臺灣博碩士論文加值系統

本研究是以1993-1996所進行的國民營養健康狀況變遷調查中，19-64歲成人的二十四小時飲食記錄及飲食頻率問卷來探討高尿酸血症與飲食營養的關係，扣除抽血前未禁食、體檢資料中有缺漏值的個案，並為排除因果倒置的可能性，也排除已知的痛風個案，得272名男性227名女性為高尿酸血症，662名男性850名女性為對照組。血清尿酸值的測量是用Hitachi 747以酵素呈色反應法測得，控制樣本變異係數為1.9%。對於高尿酸血症的定義採用相對性的高尿酸血症之定義作為切點，男性尿酸值≧7.7 mg/dl 者，及女性尿酸值≧6.6 mg/dl者定義為高尿酸血症，資料分析是以對數迴歸模式(Logistic regression model analysis)分析探討高尿酸血症與一般性的的危險因子、營養素攝取量、營養素密度、及飲食頻率之關係。
結果顯示：肥胖、有飲酒習慣、為原住民族群、腰圍大，是男性的危險因子，年老、肥胖、有飲酒習慣、為原住民族群、腰圍大為女性高尿酸血症之危險因子；原住民族群已經戒酒者是男性的危險因子，年老、肥胖是女性高尿酸血症之危險因子；漢人族群肥胖、腰圍大是男性的危險因子，年老、肥胖、腰圍大為女性高尿酸血症之危險因子。控制基本特性後，總體來看影響高尿酸血症的飲食危險因子男性有動物性食物來源、茶，女性有動物性食物來源、魚類、非葉菜蔬菜、含糖飲料或甜點，保護因子在男性方面有植物性食物來源、維生素及礦物質來源，女性方面有不飽和脂肪酸食物來源及礦物質食物來源。若以族群來看原住民族群動物性食物來源與茶為男性高尿酸血症之危險因子，植物性食物、鈉、為原住民女性的保護因子，含糖飲料、動物性蛋白、南瓜為原住民女性的危險因子；漢人族群男性方面保護因子為植物性食物來源及維生素和礦物質食物來源，危險因子有豬頭皮及茶，漢人女性不飽和脂肪油脂為保護因子，新鮮魚類、筍類、維生素B2是危險因子。普林攝取量和高尿酸血症沒有顯著的關係。
由於飲食頻評估的誤差大，須待其他研究進一步肯定本研究之發現。

The Nutrition and Health Survey in Taiwan was conducted between in 1993 and 1996. It was a mutil-stage stratified sample. This present study utilizes the values of serum uric acid, 24 hours dietary recall and food frequency questionaire data of the subjects who were 19—64 years old to examine dietary factors associated with hyperuricemia. Excluding gout patients and subjects with missing data, we obtained 499 cases (272 males 227 and females) with hyperuricemia and 1472 controls (662 males and 850 females). The serum uric acid data was analyzed by enzyme colorimetric method. The controlled sample variance was 1.9%. The definition of hyperuricemia was that males with serum uric acid ≧ 7.7mg/dl or females with serum uric acid ≧ 6.6mg/dl. Factor analysis and logistic regression were used in this study to evaluate dietary factors associated with hyperuricemia risk.
The results showed that obesity, drinking habit, aborigines, and large waist were risk factors of hyperuricemia for males; and that age, obesity, drinking habit, aborigines, and large waist were risk factors of females. For aborigines, quit drinking was risk factor for males; and age, obesity were risk factors for females. For non-aborigines, obesity and large waist were risk factors of males; and age and obesity large waist were risk factors of females. After controlling for covariates like age, waist, drinking habit, dietary factors, we found that tea, coffee vitamin B1 and pig’s head meat were risk factors of hyperuricemia for males; and that fish, legume, bamboo shoot, sugar were risk factors of females. However vegetarian food sources, dairy food sources and minerals were protective factors of males; whereas PUFA was protective factor of females. In aboriginal population, dietary factors associated with hyperuricemia in males were tea and animal food sources; and sweetened drinks, animal protein and pumpkin were risk factors for females. However vegetarian food sources and sodium were protective factors for females. In non-aboriginal population, dietary factors associated with hyperuricemia were tea and pig’s head meat for males; and fish, bamboo shoot, vitamin B2 were risk factors for females. But vegetarin food sources, vitamins and minerals rich food sources were protective factors of males and PUFA was protective factors of females. Intake of high purine food was not found associating with hyperuricemia. Possible reasons for that were recall bias in food frequency data and measurement error in 24 hours dietary recall data. Further investigations are needed to evaluated the relationship between high purine food and hyperuricemia.

