使用國民營養健康調查資料庫之資料探討兒童及青少年異位性皮膚炎之相關飲食因子

Abstract

本研究使用衛生福利部國民健康署委託辦理之國民營養健康調查資料，報告內容不代表衛生福利部國民健康署意見。科技計畫編號MOHW112-HPA-H-113-134711。 研究目的： 造成得到異位性皮膚炎風險增加的因素來自於遺傳、環境、生活型態等，在諸多因素中，飲食與生活型態是可以自我調整的風險因子，因此本研究目的在探討飲食營養相關因子與異位性皮膚炎之關聯性，以期許能提供公共衛生營養政策訂定之參考。 材料方法： 使用2013年至2020年的國民營養健康調查資料進行分析。研究樣本包括7至12歲的2864位參與者，以及13至18歲的2373位參與者，其中前者包含252位自述有異位性皮膚炎之患者，後者有188位自述患者。調查使用半定量飲食頻率問卷以及24小時飲食回顧評估個人飲食營養狀況，並使用血液和尿液檢體測量各種營養素生化指標。使用邏輯式迴歸分析探討上一個月各種食物項目攝食頻率、由24小時飲食回顧資料導出之飲食發炎指數（Dietary inflammation index, DII），以及營養生化指標與異位性皮膚炎之間的相關性。 結果： 首先，本研究發現有食物過敏史者其自述罹患異位性皮膚炎之比例較高。飲食營養方面，在7至12歲飲食中，與異位性皮膚炎勝算比增加的相關特定食物包括全穀飯類、蛋類、起司、新鮮水果、果醬、糖果和巧克力、點心甜湯。在13至18歲中，與異位性皮膚炎勝算比增加相關的特定食物包括全穀麵包類、優格、起司、新鮮水果、冰品。然而，在這兩個年齡當中，只有少部分生化指標與異位性皮膚炎之間有顯著關聯性，且兩個年齡層結果並不一致。7-12歲中，血中的硒濃度、25(OH)D濃度和鎂離子濃度顯著在有異位性皮膚炎的人群當中較低；13-18歲中，血中的維生素B2濃度顯著在有異位性皮膚炎的人群當中較低。24-小時飲食回顧法所得營養素分析顯示，7-12歲組之異位性皮膚炎患者熱量攝取較多，校正熱量後僅有維生素B1攝取較低；13-18歲組並無熱量之差異，校正熱量後之營養素攝取量比較顯示異位性皮膚炎患者之膳食纖維、維生素C、鉀攝取較高；跨年齡層並無一致現象。此外，在13-18歲中發現隨著DII分數的增加，對於異位性皮膚炎的勝算比反而是降低，但7-12歲並無此發現。 結論： 我們觀察到特定食物的飲食頻率與異位性皮膚炎之間存在顯著的相關性，包括全穀米、起司／優格、蛋類以及水果在內的各種甜食和甜飲品。隨著這些特定食物的飲食頻率增加，異位性皮膚炎的勝算比也相應增加。營養生化和營養素攝取量之分析未有一致性之結果。顯示在台灣對特殊食物以及甜食之不良反應在異位性皮膚炎病因上的重要性似乎遠大於營養素充足與否的影響。

Background & purpose: Many factors may increase the risk of developing atopic dermatitis, such as genetic, environmental, and dietary factors. Dietary factors are modifiable to reduce the risk of developing such condition. We intended to carry out an analytical epidemiological study to investigate the association between atopic dermatitis and dietary factors. We set out to understand of the roles of diet and nutrition on atopic dermatitis and to contribute to atopic dermatitis (AD) prevention and management. Material and method: The data used in the present study was from the Nutrition and Health Survey in Taiwan (2013–2020), including 2,864 participants aged between 7 and 12 years old (252 participants with AD), and 2,373 participants aged between 13 and 18 years old (188 participants with AD). Dietary and nutritional status have been assessed by semi-quantitative food frequency questionnaire, 24-hour recall, and nutritional biochemistry. Logistic regression analysis was performed to examine the association between food frequency, dietary inflammation scores derived from the 24-h recall data, and nutritional biochemistry markers with atopic dermatitis. Results: Self-reported history of food allergy associated with a higher ratio of atopic dermatitis in this analysis. Several food groups were associated with an increased odds ratio of atopic dermatitis in the 7-12 age group, including whole-grain rice, eggs, cheese/yogurt, fresh fruits, 100% juice, candies and chocolates, and pudding. Similarly, in the 13-18 age group, foods positively associated with an increased odds ratio of atopic dermatitis included whole grain bread, yogurt, cheese, fresh fruits, and ice cream. Serum level of selenium, 25(OH)D, and magnesium were significantly lower in 7-12 years old who had atopic dermatitis; serum of vitamin B2 concentration was significantly lower in 13-18 years old juniors with atopic dermatitis compared with the control group. The nutritional analysis from the 24-hour dietary recall data revealed that patients with atopic dermatitis had higher calorie intake among the 7-12 age group. After caloric adjustment, only vitamin B1 intake was lower. There was no difference in calorie intake in the 13-18 age group. Still, after caloric adjustment, nutritional intake comparison indicated higher dietary fiber, vitamin C, and potassium intake in patients with atopic dermatitis. However, there was no consistent pattern observed across the two age groups. Furthermore, in the 13-18 age group we found that the higher the DII scores, the lower odds ratio of atopic dermatitis. This phenomenon was not seen in the 7-12 years old. Conclusion: We observed a significant correlation between consumption frequency of specific foods and the odds ratio of atopic dermatitis, including whole grain rice, cheese/yogurt, and high sugar foods and drinks. As the frequency of consumption of these specific foods increased, the odds ratio of atopic dermatitis also increased. The analysis of nutritional biochemistry and nutrient intake did not yield consistent results. These findings highlight that the mportance of adverse response to certain foods may outweigh that of nutritional status in the etiology of atopic dermatitis in Taiwan.