飲食型態與心臟血管疾病前瞻性流行病學研究

Abstract

摘要 研究背景與目的： 心臟血管代謝相關疾病(cardiometabolic disease)在台灣之發生率、盛行率、死亡率都相當的高，這些相關疾病都與胰島素阻抗性息息相關。探討飲食營養與這些疾病之關係與了解其發展過程是非常重要的，過去的研究大多分開探討單一營養素與胰島素阻抗性的關係，本研究的目的是找尋反應數個與胰島素阻抗性相關營養素狀態的飲食因素以及探討這些飲食因素與心臟血管代謝疾病的關係。 材料與方法： 採用「竹東及朴子地區心臟血管疾病長期追蹤研究」第二循環之內容、臨床生化檢驗數據、病歷診斷以及健保死亡資料，並利用飲食頻率問卷統整後的資料以纖維、鎂、維生素C、升糖指數與升糖負荷等五項飲食營養指標之集合納入減維度迴歸分析(reduced rank regression)，得到兩種飲食主要因素，然後分別探討這些因素與代謝症候群、第Ⅱ型糖尿病、高血壓、缺血性中風發生關係。 結果： 透過減維度迴歸歸納出兩個較主要之飲食因素分別為：「多蔬果少米飯」因素以及「多醣少油少海菜」因素，個別解釋了近50%及20%之飲食變異度。在橫斷面研究中，「多蔬果少米飯」因素與腰圍呈現負相關(P=0.02)，而「多醣少油少海帶」因素與腰圍(P<0.001)、空腹血糖(P=0.03)、空腹三酸甘油酯(P=0.02)與血壓(P<0.001)呈正相關。數個前瞻性研究發現，「多蔬果少米飯」對代謝症候群(Ptrend=0.02)、第Ⅱ型糖尿病(Ptrend=0.03)、高血壓(Ptrend=0.01)、缺血性中風(Ptrend<0.001)提供保護作用，顯著減少發生的風險；「多醣少油少海帶」僅會增加罹患高血壓之風險(Ptrend<0.001)，與其他心臟代謝疾病無顯著關係。 結論： 隨著攝取情形越符合多蔬果少米飯飲食因素，可發現醣類佔總熱量比例明顯降低而脂質與蛋白質則是增加，其中不同種類、顏色之蔬果佔總醣類比例則是大幅攀升(從15%攀升至23%)，經本研究證實此食物組合不但能減少未來罹患代謝症候群之可能性，也能減輕第Ⅱ型糖尿病、高血壓及缺血型中風之發生風險；多醣少油少海帶這飲食因素中，看到蔬果攝取量伴隨主食類增加而增加，同時蛋白質佔總熱量之比例是減少的，若長期處於這樣飲食習慣下將提高罹患高血壓的可能性。

Abstract Background The prevalence of cardiometabolic disease which is high correlation with insulin resistance is an increasing healthy problem in Taiwan. The importance of the role of diet cannot be overemphasized because of the relation to cardiometabolic disease.Many previous studies have focused on insulin resistance and individual nutrient. However, people do not eat isolated nutrients, but a variety of foods with complex combinations of nutrients. In this context, the aim of this study was to identify a dietary pattern associated with insulin resistance and investigate whether patterns were prospectively associated with cardiometabolic disease. Methods Analysis was based on 6,316 participants of the CVDFACTS study. Dietary intake was measured using a unique 64-item food frequency questionnaire. We used the reduced rank regression(RRR) method to determine dietary patterns using several nutrients which are associated with insulin resistance as the intermediate or response variable. The association between the dietary pattern identified and incidence of cardiometabolic disease was investigated using Cox proportional hazard regression models. Results We identified two dietary factors extracted by RRR explained 68.1% of response variation, which were labeled 「vegetable-, fruit-rich and rice-poor diet」 and「carbohydrate-rich and fat-, seaweed-poor diet」.In this cross sectional study, we found 「vegetable-, fruit-rich and rice-poor diet」 is negative associated with waist circumference(P=0.02), 「carbohydrate-rich and fat-, seaweed-poor diet」 is positive associated with waist circumference、fasting glucose、triglyceride and blood pressure.(P <0.001, P=0.03, P=0.02, P<0.001).After adjustment for all confounders, higher vegetable-, fruit-rich and rice-poor dietary pattern scores were associated with decreased risk of type 2 diabetes , hypertension , ischemic stroke(hazard ratio for top quartile 0.53 [95% CI 0.33-0.84], 0.58 [95% CI 0.40-0.84], 0.44 [95% CI 0.27-0.71])；higher carbohydrate-rich and fat-, seaweed-poor dietary pattern scores were only associated with increased risk of hypertension(hazard ratio for top quartile 2.00 [95% CI 1.39-2.86]). Conclusion Eating plenty of colorful fruit and vegetables with moderate rice intake may reduce the risk of type 2 diabetes , hypertension , ischemic stroke. High consumption of refined carbohydrate with decrease fat and seaweed food intake may increase the risk of hypertension in the future.