臺灣博碩士論文加值系統

營養與健康關係之研究甚少針對全面的飲食品質與健康狀態作探討。然飲食是多種食物的組合，無法以單一食物或營養素的關係來解釋實際上的問題。本研究目的是探討一整合飲食資料之單一指標與疾病危險性的相關。以國民飲食指南、國民飲食指標和飲食多樣性的概念，產生一全面飲食指標（Overall Dietary Index；ODI），探討其與高血壓、高血糖、高血脂、高尿酸等常見慢性疾病危險因子之相關。研究資料為民國87年（橫斷面分析，57477人，女性：52.89％）與民國85與87兩年（世代分析，6003人，女性：67.45％）參加某健檢中心19-64歲、非素食會員之健檢結果。該健檢診所有完整的電腦檔案，彙整每年度參加體檢會員之完整人體測量、生化檢查、膳食評估及抽菸、喝酒及運動等行為資料。 ODI由11個項目所組成，包括奶類、蛋豆魚肉類、蔬菜、水果和五穀根莖類攝取情形、總脂肪、膽固醇和飽和脂肪攝取、精製糖、鹽分攝取以及飲食多樣性。除精製糖類和鹽分的攝取理想分數為5分，其餘為10分，總分為100分。本研究族群之ODI平均為65.4分。橫斷面分析結果顯示：將ODI得分採五分位分析比較，女性最高分組血糖異常危險性為最低分組的0.76倍；血脂異常方面，男女ODI最高分者較最低分者，分別可降低13％及11％的危險性：尿酸異常方面與血脂異常有相同趨勢。由結果得知，ODI得分較高者血糖、血脂及尿酸異常危險性較低。然ODI對高血壓卻不具預測性，針對高血壓的預防和控制，ODI恐不足。世代分析方面，僅在血脂異常看到效應，可能與檢力不足有關。儘管本研究之對象或許無法完全代表台灣地區的一般民眾，本研究結果仍提供台灣地區整體飲食品質與慢性病危險因子關係之流行病學證據與參考。

Human being’s eating behavior is a complex and multi-dimensional phenomenon. The traditional single-food or single-nutrient approach cannot completely explain the actual relationship between the overall dietary quality and the risk of disease. The present study aims to develop an overall dietary quality index, Overall Dietary Index (ODI), based on the ROC’s Food Guide, the ROC’s Food Guidelines, and dietary variety. The researcher linked ODI to the risk factors for major chronic diseases: hypertension, hyperglycemia, hyperlipidemia and hyperuricemia. The study subjects were between the ages of 19 and 64, non-vegetarians, and attended a regular physical check-up program of MJ Health-Screening Institute during the years of 1996-1998. Totally 57,477 (females: 52.89%) and 6003 (females: 67.45%) were eligible for the cross-sectional and longitudinal analyses, respectively. Information regarding subjects’ characteristics, lifestyle-related factors (smoking, alcohol drinking, etc.), and dietary data from a 25-item simplified semi-quantitative food frequency questionnaire were completed by the examinees upon registration for health check-up. Anthropometric measurements, blood pressures, blood glucose and blood lipids were obtained during check-up. ODI has 11 components, which include the consumption of milk, meats, vegetables, fruits, and staples, the moderation of dietary lipids (total fat, saturated fat, and cholesterol), salt, sugar, and dietary variety. Respondents received a score ranging from 0 to 10 for each component, except for salt and sugar, whose ideal scores are both 5. ODI of individual subject ranges from 0 to 100. The mean ODI score was 65.4 for the study population. In the cross-sectional analysis, the researcher used multiple regressions and multiple logistic regressions to appraise the correlation between the ODI score and the risk factors for major chronic diseases in the year 1998. Compared to the lowest quintile, the OR of hyperglycemia of females in the highest quintile was 0.76. Males and females in the highest ODI quintile, when compared to those in the lowest quintile, had a 13% and 11% lower risk of hyperlipidemia, respectively. The association between ODI and serum uric acid has the same pattern as serum lipids. To sum up, respondents in the highest ODI quintile had lower blood sugar, serum lipids, and uric acid. The researcher was unable to include the important risk factor of blood pressure as an ODI component; consequently, ODI cannot be used to predict the risk of hypertension. In the longitudinal prevalence and incidence analyses, the researcher used dietary quality in the year 1996 to assess the impact of diet on four risk factors for major chronic diseases of year 1998. Maybe due to the lack of power of the cohort, the researcher cannot get significant effect of ODI on the chronic disease risk factors, except for blood lipids. Though the study subjects may not be fully represented the general population, the findings of the present study offer the epidemiologic evidence and reference for the relationship between overall dietary quality and risk factors for major chronic diseases in Taiwan.

