict concentrations of iron in bone marrow in anemia of chronic disease. Clin Chem 1991; 37: 560-563.
3. Guyatt GH, Patterson C, Ali M, et al. Diagnosis of iron-deficiency anemia in the elderly. Am J Med 1990; 88: 205-209.
4. Charache S, Gittlelsohn AM, Allen H, et al. Noninvasive assessment of tissue iron stores. Am J Clin Pathol 1987; 88: 333-337.
5. Lipschitz DA. The anemia of chronic disease. J Am Geriatr Soc
1990; 38: 1258-1264.
6. Ahluwalia N, Lammi-Keefe CJ, Haley NR, and Beard. Day — to — day variation in iron — status indexes in elderly woman. Am J Clin Nutr 1993; 57: 414-419.
7. Garry PJ, Goodwin JS, Hunt WC. Iron status and anemia in elderly:new findings and a review of previous studies. J Am Ger Soc 1983; 31: 389-399.
8. Cook JD, Finch CA, Smith NJ. Evaluation of the iron status of a population. Blood 1976; 48: 449-455.
9. Thomas AJ, Bunker VW, Stansfield MF, Sodha NK, and Clayton BE. Iron status of hospitalized and housebound elderly People：Dietary intake , metabolic balances, haematological and biochemical indices . Quarterly J of Med 1989; 70(262): 175-184.
10. Nelson R, Chawla M, Connolly P, Laporte J. Ferritin as an index of bone marrow iron stores. South Med J 1978; 71: 1482-1484.
11. Bentley DP, Williams P: Serum ferritin concentration as an index of storage iron in rheumatoid arthritis. J Clin Pathol 1974; 27: 786-788.
12. Johnson MA, Fischer JG, Bowman BA, Gunter EW. Iron nutriture in elderly individuals . FASEB J 1994; 8: 609-621.
13. Lynch SR, Finch CA, Monsen ER, Cook JD. Iron status of elderly Americans. Am J Clin Nutr 1982; 36: 1032-1045.
14. Lipschitz DA. Impact of nutrition on the age-related declines in hematopoiesis. In: Chernoff R, ed. Geriatric Nutrition: The health professional’s handbook. Aspen Publishers, Gaithersburg, Maryland 1991: 271-287
15. Joosten E, Pelemans W, Hiele M, et al. Prevalence and causes of anemia in a geriatric hospitalized population. Gerontology 1992; 38: 111-117.
16. Kirkeby OJ, Fossum S, and Risoe C. Anemia in elderly
patients. Scand J Prim. Health Care 1991; 9: 167-171.
17. Yip R, and Dallman PR. The roles of inflammation and iron deficiency as causes of anemia. Am J Clin Nutr 1988; 48:1295-1300.
18. Garry PJ, Wayne SJ, Koehler KM, et al. Prediction of iron absorption based on iron status of female blood donors. Am J Clin Nutr 1992; 56: 691-698.
19. Dall PR. Iron. In: Brown ML, ed. Present knowledge in nutrition, 6th ed. Washington, DC: International Life Sciences Institute Nutrition Foundation 1990: 241-250.
20. Fairbanks VF. Iron in medicine and nutrition. In: Shils ME, Olson JA, Shike M, eds. Modern nutrition in health and disease, 8th ed. Philadelphia: Lea and Febiger 1994; 185-213.
21. Monsen ER. Iron nutrition and absorption: Dietary factors which impact iron bioavailability. J Am Diet Assoc 1988; 7: 786-790.
22. Hallberg L, Rossarder L. Improvement of iron nutrition in developing countries: comparison of adding meat, soy protein, ascorbic acid, citric acid, and ferrous sulfate on iron absorption from a simple Latin American-type of meal. Am J Clin Nutr 1984; 39: 577-583.
23. 黃伯超、游素玲. 營養學精要. 1995: 180-185。
24. Cook JD, Skikne BS, Reusser ME. Estimates of iron sufficiency in the US population. Blood 1986; 68: 726-731.
25. Beard JL, Dawson H, and Pinero DJ. Iron metabolism: A
comprehensive review. Nutrition Rev 1996; 54: 295-317.
26. Crawley H. Food Portion Sizes, HMSO, London 1988.
27. Holland B, Welch AA, Unwin ID, et al. The composition of foods (5th edn), Royal Society of Chemistry, Cambridge 1991.
28. Ashkenazi R, Ben-Shachar D, Youdim MB. Nutritional Fe and
dopamine binding sites in the rat brain. Pharmacol Biochem Behav
1982; 17 (suppl): 43-47.
