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標題: | 咖啡與健康 Coffee and Health |
作者: | KING-FU LIN 林金富 |
指導教授: | 陳秀熙(Hsiu-Hsi Chen) |
關鍵字: | 咖啡,平均餘命,整合式篩檢,Gompertz迴歸模式,羅吉式迴歸分析,半馬可夫模型,慢性病, Coffee,life expectancy,the community-based integrated screening (CIS),Gompertz regression model,logistic regression models,semi-Markov model,chronic diseases, |
出版年 : | 2020 |
學位: | 碩士 |
摘要: | 背景 雖然先前的研究顯示咖啡對許多慢性疾病與腫瘤病變具有保護效果,但咖啡對於平均餘命之影響仍未有充足的研究與討論。此外,綜合慢性病以及癌症之影響進而評估咖啡對於人類健康帶來的效果在目前之科學文獻中仍甚少著墨。本實習論文因此透過台灣族群之追蹤研究對咖啡之健康效益在慢性病以及癌症的保護效果進行評估,進而推估咖啡對於延長平均餘命的量化效益。 目的 本研究之目標包括:評估並量化咖啡飲用習慣對平均餘命影響、對大腸癌癌前病變(腺瘤、晚期腺瘤)與大腸癌之影響、對糖尿病、高血壓、代謝症候群與慢性病等慢性疾病之影響,以及建立多層次、多因素的半馬可夫發病與死亡模型,評估疾病進展進而評估咖啡在此多重因素與多階段疾病進展史之考量下對於平均餘命影響。 材料與方法 本實習研究運用世代追蹤研究設計評估咖啡之健康效益,研究對象包含基隆、竹南、彰化與台東等台灣四個社區中,參與整合式社區篩檢之民眾。運用Gompertz迴歸模式再納入多樣之人口學、生活型態,以及生物指標之影響下探討咖啡飲用習慣對平均餘命之效益。使用羅吉式迴歸分析評估咖啡對大腸腫瘤病變之影響,運用羅吉式迴歸模型評估了咖啡飲用習慣對於糖尿病、高血壓、代謝症候群與慢性腎臟病,在納入年齡、性別、教育程度、吸菸習慣、蔬菜與肉類飲食習慣等因子下評估其健康效益。更進一步運用三階段半馬可夫過程模式納入根據個人風險狀況、多重因子以及階層環境因素之影響,以咖啡飲用習慣對於個人化平均餘命進行評估與預測。 結果 習慣於喝咖啡的人中,每週1-4次平均餘命為87.26歲;5次以上者更上升至88.61歲,然未有飲用習慣者平均餘命為85.79歲。若進一步考量性別、教育程度、運動習慣、吸菸、飲酒與喝茶等生活因子影響,不喝或很少喝咖啡的族群平均餘命為88.90歲,咖啡飲用每週1-4次者則為91.66歲,每週大於5次以上者則為93.73歲。 於咖啡與大腸癌之關聯分析中,調整其他影響大腸癌發生之因素後,發現咖啡有保護大腸癌發生之效果。與很少/不喝的族群相比,大腸腺腫每週飲用1-4次者風險降低了17% (6-26%) ,飲用5次以上者風險降低15% (1-28%)。在晚期腺腫的發生方面,每週飲用1-4次者風險降低了27%(5-44%),每週飲用5次以上者風險降低37%(10-46%)。更進一步發現,大腸癌發生的風險每週飲用1-4次者風險降低了29% (4-48%) ,飲用5次以上者風險降低44% (13-63%)。在慢性病也有類似的結果,中度飲用者(每週1-4次)與重度使用者(每週大於5次)相較於很少/不喝的族群,高血壓aOR為0.97(95%CI:0.94-0.99)和0.82(95%CI:0.80-0.85);慢性腎臟病調整後勝算比為0.89(95%CI:0.86-0.93)和0.84(95%CI:0.80-0.88);重度使用者其代謝症候群發生風險也為很少/不喝族群的0.79(95%CI:0.76-0.82)。運用包含多因子、多階層之半馬可夫模型,本研究證明,每週飲用咖啡7次以上與每週飲用1-6次者,相較於很少/不喝咖啡的族群,其平均生活品質調整之餘命可達增加2.18年與3.59年之效益。 結論 透過台灣四個社區的長期追蹤研究,本實習研究證明了咖啡對平均餘命、大腸癌、慢性病的健康效益。我們利用多層次、多因子與多階段健康狀況的演進,評估咖啡對健康的影響。本實習研究除運用科學實證量結合台灣社區長期追蹤研究資料量化咖啡飲用習慣之健康效益,並可以為社區居民提供更好的介入措施之基礎。 Background Although previous studies have suggested the health effects of coffee in terms of a series of chronic diseases and neoplastic diseases, the impact of coffee on life expectancy have been barely addressed. Furthermore, there is a lacking of empirical evidence on the impact of coffee on human health that taking an integrated perspective to consider the health effects of coffee in terms of neoplastic disease and chronic disease to address the role of coffee on life expectancy through the evolution of health status. Aims The aims of the practicum study is (1)to estimate the impact of coffee drinking on life expectancy; (2)to evaluate the effect of the habit of coffee drinking on colorectal neoplasms including adenoma, advanced adenoma, and colorectal cancer; (3)to evaluated the effect of the habit of coffee drinking on chronic diseases including diabetes mellitus, hypertension, metabolic syndrome, and chronic diseases; (4)to develop a multi-level and multi-factorious semi-Markov illness-and-death model to estimate personalized life expectancy taking into account disease-duration. Materials and Methods A cohort study design was used to elucidate the health effect of coffee drinking. The study population was consisted of subjects attending the community-based integrated screening (CIS) from Keelung, Changhua Taitung, and Zhunan in Taiwan. Iinformation on age, gender, BMI, education level, and lifestyle factors including the habit of drinking coffee, tea, and alcohol, the habit of cigarette smoking, physical activity status, and metabolic factors were collected. The habit of coffee drinking by the demographic characteristics and lifestyle factors for the four communities was first explored. A Gompertz regression model was used to assess the effect of coffee drinking on life expectancy, with and without consideration of joint effects of other life style factors. For assessing the association between coffee and colorectal neoplasms including adenoma, advanced adenoma, and colorectal cancer (CRC), a series of logistic regression models were applied with the consideration of demographic and lifestyle factors. The relationships between the habit of coffee drinking and chronic diseases including diabetes mellitus (DM), hypertension, metabolic syndrome (MetS), and chronic kidney disease(CKD) were assessed by using a series of logistic regression models. The effect of coffee drinking was assessed with the consideration of multidisciplinary confounding factors such as age, gender, education level, smoking behavior, exercise, meat consumption, and vegetable consumption were included in the analysis. A multi-level multi-factorial semi-Markov model embedded in a three-state illness-death model was used to estimate personalized life-expectancy (LE) according to personal risk profiles taking into account the effect of comorbidities and environmental factor. Two indicators, potential years of life lost (PYLL) and life year gained (LLG) were used for assessing the beneficial effect brought by a protective factor. Results We assess the difference in the habit of coffee drinking through five categories (never/seldom, 1-2 times/week, 3-4 times/week, 5-6 times/week and more than 7 times/week) by demographic characteristics, lifestyle factors, and the status of chronic diseases including hypertension, components of metabolic syndrome, and FIT level for four communities. The difference in the habit of drinking coffee reflects not only the habitual variation across age groups but also the chance of being exposed to the societal environment prevail with the habit of drinking coffee as demonstrated in the history of coffee market evolution. As for Zhunan community, while the lower proportion of the elders (aged more than 70 years) reporting the habit of coffee drinking is consistent with the other three communities, the Zhunan population aged 40-49 years reported the highest proportion of having the habit of drinking coffee (more than one cup of coffee per week). For the association between coffee and life expectancy, subjects with the habit of drinking coffee for 1-4 times (87.26 years) and more than 5 times (88.61 years) per week showed a longer life expectancy compared with subjects without the habit (85.79 years). The results were similar for both male and female. After the consideration of the influence of gender, education level, physical activity, smoking, alcohol, and tea, the life expectance for subjects with the habit of drinking coffee for 1-4 times (91.66 years) and more than 5 times (93.73 years) per week was longer than subjects without the habit of drinking coffee (88.90 years). The evaluation for the impact of drinking coffee on a spectrum of colorectal neoplasms showed a significant protective effect, which was consistent after taking into account the effect of potential confounders. Compared to the seldom or non-drinkers, subjects with the habit of drinking coffee for 1-4 times and more than 5 times per week had a significantly reduced risk of adenoma by 17% (6-26%) and 15% (1-28%), respectively. The corresponding figures for advanced adenoma were 27% (5-44%) and 37% (10-46%), respectively. For CRC are 29% (4-48%) and 44% (13-63%), respectively. Combining the data derived from the four communities, a significant trend of protective effect of coffee intake was revealed for chronic diseases. The adjusted ORs (aORs) for DM were estimated as 0.98 (95% CI: 0.94-1.03) and 0.76 (95% CI: 0.72-0.81) for subjects with the habit of drinking coffee for 1-4 times and more than 5 times per week compared with seldom/non-user of coffee, respectively. The corresponding figures for hypertension were estimated as 0.97 (95% CI: 0.94-0.99) and 0.82 (95% CI: 0.80-0.85) for subjects with the habit of drinking coffee for 1-4 times and more than 5 times per week compared with seldom/non-user, respectively. The habit of drinking coffee more than five times per week was associated with a reduced risk of having MetS with the aOR estimated as 0.79 (95% CI: 0.76-0.82). The habit of drinking coffee for 1-4 times and more than 5 times per week is associated with a reduce risk of CKD with the aORs estimated as 0.89 (95%CI: 0.86-0.93) and 0.84 (95% CI: 0.80-0.88), respectively, compared with seldom/Never drinking coffee. Regarding the comparison of quality-adjusted LEs for subjects with the habit of drinking coffee for 1-6 times and 7+ time per week with subjects without the habit of drinking coffee, the LLG was estimated as 2.18 and 3.59 years, respectively, taking into account the multi-level and multi-factorial evolution of health status. Conclusions By using a longitudinal follow-up study design for four Taiwan communities, my practicum study provides the empirical evidence on the health effects of coffee on life expectancy, colorectal neoplasms, and chronic disease. We further assessed the impact of coffee on the quality-adjusted life history of health status with the consideration of multi-level, multi-factorial factors evolution of health status. Our results affirmed the health benefit of coffee not only in terms of LEs but also in alleviating the threat from colorectal neoplasm and chronic diseases. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/54616 |
DOI: | 10.6342/NTU202002241 |
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顯示於系所單位: | 公共衛生碩士學位學程 |
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