第一章 緒言 ………………………………………………………….1
第一節 研究背景及重要性……………………………………….1
第二節 研究目的………………………………………………….3
第二章 文獻回顧………………………………………………………4
第一節 全面飲食指標…………………………………………….4
第二節 飲食多樣性……………………………………………….8
第三節 飲食品質與死亡率或存活之相關……………………...15
第四節 飲食品質與疾病危險性之相關………………………...17
第五節 慢性病危險因子與健康………………………………...19
第三章 研究問題與假設……………………………………………..20
第一節 研究問題………………………………………………...20
第二節 研究假設…………………………………….…………..21
第四章 研究材料、方法與步驟……………………………………...22
第一節 研究對象………………………………………………...22
第二節 基本資料與飲食問卷…………………………………...23
第三節 飲食品質指標的建立…………………………………...24
第四節 慢性疾病危險因子之獲得……………………………...28
第五節 統計方法………………………………………………...30
第五章 結果…………………………………………………………..33
第一節 基本資料分布…………………………………………...33
第二節 飲食攝取狀況…………………………………………...38
第三節 慢性疾病危險因子分布狀況…………………………...42
第四節 全面飲食品質…………………………………………...43
第五節 橫斷性分析結果………………………………………...48
第六節 世代分析結果…………………………………………...53
第六章 討論…………………………………………………………..55
第一節 研究對象特性…………………………………………...55
第二節 飲食狀況………………………………………………...57
第三節 飲食指標……………………….………………………..58
第四節 飲食指標與慢性疾病危險因子之相關………………...62
第五節 全面飲食指標的應用與建議…………………………...68
第六節 研究限制………………………………………………...69
第七章 結論………………………………………………………….70
第八章 參考文獻…………………………………………………….72

Byers, T. (1999). The role of epidemiology in developing nutritional recommendations: past, present, and future. [see comments]. American Journal of Clinical Nutrition, 69(6), 1304S-1308S.
Chalmers, J. (1999). The 1999 WHO-ISH Guidelines for the Management of Hypertension. Medical Journal of Australia, 171(9), 458-459.
Dixon, L. B., Cronin, F. J., & Krebs-Smith, S. M. (2001). Let the pyramid guide your food choices: capturing the total diet concept. Journal of Nutrition, 131(2S-1), 461S-472S.
Drewnowski, A., Henderson, S. A., Driscoll, A., & Rolls, B. J. (1997). The Dietary Variety Score: assessing diet quality in healthy young and older adults. Journal of the American Dietetic Association, 97(3), 266-271.
Drewnowski, A., Henderson, S. A., Shore, A. B., Fischler, C., Preziosi, P., & Hercberg, S. (1996). Diet quality and dietary diversity in France: implications for the French paradox. Journal of the American Dietetic Association, 96(7), 663-669.
Farchi, G., Fidanza, F., Grossi, P., Lancia, A., Mariotti, S., & Menotti, A. (1995). Relationship between eating patterns meeting recommendations and subsequent mortality in 20 years. European Journal of Clinical Nutrition, 49(6), 408-419.
Friedewald, W. T., Levy, R. I., & Fredrickson, D. S. (1972). Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry, 18(6), 499-502.
Fung, T. T., Rimm, E. B., Spiegelman, D., Rifai, N., Tofler, G. H., Willett, W. C., & Hu, F. B. (2001). Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. [see comments]. American Journal of Clinical Nutrition, 73(1), 61-67.
Gillman, M. W., Cupples, L. A., Millen, B. E., Ellison, R. C., & Wolf, P. A. (1997). Inverse association of dietary fat with development of ischemic stroke in men. JAMA, 278(24), 2145-2150.
Haines, P. S., Siega-Riz, A. M., & Popkin, B. M. (1999). The Diet Quality Index revised: a measurement instrument for populations. Journal of the American Dietetic Association, 99(6), 697-704.
Hajjar, I. M., Grim, C. E., George, V., & Kotchen, T. A. (2001). Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III. Archives of Internal Medicine, 161(4), 589-593.
Hann, C. S., Rock, C. L., King, I., & Drewnowski, A. (2001). Validation of the Healthy Eating Index with use of plasma biomarkers in a clinical sample of women. American Journal of Clinical Nutrition, 74(4), 479-486.
Hu, F. B., Rimm, E. B., Stampfer, M. J., Ascherio, A., Spiegelman, D., & Willett, W. C. (2000). Prospective study of major dietary patterns and risk of coronary heart disease in men. American Journal of Clinical Nutrition, 72(4), 912-921.
