生活品質、不良習慣與代謝症候群之關係：以台灣地區全國調查為例

Abstract

背景：代謝症候群的危險因子是糖尿病與心血管疾病預防的重要議題，過去研究大多只將生活型態視為危險因子，生活品質好壞與代謝症候群的關係少有探討。生活品質與已知的危險因子及代謝症候群之間的關係尚不清楚，有待進一步探討。 目的：本研究有兩個目的，分別是探討不良習慣（抽菸或嚼檳榔）在生活品質與代謝症候群之間的中介作用，並且檢驗此中介作用是否因性別而有差異。 設計：本研究採相關性研究設計，使用全國具代表性的兩個資料庫進行二次資料分析。 方法：資料來源為2001年「國民健康訪問調查」、2002年「台灣地區高血壓、高血糖及高血脂盛行率調查」資料庫，代謝症候群的診斷標準是依據國民健康局2007年所修定的版本，生活品質以台灣版的世界衛生組織生活品質量表簡明版進行測量；個案基本屬性和生活型態的資料，由訪員以結構式問卷面對面進行資料收集，包括性別、教育、職業、身高、體重和慢性病；運動、飲食、喝酒、抽菸、嚼檳榔的習慣。所得結果以SPSS17.0統計軟體分析，以描述性統計呈現個案的基本屬性、生活型態、生活品質及代謝症候群的分布情形，再以t檢定、卡方分析、相關分析及多變項邏輯斯回歸分析，檢測生活品質、不良習慣與代謝症候群的關係。 結果：研究結果共有4567位個案納入分析，男性2,201人（48.2％）女性2,366人（51.8％），代謝症候群盛行率為15％，雙變項分析時，男性、年齡大者、身體質量指數大者、低社經地位者、有慢性病者、有喝酒者、有不良習慣者，代謝症候群盛行率較高，而運動與飲食與代謝症候群無關，在控制性別、年齡、身體質量指數、社經地位、喝酒習慣後，不良習慣在生活品質總分與代謝症候群之間具有中介作用，而且此關係在生理、心理、社會及環境四個範疇的生活品質也都存在。生活品質總分、心理範疇和環境範疇的生活品質與代謝症候群有顯著負相關，生活品質總分、心理範疇和環境範疇的生活品質對代謝症候群有直接作用，同時也透過不良習慣有間接作用，生理範疇和社會範疇的生活品質對代謝症候群沒有直接作用，但會透過不良習慣有間接作用。沒有慢性病者，不良習慣在生活品質與代謝症候群之間具有中介作用，但有慢性病者，此中介作用不存在。性別對於不良習慣於生活品質總分與代謝症候群之間，並無調節式中介作用，而且此調節式中介作用的關係在生理、心理、社會及環境四個範疇的生活品質也都不存在，可見性別並非是此中介作用的調節因子。 結論與建議：不良習慣在生活品質與代謝症候群之間具有中介作用，性別對此中介關係不具調節作用。未來研究可針對低生活品質者，探討提升生活品質及預防或戒除不良習慣的方法，以及介入措施對預防代謝症候群的成效。

Background: The risk factors of metabolic syndrome are an important issue in the prevention of diabetes mellitus and cardiovascular disease. Most previous studies have only focused on lifestyle habits, regarding them as risk factors. Little research has been done to examine whether better or poor quality of life (QOL) is associated with metabolic syndrome. The relationship between QOL, known risk factors, and metabolic syndrome remains unclear. Objectives: This study had two purposes: (1) to explore the mediating effect of unhealthy habits—namely, cigarette smoking or betel-nut chewing—on the relationship between QOL and metabolic syndrome; and (2) to examine how gender moderates the mediating effect of unhealthy habits. Design: The research design was a correlational study. Secondary analysis was conducted using two nationally representative datasets. Method: The data was derived from the 2001 Taiwan National Health Interview Survey and the 2002 Taiwanese Survey on Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia. Metabolic syndrome was diagnosed according to the revised standard of the Bureau of Health Promotion, Department of Health, Taiwan, ROC (2007). QOL was measured according to the Taiwanese version of the WHOQOL-BREF. Demographic and lifestyle data were collected via face-to-face interviews using a structured questionnaire. Questions were related to gender, age, education level, occupation, body height, body weight, chronic disease, exercise habits, diet, alcohol consumption, cigarette smoking, and betel-nut chewing. Data were analyzed using SPSS 17.0 statistical software. We used descriptive statistics to characterize the demographic data, lifestyle, QOL, and prevalence of metabolic syndrome. Data analysis was performed using t-tests, chi-square tests, Pearson correlation coefficients, and multivariate logistic regression to assess the association between QOL, unhealthy habits, and metabolic syndrome. Results: A total of 4,567 subjects were included in the analyses. The data from 2,201 (48.2%) males and 2,366 (51.8%) females from Taiwan were analyzed. The prevalence of metabolic syndrome was 15%. Bivariate analysis showed that male gender, age, higher body mass index, lower socioeconomic status, with chronic disease, alcohol consumption, and unhealthy habits were associated with higher prevalence of metabolic syndrome. In contrast, exercise and diet habits were not associated with metabolic syndrome. After adjustment for controlled variables, including gender, age, body mass index, education, occupation, regular exercise, high-fat diet, and alcohol consumption, unhealthy habits was found to have a mediating effect on the relationship between the total QOL score and metabolic syndrome. This association was observed for the physical, psychological, social, and environmental domains of QOL. Furthermore, the total QOL score and the psychological and environmental domains of QOL had a negative association with the prevalence of metabolic syndrome. These however, had a direct effect on prevalence of metabolic syndrome, and had an indirect effect via unhealthy habits. The physical and environmental domains of QOL did not have a direct effect on prevalence of metabolic syndrome, but had an indirect effect via unhealthy habits. Unhealthy habits were found to have a mediating effect on the relationship between QOL and metabolic syndrome in subjects without chronic disease, but not in subjects with chronic disease. The mediating effect of unhealthy habits on the relationship between total QOL score and metabolic syndrome was not moderated by gender. A moderated mediation model did not fit the physical, psychological, social, and environmental domains of QOL. Therefore, gender was not a moderator of the mediating effect of unhealthy habits. Conclusions and suggestion: Unhealthy habits had a mediating effect on the relationship between QOL and metabolic syndrome, and this mediating effect was not moderated by gender. Further studies may target subjects with lower QOL to develop strategies for promoting QOL and preventing or discontinuing unhealthy habits, and to explore the effects of such interventions for preventing metabolic syndrome.