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研究生:陳郁蓓
研究生(外文):Yu-Pei Chen
論文名稱:飲食中n-3多元不飽和脂肪酸及α次亞麻油酸與代謝症候群之先驅性研究 : 橫斷及縱貫分析
論文名稱(外文):The relationships of dietary n-3 polyunsaturated fatty acids,α-linolenic acid and metabolic syndrome : a pilot study in cross-sectional and longitudinal analysis
指導教授:白其卉白其卉引用關係
指導教授(外文):Chyi-Huey Bai
口試委員:李弘元楊淑惠
口試委員(外文):HUNG-YUAN LIShwu-Huey Yang
口試日期:2017-07-02
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:公共衛生學系暨研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:84
中文關鍵詞:n-3多元不飽和脂肪酸代謝症候群ALA
外文關鍵詞:n-3 polyunsaturated fatty acidsmetabolic syndromeALA
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前言:
罹患代謝症候群可能增加二到三倍發生心血管疾病的風險。n-3多元不飽和脂肪酸(n-3 polyunsaturated fatty acids, n-3 PUFA)有抑制發炎的效用,可以降低全身性的發炎反應。發炎反應的降低則與代謝症候群的風險降低相關。有研究指出n-3 PUFA對於心血管疾病具有保護性的作用,但其與代謝症候群的關係則多有歧見。此外,過去縱貫研究大多使用飲食頻率問卷探討高n-3 PUFA的飲食型態攝取,但使用24 小時飲食回顧探討n-3 PUFA的攝取量的研究資料相對較少。

研究目的:
本研究嘗試以橫斷分析探討n-3多元不飽和脂肪酸攝取與代謝症候群的關係,並進一步以縱貫分析探討n-3多元不飽和脂肪酸攝取與罹患代謝症候群的風險。

材料方法:
本研究分為橫斷研究及縱貫研究兩部分。研究對象是2006年-2009年間由台大醫院雲林分院建立的「糖尿病自然史世代」中願意配合飲食紀錄且較具健康意識的民眾。進行其體位測量(身高、體重、腰圍)並填寫問卷資料:基本人口學指標(年齡、性別、教育程度等)、飲食頻率問卷、三日的24小時飲食紀錄。將民眾的三日的24小時飲食回顧透過營養軟體轉為三大營養素、纖維、脂肪酸。輸出的脂肪酸內容歸類為多元不飽和脂肪酸(Polyunsaturated fatty acids, PUFA)、n-3 PUFA(如:α次亞麻油酸(α-linolenic acid , ALA)、20碳五烯酸(Eicosapentaenoic acid, EPA)、22碳六烯
酸(Docosahexaenoic acid, DHA))、n6多元不飽和脂肪酸(n-6 polyunsaturated fatty acids, n-6 PUFA),依人數平分成三組,以數值最小的組別為1st tertile(T1),其餘依序為2nd tertile(T2)、3rd tertile(T3)。橫斷分析針對基線收案且願意配合飲食紀錄的民眾595人,經排除條件共納入574人,以t檢定及邏輯斯迴歸進行分析。縱貫分析針對在基線時沒有代謝症候群的民眾423人,追蹤其爾後的代謝症候群罹患狀況,使用存活分析進行檢定。

結果:
進行橫斷分析的574人中,有代謝症候群的民眾有151人、無代謝症候群的民眾有423人。人口學變項上,有代謝症候群的民眾:年齡偏長、男性較多、BMI值偏大、教育程度偏低(皆p<0.05)。營養攝取上,總熱量及纖維量,皆沒有統計顯著差異。有代謝症候群的民眾,碳水化合物攝取顯著的較多(p=0.01),脂質攝取顯著的較少(p=0.01)。無論有無代謝症候群的民眾,n-3多元不飽和脂肪酸的攝取量平均值無統計顯著差異。ALA的攝取與代謝症候群的盛行狀況具風險傾向(僅T2對T1呈現OR=1.81, 95%CI:1.06-3.10,其餘無顯著),但多加上校正了n-6PUFA的攝取量後,ALA攝取量與代謝症候群的盛行狀況增加達顯著相關(p for trend=0.007)。
進行縱貫分析的423人中,平均追蹤6.49年。至追蹤終點仍無發生代謝症候群的民眾有341人、追蹤期間新發生代謝症候群的民眾有82人。人口學變項上年齡較長、男性、BMI值偏大的人有較高的代謝症候群發生風險(皆p<0.05)。營養攝取上,飲食的總熱量及纖維量與代謝症候群發生風險皆沒有顯著相關。n-3多元不飽和脂肪酸的攝取與代謝症候群的發生風險也無顯著相關。攝取較高ALA的民眾,有較高的風險罹患代謝症候
群(HR=1.72, 95%CI:1.02-2.88)。多加上校正了n-6PUFA的攝取量後,ALA攝取與代謝症候群的發生風險增加仍有顯著關係(p for trend=0.017)。

結論:
本研究發現n-3PUFA攝取量與代謝症候群無關,EPA、DHA攝取量與代謝症候群無關,ALA攝取與代謝症候群的盛行狀況及發生風險增加有顯著關係,皆與過去研究不同。
Background:
Compared to ordinary people, those who have metabolic syndrome may double or triple its possibility of having cardiovascular disease. N-3 polyunsaturated fatty acids (n-3 PUFA) is effective in ceasing inflammation and can further decrease general inflammation. Decrease in inflammation is related to decreased risk in metabolic syndrome. Some researches showed an inverse association between n-3 PUFA intake and cardiovascular disease, however the relationship between n-3 PUFA and Metabolic syndrome is still debatable.
Besides, in the past, it’s more common to use food frequency questionnaire to discuss the dietary pattern, which contains high intake of n-3 PUFA. Compared to previous one, researches which focus on discussing the n-3 PUFA intake by 24-hour dietary recall is comparably less.

