以生物代謝指標及8-OHdG 探討高壓工作族群之飲食及工作/生活型態對健康之影響

Abstract

均衡、多樣化之健康飲食可提供充分且完整的營養素幫助人體正常運作及代謝機制，以消除壓力所導致之自由基累積。然而在高度競爭力及工作負荷之職場環境易產生工作壓力而導致個人心理壓力增加，若再加上生活習慣不正常，例如飲食不均衡、睡眠不足、缺乏運動等，使身體無法獲得足夠休息及修復所需之營養素，易逐漸累積形成慢性疲勞且在體內產生自由基造成氧化壓力傷害，進而導致疾病發生。過去研究指出處於壓力環境之高科技業勞工被認為是造成不良健康效應的高風險族群。為了解高壓工作族群之飲食習慣、體內代謝情形及氧化壓力程度，本研究以職業壓力量表及過勞量表招募篩選國內3家電子零組件製造廠共94位壓力組及30位對照組參與者，採集尿液檢體以確效之極致效能液相層析串聯質譜法 (ultra-performance liquid chromatography-tandem mass spectrometry, UPLC-MS/MS) 分析粒線體能量代謝、維生素B群缺乏、神經傳導物質代謝及腸道菌相分佈等代謝相關之尿液有機酸指標，以及DNA損傷指標8-羥基2'-去氧鳥嘌呤核苷 (8-hydroxy-2'-deoxyguanosine, 8-OHdG)，並採集血液分析脂質過氧化指標丙二醛 (malondialdehyde, MDA)，搭配尿素氮、肌酸酐、尿蛋白、尿糖、膽紅素、白血球等尿液常規指標、結合職業壓力量表、過勞量表及飲食/生活型態問卷，探討工作壓力、飲食與生活型態之關係，找尋可反應身體疲勞情況的代表性尿液指標。 分析參與者之生物檢體檢測數據及問卷資料，初步結果顯示多數壓力組參與者尿中DNA氧化損傷的生物指摽8-OHdG濃度在工作後顯著增加 (p-value < 0.05)，而低壓組的勞工則無顯著變化；尿液有機酸兩項指標與工作壓力呈現顯著相關，分別為神經傳導物代謝產物-香草基扁桃酸 (vanimandelic acid)，可反應交感神經系統的過度活躍，以及腸道菌群失調相關指標-苯乙酸 (phenylacetic acid)，為腸道微生物群的代謝產物。此結果可對未來人體生物監測計畫針對尿液中與人體慢性疲勞相關的生化指標提供參考依據，但仍需要更多研究探討此兩項指標與工作壓力及慢性疲勞間之生化機制。 本研究已成功開發並確校一套可同時定量與疲勞相關的13種尿液有機酸的UPLC-MS/MS分析方法，評估勞工的壓力與體內代謝物的狀況，並綜合參照主客觀資料後，藉由註冊營養師及研究人員對參與者勞工進行健康飲食衛教講座，使參與者了解體內慢性疲勞與氧化壓力之情形，希望經由個人之健康飲食攝取及生活型態的調整，緩解工作、疲勞及壓力所產生之健康影響，以達到早期診斷及飲食、生活習慣的改善，達到預防過勞、過負荷之健康促進目標。

A balanced and diverse healthy diet can provide sufficient nutrients which are essential for body development, maintaining normal function and metabolization. In an occupational environment with highly competitive and intensive productivity request, however, workers may prone to suffer from work pressure and lead to an increase in psychological stress. If combined with lifestyle disorder, such as unbalanced diet, insufficient sleep time and lack of exercise, the body cannot get enough rest and the nutrients needed for repair and gradually accumulate to chronic fatigue. It can be followed by the generation of free radicals in the body, and cause oxidative stress damage, which can lead to disease. To understand the dietary habits, metabolic status and oxidative stress level of the stressful workers, this study recruited 94 participants as the stress group and 30 participants as the control group from 3 domestic electronic component manufacture factories using the Occupational stress scale and Overwork scale. Participant’s urine samples were collected and analyzed by the validated methods using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for quantitating the biomarker of oxidative damage, i.e. 8-hydroxy-2'-deoxyguanosine (8-OHdG), and target urinary organic acids, including the metabolites of tricarboxylic acid in energy metabolism reaction, the indicators of vitamin B deficiency, neurotransmitters and gut bacteria imbalance. Additionally, the comprehensive assessment also combined with the analysis of the lipid peroxidative biomarker, malondialdehyde (MDA), routine urine test including urine glucose, urine protein, urea nitrogen, urinary white blood cells, total-bilirubin and creatinine, and the Occupational stress/ Overwork scales and diet / lifestyle questionnaire. The aims of this study was to investigate the relationship between work stress, diet and lifestyle, and to find the representative urinary biomarkers related to fatigue. Preliminary results indicated the concentrations of urinary 8-OHdG in most of the participants from the stress group revealed a significant increase after work (p-value < 0.05). However, those in the control group revealed no significantly changed. On the other hand, the results of urinary organic acids indicated that two urinary organic acids, i.e. vanimandelic acid (VMA) and phenylacetic acid (PAA), were significantly correlated with work pressure. VMA and PAA are the metabolites of neurotransmitter refers to sympathetic nervous system hyperactivity and gut microbiota associated with intestinal flora disorder, respectively. The results might provide a reference of biochemical indicators in urine related to chronic fatigue for human biomonitoring studies in future. Notably, advanced studies are needed to identify the relationship between these two indicators and work stress. A validated UPLC-MS/MS method for simultaneously quantifying 13 urinary organic acids associated to fatigue was successfully developed. After comprehensively referring to the subjective and objective data, a healthy diet workshop was held by a registered dietitian and researchers, so that participants can learn about the state of chronic fatigue and inflammation. It is expected that through the adjustment of individual healthy diet pattern and life style, the health effects of work, fatigue and stress will be alleviated, so as to achieve early diagnosis and improvement of diet and living habits, and to achieve the health promotion goal of preventing overwork and overload.