29. Walter T, De Andraca I, Chadud P, Perales CG. Iron deficiency anemia: adverse effects on infant psychomotor development. Pediatr 1989a; 84: 7-17.
30. 石燕珍、賈中芬、周森龍、王俊怡、包中首. 559例 嬰幼兒鐵
缺乏症調查與防治 營養學報 1989; 11 (3): 251-255。
31. Oski FA. Iron deficiency in infancy and childhood. New Engl J Med 1993; 329: 190-193.
32. 張焍、朱清華、梁杏蘭.缺鐵性貧血對嬰幼兒智能發育影響的探
討. 營養學報 1989; 11 (3): 246-250。
33. Brigham D, Beard JL. Iron and thermoregulation: a review. Crit Rev Food Sci Nutr 1996; 36: 747-763.
34. Bothwell TH, Charlton RW, Cook JD, Finch CA. Iron metabolism in man. Oxford: Blackwell Scientific Publications 1979.
35. Cook JD, Skikne BS. Serum ferritin: a possible model for the
assessment of nutrient stores. Am J Clin Nutr 1982; 35: 1180-1185.
36. Lipschitz DA, Cook JD, Finch CA. A clinical evaluation of serum ferritin as an index of iron stores. Proc Soc Exp Biol Med 1975; 148: 358-364.
37. Macaron CI, Macaron ZG. Increased serum ferritin levels in
hyperthyroidism. J Clin Endocrinol Metab 1985; 61: 672-676.
38. Leggett BA, Brown NN, Bryant SJ, et al. Factors affecting the concentration of ferritin in serum in a healthy Australian population. Clin Chem 1990; 36: 1350-1355.
39. Huebers HA, Finch CA. Transferrin: physiologic behavior and
clinical implications. Blood 1984; 64: 763-767.
40. Dallman PR. Manifestations of iron deficiency. Semin Hematol 1982; 19: 19-30.
41. Siimes MA, Refinoo C, Dallman PR. Manifestations of iron
deficiency at various levels of dietary iron intake. Am J Clin Nutr 1980; 33: 570-574.
42. Linder MC. Nutritional biochemistry and metabolism with clinical application 1991: 215-226.
43. Herbert V. Recommended dietary intakes (RDI) of iron in humans. Am J Clin Nutr 1987; 45: 679-686.
44. Expert Scientic Working Group: Summary of a report on assessment of the iron nutritional status of the United States population. Am J Clin Nutr 1985; 42: 1318-1330.
45. Kasdan TS. Nutritional care in anemia. In: Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition and Diet Therapy, 9th ed. Philadelphia: WB Saunders Company 1996: 717-736.
46. Looker AC, Gunter EW, Johnson CL. Methods to assess iron status in various NHANES surveys. Nutr Rev 1995; 53: 246-254.
47. Hann H-W, Kim CT, London WT, and Blumberg B. Increased
serum ferritin in chronic liver disease: a risk factor for primary hepatocellular carcinoma. Int J Cancer 1989; 43: 376-379.
48. Ascherio A, Willett WC, Rimm EB, Giovannucci EL, Stampfer
M J. Dietary iron intake and risk of coronary disease among man.
Circulation 1994; 89: 969-974.
49. Milman N, Kirchhoff M. The influence of blood donation on
iron stores assessed by serum ferritin and hemoglobin in a population survey of 1359 Danish women. Ann Hematol 1991; 63: 27-32.
50. Bear DM, Tekawa IS, and Hurley LB. Iron stores are not associated with acute myocardial infarction. Circulation 1994; 89: 2915-2918.
51. Yip R, Williamson DF, and Byer T. Is there an association
between iron nutrition status and the risk of cancer? Am J Clin Nutr 1992; 53: 30-36.
52. Hallberg L, Bengtsson C, Lapidus L, et al. Screening for iron deficiency: an analysis based on bone-marrow examinations and serum ferritin determinations in a population sample of women. Brit J Haematol 1993; 85: 787-798.
53. Waters GO, Miller FM, Worwood M. Serum ferritin
concentration and iron stores in normal subjects. J Clin Path 1973; 26: 770-772.
54. 行政院衛生署. 1993-1996 國民營養健康狀況變遷調查結果。
55. Milman N, Kirchhoff M, Jorgensen T. Iron status markers,
serum ferritin and hemoglobin in 1359 Danish women in relation to menstruation, hormonal contraception, parity, and postmenopausal hormone treatment. Ann Hematol 1992; 65: 96-102.
56. Milman N, Rosdahl N, Lyhne N, Jorgensen T, and Graudal N.
Iron status in Danish women aged 35-65 years, relation to
menstruation and method of contraception. Acta Obstet Gynecol
Scand 1993; 72: 601-605.