Hu, F. B., Stampfer, M. J., Manson, J. E., Rimm, E. B., Wolk, A., Colditz, G. A., Hennekens, C. H., & Willett, W. C. (1999). Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. American Journal of Clinical Nutrition, 69(5), 890-897.
Huijbregts, P., Feskens, E., Rasanen, L., Fidanza, F., Nissinen, A., Menotti, A., & Kromhout, D. (1997). Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ, 315(7099), 13-17.
Huijbregts, P. P., Feskens, E. J., & Kromhout, D. (1995). Dietary patterns and cardiovascular risk factors in elderly men: the Zutphen Elderly Study. International Journal of Epidemiology, 24(2), 313-320.
Hulshof, K. F., Wedel, M., Lowik, M. R., Kok, F. J., Kistemaker, C., Hermus, R. J., ten Hoor, F., & Ockhuizen, T. (1992). Clustering of dietary variables and other lifestyle factors (Dutch Nutritional Surveillance System). Journal of Epidemiology & Community Health, 46(4), 417-424.
Jacobs, D. R., Jr., Meyer, K. A., Kushi, L. H., & Folsom, A. R. (1998). Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women''s Health Study. American Journal of Clinical Nutrition, 68(2), 248-257.
Jacques, P. F., & Tucker, K. L. (2001). Are dietary patterns useful for understanding the role of diet in chronic disease? [letter; comment]. American Journal of Clinical Nutrition, 73(1), 1-2.
Kant, A. K. (1996). Indexes of overall diet quality: a review. [Review] [69 refs]. Journal of the American Dietetic Association, 96(8), 785-791.
Kant, A. K., Block, G., Schatzkin, A., Ziegler, R. G., & Nestle, M. (1991). Dietary diversity in the US population, NHANES II, 1976-1980. Journal of the American Dietetic Association, 91(12), 1526-1531.
Kant, A. K., Schatzkin, A., Graubard, B. I., & Schairer, C. (2000). A prospective study of diet quality and mortality in women. JAMA, 283(16), 2109-2115.
Kant, A. K., Schatzkin, A., Harris, T. B., Ziegler, R. G., & Block, G. (1993). Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. [see comments]. American Journal of Clinical Nutrition, 57(3), 434-440.
Kennedy, E., Shaw, A., & Davis, C. (1995). Essential fatty acids and USDA''s Food Guide Pyramid. American Journal of Clinical Nutrition, 62(3), 645-647.
Kennedy, E. T., Ohls, J., Carlson, S., & Fleming, K. (1995). The Healthy Eating Index: design and applications. [see comments]. Journal of the American Dietetic Association, 95(10), 1103-1108.
Krebs-Smith, S. M., Smiciklas-Wright, H., Guthrie, H. A., & Krebs-Smith, J. (1987). The effects of variety in food choices on dietary quality. Journal of the American Dietetic Association, 87(7), 897-903.
Kuzuya, T. (2000). Early diagnosis, early treatment and the new diagnostic criteria of diabetes mellitus. British Journal of Nutrition, 84(Suppl 2), S177-181.
Margetts, B. M., Martinez, J. A., Saba, A., Holm, L., Kearney, M., & Moles, A. (1997). Definitions of ''healthy'' eating: a pan-EU survey of consumer attitudes to food, nutrition and health. European Journal of Clinical Nutrition, 51(Suppl 2), S23-29.
Margetts, B. M., Thompson, R. L., Speller, V., & McVey, D. (1998). Factors which influence ''healthy'' eating patterns: results from the 1993 Health Education Authority health and lifestyle survey in England. Public Health Nutrition, 1(3), 193-198.
McCann, S. E., Randall, E., Marshall, J. R., Graham, S., Zielezny, M., & Freudenheim, J. L. (1994). Diet diversity and risk of colon cancer in western New York. Nutrition & Cancer, 21(2), 133-141.
McCrory, M. A., Fuss, P. J., McCallum, J. E., Yao, M., Vinken, A. G., Hays, N. P., & Roberts, S. B. (1999). Dietary variety within food groups: association with energy intake and body fatness in men and women. [see comments]. American Journal of Clinical Nutrition, 69(3), 440-447.
McCullough, M. L., Feskanich, D., Rimm, E. B., Giovannucci, E. L., Ascherio, A., Variyam, J. N., Spiegelman, D., Stampfer, M. J., & Willett, W. C. (2000). Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. American Journal of Clinical Nutrition, 72(5), 1223-1231.
McCullough, M. L., Feskanich, D., Stampfer, M. J., Rosner, B. A., Hu, F. B., Hunter, D. J., Variyam, J. N., Colditz, G. A., & Willett, W. C. (2000). Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. American Journal of Clinical Nutrition, 72(5), 1214-1222.
