臺灣博碩士論文加值系統

背景: 氧化壓力被認為是空氣污染對人類造成健康危害的機制之一。氧化壓力的形成是因體內氧化物與抗氧化物的不平衡所造成的，並與呼吸系統疾病、慢性病等健康效應與整體死亡率和發病率相關。從工業區排放出的空氣粉塵微粒內所含的重金屬也被假設為造成氧化壓力的原因之一。兒童是氧化壓力的易感受族群，淺在的健康危害包括從呼吸系統疾病到神經損害等。近年，研究推測, 透過飲食攝取的抗氧化物可能能夠對氧化壓力達到保護作用。
目的: 本研究的目的是探討營養與污染狀況的社會決定因子、判定從飲食攝取之抗氧化物是否會產生保護作用以預防氧化傷害、並評估臺灣雲林六輕石化工業區附近幼稚園兒童的氧化壓力是否與其重金屬暴露呈現正相關。
方法: 本研究招募了168名4-8歲的兒童，其中87名來自預先定義的高暴露區域、81名來自低暴露區域。本橫斷面研究特別開發了一半定量的飲食頻率問卷(Food Frequency Questionnaire, FFQ)來評估受試者的抗氧化物攝取、飲食習慣以及社經地位特性。同時, 填寫FFQ時每位受試者也收集了晨尿樣本。研究團隊與營養師分析FFQ，以確定每位受試者每週的總抗氧化物攝取量。尿液樣本則是以電感耦合等離子體質譜 (ICP) 和液相色譜質譜 (LC) 進行分析，偵測十一種重金屬和四種氧化壓力生物標記的濃度。群體之間社會經濟、飲食和暴露因子的差異是以ANCOVA 測試檢定。本研究採用多元線性回歸法判定尿液氧化壓力的顯著預測因子。
結果: ANCOVA 檢定發現高、低暴露組在尿液中 8-OHdG 和8種重金屬元素 (mg/g-creatinine) 有顯著差異，而高暴露組的平均濃度高於低暴露組。受試者住址和幼稚園地址離暴露源的距離加權平均是尿液中重金屬元素濃度的重要預測因子。飲食習慣雖觀察到有差異，但並不具統計意義。多線性回歸檢定顯示高尿中重金屬元素與高尿中8-OHdG呈現相關。每週總抗氧化劑攝取量 (mol/g) 的增加導致尿液中 8-OHdG 的減少，但未達統計顯著。
結論和建議: 本研究提供社會經濟因子、空氣污染和營養之間的關聯資料。在靠近石化工業園區的族群中的尿液重金屬和氧化壓力濃度較高，顯示暴露的風險增加。飲食中的抗氧化物攝入與較低的氧化壓力雖呈現相關，但並未達到統計意義，顯示目前本研究平均普遍較低的抗氧化物攝取尚不足對氧化壓力達到保護作用。本研究建議對本研究族群進一步探討，以確定較高的飲食中抗氧化物攝取是否會對氧化壓力產生保護作用，並調查除了重金屬外以外其他的氧化壓力來源。此外、也建議對工業排放污染進行更嚴格的管制，以減少對研究族群的暴露。

