注意力缺陷過動症與營養狀況及過敏關係之探討

Abstract

研究目的 注意力缺陷過動症是目前兒童最常見的行為異常之疾病，在台灣地區的盛行率約佔10%左右。然而這個領域的主流研究多集中在遺傳、腦部傷害及心理因素等層面；過去雖然有文獻指出某些營養素、飲食因子、或某些與環境因素相關的生理現象可能與注意力缺陷過動症有關，但此類型的研究十分有限，也未以多因子的概念來進行研究。故本研究旨在探討注意力缺陷過動症與這類可導正的環境及生活形態相關因素之關係，以期能增進對致病機制的了解，並應用於疾病防治工作上；主要著重學童的營養狀況、飲食型態及過敏現象的影響。 材料與方法 本研究以病例-對照研究（case-control study）的方法，對大台北地區6-12歲國小學童進行收案，藉由問卷填寫、體位測量、肺功能測量及血液採集等方式，進行學童個人及家庭基本特性、飲食喜好、飲食頻率、營養生化值、過敏現象等資料的收集。 資料的分析首先以t檢定或卡方檢定來分析注意力缺陷過動症與對照組之間基本特性、過敏現象、飲食頻率與營養生化值的差異性，接著以因素分析將營養生化值或飲食型態依相關性的程度歸類為數個因子，最後以多變項分析法在調整可能的相關危險因子，分析過敏現象、營養因子及飲食型態與注意力缺陷過動症之間的關係。 結果 父母親的族群、教育程度、家庭經濟狀況、母親吸煙習慣、母親懷孕初期流產徵兆、學童出生時的黃疸、臍帶脫垂或纏繞頸部、缺氧或發紫等已知傳統危險因子均與注意力缺陷過動症有顯著的相關性。今調整前述可能的相關危險因子後 ，蔬、果、肉、魚、蛋、豆、奶類等高品質食品攝取頻率高或喜好程度強與注意力缺陷過動症呈顯著的負相關，油炸與甜食等低品質食品類的攝取頻率高或喜好程度強則與注意力缺陷過動症呈顯著的正相關。而營養生化指標依因素分析分為五個因素，其中血色素因子、血清素合成相關營養素因子、抗氧化能力及非多元不飽和脂肪酸因子（即高MUFA低SFA因子）與注意力缺陷過動症呈顯著的負相關，而血清中礦物質因子（即高磷低鐵蛋白因子）、n6/n3 PUFA比值及過敏現象則與注意力缺陷過動症呈顯著正相關。若將上述所有與注意力缺陷過動症有顯著相關性的變項均放入同一個模式（model）中，學童的飲食型態、營養狀況及過敏現象與注意力缺陷過動症之間仍具有顯著獨立的相關性。同時，隨著學童擁有過敏現象、不良的營養狀況及飲食型態的個數愈多，注意力缺陷過動症的風險就愈高。 結論 本研究結果顯示學童的營養生化狀況、過敏現象及飲食型態可能與注意力缺陷過動症有顯著的相關性。雖然病例-對照研究無法釐清因果關係，但學童對食物的喜好強度、該項食物的攝取頻率與血液生化值的顯著關係，隱喻飲食、營養與注意力缺陷過動症可能有著密切關係，尚亟待日後前瞻性研究或介入性研究來加以確定其因果性。

Background and Objectives：Attention-deficit/hyperactive disorder (ADHD) is one of the most common neuropsychiatric disorders in children characterized by a triad of symptoms involving age-inappropriate behaviors with attention, impulse control and hyperactivity. It is estimated to affect 3-7% of school-aged children. Most of previous studies focused on the non-modifiable factors on ADHD such as familial-genetic factors, neurotransmitter defects (dopamine, serotonin and noradrenaline genes disorder), pregnancy or delivery complications. Previous studies have linked ADHD and some environment factor (such as nutrient deficiency or allergy status), but they focused mostly on single factor at a time. Our study investigated the relationship between ADHD and children’s nutritional status (eating patterns) and allergy taking into considerations Traditional factors by using a multi-variate approach. Methods：This match case-control study recruited 216 ADHD and 216 age, sex, height and weight-matched control children, aged 6-12 years which complete data. Differences in characteristics between children with ADHD and control were compared using t-test and chi-squared test. Twenty-eight were measured from whole blood or serum specimen, fifteen of which were significantly different between cases and controls by t-test. Using factor analysis, 15 biochemical profiles were grouped into 7 factors. Meanwhile, using factor analysis, the food frequency of 20 food groups was grouped into 5 factors which were used to construct dietary patterns. The association between ADHD and allergy, poor biochemical profile, dietary patterns were assessed by multiple logistic regression after adjusting potential confounding factors. Results：ADHD was negatively associated with hemoglobin status, serotonin and related nutritional factor (folate, B6, B12 and serotonin), non-PUFA factor (high MUFA and low SFA) and antioxidant factor. ADHD was positively associated with mineral factor (a linear combination of high phosphorus and low ferritin), n-6/n-3 ratio, and Allergy. Children with a greater number of malnutrition patterns were more at risk for ADHD. Meanwhile, ADHD was positively associated with unhealthy eating patterns, which included high intake of low-quality foods (e.g. ice, sweets, and fried foods) and low intake of low-quality foods (e.g. vegetables, fruit, meat, fish, eggs, soybean and milk). Children with a greater number of unhealthy eating patterns were more at risk for ADHD. Conclusions：The study has found that ADHD may be in part explained by their allergic conditions and poor nutritional status which maybe associated with their unhealthy eating patterns, implicating that good nutritional status/healthy eating patterns and controlling allergic symptoms are important in mitigating ADHD.