Objective:
This research tries to use cross-sectional analysis to discuss the relationship between the n-3 PUFA intake and metabolic syndrome and further use longitudinal analysis to discuss the relationship between the n-3 PUFA intake and the incidence of metabolic syndrome.

Materials and methods:
This research contains two parts –cross-sectional and longitudinal parts.We recruited the subjects who are more willing to follow dietary records and have higher level of health consciousness. The data set was established from 2006 to 2009 in the clinics of National Taiwan University Hospital Yunlin Branch. Conducting measures of anthropometric data (weight, height and waist) and
filling out the questionnaires: socio-demographic indicators (age, sex and education degree), food frequency questionnaire and 24-hour dietary recall for three days.Then using nutrition software to transfer 3-day 24-hour dietary recall into macronutrients, fiber intake and fatty acids intake. Outputting fatty acids intake can be categorized as following: polyunsaturated fatty acids(PUFA), n-3 PUFA(for example:α-linolenic acid (ALA), eicosapentaenoic acid(EPA) and docosahexaenoic acid(DHA)) and n-6 polyunsaturated fatty acids(n-6 PUFA). Total population can be divided into three equal groups: 1st tertile(T1) with minimum amount of intake, escalating as following two groups: 2nd tertile(T2) and 3rd tertile(T3).Cross-sectional analysis focuses on 595 people who are at baseline and are more willing to follow dietary records. After certain exclusions, there are 574 people included in and we analyze these data by running t-test and logistic regression. Longitudinal analysis focuses on 423 people, who don’t have metabolic syndrome at baseline and follow up their later conditions of having metabolic syndrome or not. Cox proportional hazards model was used to assess the hazard ratios of incidence.

Result:
Among 574 people in the cross-sectional analysis, 151 people have metabolic syndrome and 423 people don’t. Individuals with MetS are commonly in those people of elderly, male, larger BMI and lower education level (all of them p<0.05). Total energy of intake and dietary fiber show no significant difference between two groups. People with Metabolic syndrome usually obtain significantly more carbohydrates (p=0.01) and significantly less fat (p=0.01). No matter having metabolic syndrome or not, the average intake of n-3 PUFA is not significantly different. The intake of ALA and the prevalence of
metabolic syndrome just show an positive association, however, after adjusting the n-6PUFA intake, the relationship between ALA intake and the prevalence of metabolic syndrome show a statistical significance (p for trend=0.007).
Among 423 people in longitudinal analysis, the average follow-up time is 6.49 years. Until the endpoint of follow-up, there are 341 people without metabolic syndrome and 82 incident cases are identified. People, who are elderly, male and higher BMI value usually are more likely of having metabolic syndrome (all of them p<0.05). There’s no statistically significance between total energy of intake and the risk of having metabolic syndrome, as well as dietary fiber and metabolic syndrome. There is no significantly relationship between the intake of n-3 PUFA and having metabolic syndrome. People, who consume more ALA usually have higher risk of having metabolic syndrome (HR=1.72, 95%CI:1.02-2.88). After adjusting the n-6PUFA intake, the relationship between ALA intake and the risk of having metabolic syndrome show a statistical significance (p for trend=0.017).

Conclusion:
This research finds that there is no relationship between the n-3 PUFA intake and metabolic syndrome. There is also no relationship between the intake amount of EPA, DHA and metabolic syndrome. There is a relationship between the ALA intake and the prevalence of metabolic syndrome as well as the increasing risk of having metabolic syndrome. Both results are contrary to previous studies.
第一章 、緒論-1-
第一節、研究背景與動機-1-
第二節、研究目的-2-
第三節、縮寫-3-
第二章、文獻回顧-4-
第一節、代謝症候群-4-
第二節、飲食評估-10-
第三節、n-3多元不飽和脂肪酸-13-
第四節、n-3多元不飽和脂肪酸攝取與代謝症候群流行病學研究-17-
第三章、研究方法與材料-30-
第一節、研究設計與研究假設-30-
第二節、資料來源-31-
第三節、橫斷研究(Cross-sectional study)的研究對象及流程-33-
第四節、縱貫研究(Longitudinal study)的研究對象及流程-34-
第五節、暴露資料測量方法-36-
第六節、研究變項與操作型定義-37-
第七節、統計及資料分析-40-
第四章、結果-42-
第一節、多元不飽和脂肪酸與代謝症候群的相關性:橫斷性研究-42-
第二節、多元不飽和脂肪酸與罹患代謝症候群的風險:縱貫分析-57-
第五章、討論-67-
第一節、多元不飽和脂肪酸與代謝症候群的關係-67-
第二節、n-3多元不飽和脂肪酸與代謝症候群的關係-70-
第三節、研究限制-74-
第六章、結論-75-
參考文獻-76-
附錄-84-
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