目 錄
誌謝--------------------------------------------------------Ⅰ
中文摘要----------------------------------------------------Ⅱ
英文摘要----------------------------------------------------Ⅳ
目錄--------------------------------------------------------Ⅵ
表目錄------------------------------------------------------Ⅷ
圖目錄----------------------------------------------------ⅩⅤ
第壹章 前言-------------------------------------------------1
第貳章 文獻探討---------------------------------------------2
第一節 尿酸之生合成-----------------------------------------2
第二節 高尿酸血症與痛風-------------------------------------3
第三節 高尿酸血症的危險因子---------------------------------5
第四節 飲食資料的收集--------------------------------------11
第參章 材料與方法------------------------------------------14
第一節 研究設計--------------------------------------------14
第二節 研究樣本--------------------------------------------19
第三節 資料統計與分析--------------------------------------20
第肆章 結果------------------------------------------------40
第一節 本資料分基析----------------------------------------40
第二節 飲食分析--------------------------------------------47
第三節 因素分析------------------------------------------ 149
第伍章 討論---------------------------------------------- 171
第陸章 結論---------------------------------------------- 182
參考文獻--------------------------------------------------183
附錄一 飲酒習慣問卷---------------------------------------191
附錄二 抽煙習慣問卷---------------------------------------192
附錄三 飲食頻率問卷---------------------------------------193

1. The Merck Index of Chemiacls and Drugs(8 edi). p1096.
2. Dennis J , Levinson et al . Clinical gout and pathogenesis of hyperurocemia:Metabolic bone and joint disease . Arthritis 1993;1773-1805
3. Kelly WN , et al . Textbook of Rheumatology .3rd ed. Philadelphia.WB Sanuders1989;898
4. Heuckenkamp PU , Harris HD , et al . Pathogensis of gout arthrities. Zeitschrift fur die Gesamte Inner Medizin und Ihre Grenzgebiete 1982;37:424-8
5. Ganong WF . Review of medical physiology 11th ed . Lange Medical Publications 1983
1. 林孝義 : 痛風與高尿酸血症 。 健康世界叢書 1986 台北
7. Wyngaarden JB,Kelley WN 1976. Gout and hyperuricemia . Grune & Stratton .New York .
8. Abbott RD , et al . Gout and coronary artery disease : the Framingham Study . J Clin Epidemiol 1988;41:237-42
9. Pesus Chou , L-N Soong ,et al . Community-based Epidemiology Study on Hyperuricemia in Pu-Li . Taiwan J formos Med Assoc 1993 ;92:597-602
10. Selby JV , Friedman GD , et al . Uric acid study . Am J Epidemiol 1990;131:1017-27
11.K Jinnal , et al . Glycogenosis type V with hyperuricemia . Eur Neurol 1993;204- 207
12.Roubenoff R , et al . Incidence and risk factor for gout in white men . JAMA 1991;266:3004-7
13.Harrison’s . Principles of Internal Medicine . Chp.106.