Background: Air pollution is believed to cause harmful human effects in part through the mechanism of oxidative stress. Oxidative stress occurs when there is an imbalance between oxidants and antioxidants in the body, and it is associated with many human health effects, including respiratory diseases, chronic diseases, and overall mortality and morbidity. Heavy metals, present in particulate matter linked to industrial complexes, have been hypothesized as a cause of oxidative stress. Children are particularly vulnerable to oxidative stress, with potential health effects ranging from respiratory disease to neurological damage. Researchers recently have hypothesized that dietary antioxidant intake might provide a protective effect against oxidative stress.
Objective: The objective of this study is to investigate the social determinants of health of nutritional and pollution status, to determine whether dietary antioxidant intake plays a protective role in preventing oxidative damage, and to assess whether oxidative stress is positively associated with heavy metal exposure in kindergarten children living near a petrochemical complex in Yunlin County, Taiwan.
Methods: 168 children ages 4-8 were recruited, 87 from the pre-determined high exposure area and 81 from the pre-determined low exposure area. This cross-sectional study used a specially-developed semi-quantitative food frequency questionnaire (FFQ) to assess the participants’ intake of antioxidants, overall dietary patterns, and socioeconomic characteristics. A morning spot urine sample was collected from each participant at the same time as the FFQ. The FFQ was analyzed with nutritionists to determine each participant''s’ total antioxidant intake per week. The urine samples were analyzed using Inductively coupled plasma mass spectrometry (ICP-MS) and liquid chromatography mass spectrometry (LC-MS) to find concentrations of eleven heavy metals and four biomarkers for oxidative stress. ANCOVA tests were performed to determine between-group differences in socioeconomic, dietary, and exposure variables. Multiple linear regression was performed to determine significant predictors of urinary oxidative stress.
Results: ANCOVA tests revealed significant differences in urinary 8-OHdG and eight heavy metals (g/g-creatinine) between the high and low exposure group, with the high exposure group’s average concentrations higher than the low exposure group’s. Weighted average distance of the participants’ home and kindergarten addresses to the exposure site was a significant predictor of urinary heavy metal concentrations. Dietary differences were observed but they were not statistically significant. Multiple linear regression tests showed higher urinary heavy metal concentrations associated with higher urinary 8-OHdG. Increased total antioxidant intake per week (mmol/g) resulted in a decrease in urinary 8-OHdG, but these results were not statistically significant.
Conclusion and Recommendations: This study provided data on the associations between socioeconomic factors, air pollution, and nutrition. Heavy metals and oxidative stress were higher in the group living closer to the petrochemical plant, indicating an increased risk of exposure. Dietary antioxidant intake was associated with lower oxidative stress, but these results were not statistically significant, indicating that the current dietary intake of antioxidants, which is lower than average, is not enough to protect this population from urinary oxidative stress. It is recommended that further studies be done on this population to determine if a higher intake of dietary antioxidants would provide a protective effect against oxidative stress, as well as investigate other sources of oxidative stress besides heavy metal exposure. In addition, stricter regulation of industrial pollution to reduce exposure for the study population is also recommended.

Table of Contents
Acknowledgments i
摘要 ii
Abstract iv
LIST OF FIGURES viii
LIST OF TABLES ix
1.0 Introduction 1
1.1 Practicum unit features 1
1.2 Background 2
1.2.1 Central Taiwan and Yunlin County 2
1.2.2 Petrochemical Industry in Yunlin 3
1.3 Framework and Hypotheses 3
1.4 Literature Review 4
1.4.1 Petrochemical industry exposure 4
1.4.2 Oxidative stress mechanism 5
1.4.3 Influence of diet 8
1.4.4 Measuring food intake 10
1.4.5 Dietary contamination potential 11
1.5 Research gap and objectives 11
1.5.1 Previous studies in Yunlin 11
1.5.2 Previous studies not in Taiwan 12
1.5.3 Research Gap & Purpose 12
2. Methods 16
2.1 Selection of subjects 16
2.1.2 Study area 16
2.1.3 Study population 17
2.1.4 Study design 18
2.1.5 Incentives & Study Recruitment 18
2.2 Sample analysis 19
2.2.1 Analysis of heavy metals (exposure biomarkers): Urine samples 19
2.2.2 Analysis of Oxidative Stress Biomarkers: Urine samples 22
2.2.3 Analysis of Total Antioxidant Intake: Food Frequency Questionnaire 22
2.2.4 Kindergarten Menu Integration 25
2.2.5 Ethical approval and support 25
3. Results 26
3.1 Characteristics of Study Subjects 26
3.2 Exposure status of study subjects 33
3.2.1 Heavy metals 33
3.2.2 Oxidative stress 37
3.2.3 Total Antioxidant Intake and Dietary Patterns 39
3.2.4 Linear regression analysis 43
4.0 Discussion 49
4.1 Objectives 49
4.2 Implications from analysis results 50
4.3 Comparison to other study’s findings 52
4.4 Socioeconomic Differences 59
4.5 Representativeness of Study Population 60
4.6 Strengths 63
4.7 Limitations 63
4.8 Conclusion and further recommendations 64
5.0 References 67
6.0 Appendix 80
6.1 Reflection 80
6.2 Food Frequency Questionnaire 81
6.3 Ethical Approval 90
6.4 ANCOVA comparison tests for between-group differences, separated by kindergarten 92
6.5 Stratified analysis of means by gender and age. 95
6.6 Boxplots comparing high and low exposure group’s adjusted mean urinary heavy metal concentrations 96
6.7 Multiple linear regression results for 8-NO2Gua 99
6.8 Multiple linear regression results for 4-HNEMA 100
6.9 Beta coefficients for multiple linear regression tests of 8-OHdG. 101

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