Nicklas, T. A., Webber, L. S., Thompson, B., & Berenson, G. S. (1989). A multivariate model for assessing eating patterns and their relationship to cardiovascular risk factors: the Bogalusa Heart Study. American Journal of Clinical Nutrition, 49(6), 1320-1327.
Nube, M., Kok, F. J., Vandenbroucke, J. P., van der Heide-Wessel, C., & van der Heide, R. M. (1987). Scoring of prudent dietary habits and its relation to 25-year survival. Journal of the American Dietetic Association, 87(2), 171-175.
Oomen, C. M., Feskens, E. J., Rasanen, L., Fidanza, F., Nissinen, A. M., Menotti, A., Kok, F. J., & Kromhout, D. (2000). Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands. American Journal of Epidemiology, 151(10), 999-1006.
Patterson, R. E., Haines, P. S., & Popkin, B. M. (1994). Diet quality index: capturing a multidimensional behavior. [see comments]. Journal of the American Dietetic Association, 94(1), 57-64.
Sacks, F. M., & Willett, W. W. (1991). More on chewing the fat. The good fat and the good cholesterol. New England Journal of Medicine, 325(24), 1740-1742.
Sherwin, R., & Price, T. R. (1997). Fat chance: diet and ischemic stroke. JAMA, 278(24), 2185-2186.
Torng, P. L., Su, T. C., Sung, F. C., Chien, K. L., Huang, S. C., Chow, S. N., & Lee, Y. T. (2000). Effects of menopause and obesity on lipid profiles in middle-aged Taiwanese women: the Chin-Shan Community Cardiovascular Cohort Study. Atherosclerosis, 153(2), 413-421.
Trichopoulou, A., Kouris-Blazos, A., Wahlqvist, M. L., Gnardellis, C., Lagiou, P., Polychronopoulos, E., Vassilakou, T., Lipworth, L., & Trichopoulos, D. (1995). Diet and overall survival in elderly people. BMJ, 311(7018), 1457-1460.
Truswell, A. S. (1998). Practical and realistic approaches to healthier diet modifications. [Review] [90 refs]. American Journal of Clinical Nutrition, 67(3 Suppl), 583S-590S.
Verhage, B., Vervoort, G., Wolkotte, C., Elving, L. D., Wetzels, J. F., Willems, H., Smits, P., Verbeek, A. L., & Berden, J. H. (1999). Prevalence of "syndrome X" features in parents of type 1 diabetic patients with or without nephropathy. Diabetes Care, 22(7), 1048-1052.
Yao, X. H., Kong, B. Q., Yan, J. X., Zhu, X. C., & Lu, Y. F. (1987). Lactose tolerance test by hydrogen breath method in Chinese. Chinese Medical Journal, 100(4), 316-318.
Zamboni, M., Armellini, F., Milani, M. P., De Marchi, M., Todesco, T., Robbi, R., Bergamo-Andreis, I. A., & Bosello, O. (1992). Body fat distribution in pre- and post-menopausal women: metabolic and anthropometric variables and their inter-relationships. International Journal of Obesity & Related Metabolic Disorders, 16(7), 495-504.
內政部。人口統計。內政部，1997。
行政院衛生署：民國88年公共衛生年報。行政院衛生署，1999。
行政院衛生署：國民飲食指標第三版。行政院衛生署，1995a。
行政院衛生署：每日飲食指南。行政院衛生署，1995b。
吳幸娟，章雅惠，章新儀，潘文涵。台灣地區成年人維生素A、B1、B2、C、E、及菸鹼酸的食物來源:1993~1996國民營養狀況變遷調查結果。中華營誌，2001；26： 213-229。
吳德敏，白璐，宋丕錕，蔡宗仁，徐黎玲，李敏貞，孫建安。抽煙飲酒與嚼檳榔習慣個人聚集之初探:以健康檢查族群為例。中華衛誌，1999；18：453-459。
邱清華，章樂綺。中國人飲食指南之探討研究：中華營誌，1977；43-55。
陳建仁：流行病學原理與方法－第二章疾病自然使與致病模式，13-23頁。聯經出版社。1999。
董氏基金會 健康飲食促進委員會：全民營養 健康之鑰。董氏基金會，2001。
張薰文，李源德，林瑞雄，許秀卿，蘇大成，簡國龍，陳文鍾，黃玉貞，宋鴻樟。活動量與高血壓及高血之證的相關探討-金山成年居民的研究：中華衛誌，1999；413-422。
楊燕雲：飲食因子與血脂生化值之相關探討。國防大學國防醫學院公共衛生研究所碩士論文，2000。