14.Tarle SA , et al . Determination of the mutations responsible for the Lesch-Nyhan syndrome in 17 subjects . Genomic 1991;10:499-501
15.Prior IA , et al . Hyperuricemia , gout , and diabetics abnormality in Polynesian people . Lancet 1966;1:333-8
16.Prior IA . Epidemiology of rheumatic disorders in the Pacific with particular emphasis in hyperuricemia and gout . Semin Arthritis Rheum 1981;11:213-29
17.Darmawan J , et al . The epidemiology of gout and hyperuricemia in a rural population of Java . J Rheumatol 1992;19:1595-9
18.Tsung-Po Kuo . Gout In The Tropical Taiwan . Taiwan J formos Med Assoc 1964;9:415-425
19.Lai SC , et al . Hyperuricemia in Ilan County . Epidemiol Bull 1991;7:101-8
20.Korenman SG . The Menopaus . 1989
21.Walton C , et al . The effect of the menopause on insulin sensitivity,secretion and elimination in non-obese ,Health Woman . European J of Clin Investigation 1993;23:466-73
22.Matthews KA , Meilaha e , et al . Menopause and risk factor for coronary heart disease . The new England J of Med 1989;321:641-6
23.Woolliscroft JO , Colfer H ,Fox IH . Hyperuricemia in accute illness: A poor prognostic sign .Am J Med 1982;72:59-62
24.Breckenridge A. Hypertention and hyperuricemia . Lancet 1966;1:15-18
25.Dodge HJ , Mikkelsen WN . Observation on the distribution of serum uric acid level in participants of the Tecumseh,Michigan,community health studies . J Chron Dis 1970;23:161-72
26. Takala J , et al . Diuretics and hyperuricemia in the elderly . Scand Rheumatol 1988;17:155-60
27.Willam M. Obrien . Geneticamia in Blackfeet and Pima Indian . Ann Rheum Dis 1968;25:117-119
28.Jaakko Tuomilehto . Plasma Uric Acid Level and Its Assocation with Diabetes Mellitus and Some Biologic Parameters in a Biracial Population of Fiji . Am J Epidemiol 1988 ;127:321-335
29.Uri Goldbourt , et al . Serum uric acid : Correlation with biochemical ,anthropometric, clinical and behavioral parameters in 10,000 Israeli men . J Chro Dis 1979;33:435-443
30.Jerry Lee . Uric acid and coronary heart disease risk : Evidence for a role of uric acid in the obesity-insulin resistance syndrom . Am J Epidemiol 1995 ;142:288-293
31.James I , C Leeman . Report of national cholesterol education program expert panel on detection , evaluation , and treatment of high blood cholesterol in adults . Arch Intern Med 1988;148:36-39
32.Zalokar J , et al . Serum uric acid in 23923 men and gout in a subsample of 4257 men in France . J Chron Dis 1972;25:305-312
33.K.Yano , et al . Epidemiology of Serum Uric Acid among 8000 Japanese-American Men in Hawaii . J Chron Dis 1977;30:171-184
34.Oshima Y . Clinical studies on Japanese gout .Nippon Naika Gakkai Zasshi 1965;27:319-325
35.Nishimura T , Shimizu T , et al . Influence of daily drinking habits on ethanol-induced hyperuricemia . Metabolism 1994;43:745-8
36.Whitehead TP , et al . Biochemical and haematological markers of alcohol intake . Lancet 1978;1:978-981
37.Kagan A , et al .Epidemiologic studies of coronary heart disease and stroke in Japanese men livinig in Japan , Hawaii and California ; Demographic , physical , dietary , and biochemical risk factors . Am J Epidemiold 1975;102:491-501
38.Yamanaka H , Kawagoe Y , et al . Accelerated purine nucleotide de-gradation by aerobic ergometer muscle exercise . Metabolism 1992;41:364-369
39.Batuman . Lead nephropathy , gout , and hyperuricemia . Ame J of Med Sci ;241-248
40.Bingham S , et al .1988 . Methods for data collection at individual level . In Cameron M & Van Staveren W (Eds) . Manual on Methodology for Food Consumption Studies . Oxford Univ Press . New York .