57. Samuelson G, Bratteby L-E, Berggren K, Elverby J-E, and Kempe B. Dietary iron intake and iron status in adolesents. Acta Pediatr 1996; 85: 1033-1038.
58. Hallberg L. Results of surveys to assess iron status in Europe. Nutr Rev 1995; 53: 314-322.
59. Salonen JT, Nyyssonen K, Korpela H, et al. High stored iron levels are associated with excess risk of myocardial infarction in Eastern Finnish Men. Circulation 1992; 86: 803-811.
60. Preziosi P, Hercberg S, Galan P, et al. Iron status of a healthy French population: factors determining biochemical markers. Ann Nutr Metab 1994; 38: 192-202.
61. Leggett BA, Brown NN, Bryant SJ, et al. Factors affecting the concentrations of ferritin in serum in a healthy Australian population. Clin Chem 1990; 36: 1350-1355.
62. 行政院衛生署: 每日營養素建議攝取量及其說明，第五修訂版
台北 (1993)
63. FAO/WHO : Nutritional anemias. WHO Technical report series No. 405. Geneva: WHO 1968.
64. Cook JD, and Finch CA. Assessing iron status of a population. Am J Clin Nutr 1979; 32: 2115-2119.
65. Patterson C, Guyatt GH, Singer J, Ali M, Turpie I. Iron deficiency anemia in the elderly: the diagnostic process. Can Med Assoc 1991; 144: 435-440.
66. Pao EM, Micelle SJ, Burk MC. One-day and 3-day nutrient intakes by individuals-nationwide food consumption survey findings. J Am Diet Assoc 1985; 85: 313-324.
67. Johnson RM, Smiciklas-Wright J. Dietary intakes in female
nursing home residents. J Am Diet Assoc 1991; 91: A12.
68. Koehler KM, Hunt WC, Garry PJ. Meat, poultry, and fish
consumption and nutrient intake in the healthy elderly. J Am Diet Assoc 1992; 92: 325-330.
69. Roebothan BV, Chandra RK. The contribution of dietary iron to iron status in a group of elderly subjects. Internat J Vit Nutr Res 1996; 66: 66-70.
70. Deehr MA, Dalla GE, Smith KT, Taulbee JD, Dawson-Hughes B.
Effects of different calcium sources on iron absorption in
postmenopausal women. Am J Clin Nutr 1990; 51: 95-99.
71. Cook JD, Dassenko SA, Whittaker P. Calcium supplementation:
effect on iron absorption. Am J Clin Nutr 1991; 53: 106-111.
72. Reddy MB, Cook JD. Effect of calcium intake on nonheme-iron
absorption from a complete diet. Am J Clin Nutr 1997; 65: 1820-
1825.
73. Cook JD, Monsen ER. Vitamin C, the common cold and
iron absorption in man. Am J Clin Nutr 1977; 30: 235-241.
74. Payette H, Gray-Donald K. Dietary intake and biochemical indices of nutritional status in an elderly population, with estimates of the precision of the 7-d food record. Am J Clin Nutr 1991; 54: 478-488.
75. Yearick ES, Wang MSL, Pisias SJ. Nutritional status of the elderly:dietary and biochemical findings. J Gerontol 1980; 35: 663-671.
76. Johnson MA. Iron: Nutrition monitoring and nutrition status
assessment. J Nutr 1990; 120; 1486-1491.
77. Sears DA. Anemia of chronic disease. Med Clin North Am 1992;
76: 567-579.
78. Blake DR, Waterworth RF, Bacon PA. Assessment of iron stores in inflammation by assay of serum ferritin concentrations. Br Med J 1981; 283: 1147-1148.
79. Yip R, Johnson C, Dallman PR. Age-related changes in laboratory values used in the diagnosis of anemia and iron deficiency. Am J Clin Nutr 1984; 39: 427-436.
80. Christensen DJ. Differentiation of iron deficiency and the anemia of chronic disease. J Fam Prac 1985; 20: 35-39.
81. Krause JR, Stolc V. Serum ferritin and bone marrow biopsy
iron stores. Am J Clin Pathol 1980; 74: 461s-464s.
82. Cook JD. Adaptation in iron metabolism. Am J Clin Nutr 1990;
51: 301-308.
83. Mahalko JR, Johnson LK, Gallagher SK, Milne DB. Comparison of dirtary histories and seven-day food records in a nutritional
assessment of older adults. Am J Clin Nutr 1985; 42: 542-553.
84. Garry PJ, Wayne SJ, Koehler KM, et al. Prediction of iron absorption based on iron status of female blood donors. Am J Clin Nutr 1992; 56: 692-698.