41.Tompson FE , Byers T . Dietary assessment resource mannal . J Nutr 1994;124(11S):2245S-2317S
42.White EC , et al . Validation of a dietary record system for the estimation of daily cholesterol intake in individual outpatients . Am J Clin Nutr 1981;34:199-203
43.Beaton GH , et al . Source of variance in 24-hr dietary recall data : Implication for nutrition study design and interpretation . Am J Clin Nutr 1979;32:2546-59
44.Gibson R . 1990 . Principles of nutrition assessment . Oxford Univ Press . New York .pp37-152
45.Willett, W 1990. Nutritional epidemiology. Oxford Univ Press . New York .pp52-92
46.潘文涵 : 二十四小時飲食回顧法之方法學研究 。行政院衛生署七十七年度科技研究發展計畫研究報告 DOH 77-68 1988
47.黃舒儀 : 家戶二十四小時飲食回憶法及其使用模型之效度研究 。中國文化大學家政研究所營養組碩士論文 1996
48.Stefanik PA , et al . Determining the frequency intakes of foods in large group studies . Am J Clin Nutr 1962;11:335-43
49.Anderson SA . 1986 .Guidelines for use of dietary intake data . Life Sciences Research Office , Federation of American Societies for Experimental Biology ,Bethesda . Maryland .
50.Gray GE , et al . Assessment of three brief methods of estimation of vitamin A and C intakes for a prospective study of cancer : Comparison with dietary history . Am J Epidemiol 1984;119:581-90
51.Willett W , et al . Reproducibility and validity of a semiquantitative food frequency questionaire . Am J Epidemiol 1985;122:51-56
52.Hirayma T . Diet and cancer . Nutr and cancer 1981;1:67-81
53.Mikkelsen WM , Dogde HJ ,et al . The distribution of serum uric acid values in a population unselected as to gout or hyperuricemia ,Tecumseh,Michigan,1959-1960 . Am J Med 1965;39:242
54.余光輝 等 ：痛風病人822例之臨床回溯分析 。風濕病雜誌 1993 ;10卷之1.2期
55.Prior IA . Hyperuricemia , Gout and Diabetic abnormality in polynesian people . Original Articles 1966 ;333-9
56. 駱錫能 等 : 水煮過程對魚體嘌呤含量的影響 。食品科學 1997;24:258-62
57.Balas DJ , Reisenauer IR . Level of serum acid and serum cholesterol various population groups in Ethiopia . Am J Med Sci 1965;250:308-14
58.Myer AR ,et al . The relationship of serum uric acid to risk factors in coronary heart disease . Am J Med 1968;45:520-8
59.Gibson T , Grahame R . Gout and hyperlipidemia . Ann Rheum Dis 1974;33:288-93
60.Nugent CA , Tyler FH . The renal excretion of uric acid in patients with gout and in nongouty subject . J Clin Invest 1959;38:1890
61.Charly JS ,et al 1999 .Gout , hyperuricemia , and other crystal-associted arthropathies . Marcel Dekker ,Inc .New York.pp205-218
62.章順仁 : 台灣原住民痛風之流行病學研究 。高雄醫學院醫學研究所博士論文 1997
63.廖龍仁 : 南投縣原住民高尿酸血症之病因探討─橫斷性研究。中國醫藥學院環境醫學研究所碩士論文 1996
64.林寬佳 : 金湖鎮社區性高尿酸血症及痛風之流行病學研究。國立陽明大學公共衛生學研究所碩士論文 1997
65.Henriette MJA , et al .Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch nutrition surveillance system) . J clin Epidemiol 1990;43:1297-1303
66.何威德 : 台灣常用食品的嘌呤和嘧啶含量分析 。中華營誌 1986;12:41-62
67.Wallace SL , Robinson H ,et al . Preliminary criteria of the acute arthritis of primary gout . Arthritis Rheum 1977;20:895-900
68.國民營養現況 1993-1996國民營養健康狀況變遷調查結果 。行政院衛生署編印 1998
69.Kline P 1994 . An easy guide to factor analysis . Routledge,Champman an Hall , Inc . New York .
70.Martha LS , Kenneth MB ,et al . Eating pattern and risk of colon cancer . Am J Epidemiol 1998 ;148:4-16
71.呂秉源 : 竹東及朴子地區居民飲食與心臟血管疾病危險因子相關之流行病學研究 。國立陽明大學公共衛生學研究所碩士論文 1992
72. Bryan TE . The management of gout . The new England J of Med 1996;334:445-51
73. Morgan KJ , Johnson SR ,et al . Collection of food intake data:An evaluation of methods .J Am Diet Assoc 1987;87;888-896