飲食與呼吸道疾病之相關性：以台灣孩童健康研究為例

Abstract

背景： 行政院環保署氣喘照護手冊，1974年，台北巿學童氣喘病罹病率為 1.30%， 1985年增為5.08%，1991年為5.80%，而1994年更增加到10.79%。二十年間增加8倍以上。危險因子包括了工業化所帶來的環境污染、居家環境、空調系統、黴菌、二手菸、飲食習慣的改變和崇尚高熱量、高蛋白和高脂肪、母奶哺育減少等。氣喘如果沒有獲得適當的治療將會影響到患者的生活品質，例如：睡眠、運動、等，更嚴重甚至造成死亡。 方法： 從2010年開始以台灣孩童健康研究 (Taiwan Children Health Study) 為收案來源，研究對象為台灣14個鄉鎮的國小四年級的孩童為收案對象，請他們填寫孩童健康研究問卷，內容包括基本人口學、飲食頻率問卷、呼吸道疾病評估問卷等。結果共有2397位孩童納入分析研究。 結果： 各類食物進食天數的部份，蔬菜類、水果類、奶類、乳酸飲料、豆魚肉蛋類、五穀根莖類、零食速食類在有無喘鳴及有無氣喘之間沒有顯著差異；水果類、奶類、豆魚肉蛋類有過敏性鼻炎的孩童攝取天數高於沒有過敏性鼻炎的孩童，統計上達到顯著差異（P＜0.05），其他蔬菜類、乳酸飲料、五穀根莖類、零食速食類的進食天數在有無過敏性鼻炎上並沒有差異；奶類在有支氣管炎的孩童平均攝取天數高於無支氣管炎的孩童，統計上達到顯著差異（P＜0.05），其他蔬菜類、水果類、乳酸飲料、豆魚肉蛋類、五穀根莖類、零食速食類的進食天數在有無支氣管炎上並沒有差異。 藉由因素分析（factor analysis）將飲食型態分為兩類，屬於”高蛋白高脂肪及西方飲食型態”的孩童在對於過敏性鼻炎(OR=1.10, CI=1.01-1.20)具有較高危險性，在統計上達顯著差異。而”健康飲食型態”的孩童對於過敏性鼻炎(OR=1.13, CI=1.04-1.24)具有較高危險性，但在其他疾病喘鳴、氣喘、支氣管炎的勝算比均低於”高蛋白高脂肪及西方飲食型態”的孩童。 而減維排序回歸（reduced rank regresion）分析7類食物，結果飲食型態為”高蛋白高脂肪飲食型態”的孩童會增加其過敏性鼻炎(OR=1.17, CI=1.07-1.27) 、喘鳴(OR=1.22, CI=1.03-1.45)，及支氣管炎(OR=1.26, CI=1.09-1.45)的危險性，另外在氣喘方面其勝算比沒有達到顯著差異(OR=1.07, CI=0.94-1.22)。 結論： 在此橫斷研究中，飲食型態趨向於”高蛋白高脂肪飲食型態”的孩童具有較高的危險性得到過敏性鼻炎、喘鳴及支氣管炎，因此飲食中的蛋白質和脂肪會增加罹患呼吸道疾病之危險性，所以修正孩童飲食型態可能有助於減少得到疾病的風險。

Background According to the Asthma care handbook published by Environmental Protection Administration of Executive Yuan, R.O.C, Taiwan, the incidence rate of asthma in children who lived in Taipei city had increased from 1.3％ to 5.08％ from 1974 to 1985. From 1991 to 1994, the incidence rate of asthma in children who lived in Taipei city increased from 5.8％ to 10.79%. The incidence rate increased eight times over two decades. Risk factors for asthma include environmental pollution by industrialization, air pollutant, changes in household environment, excessive air conditioning, second hand smoke, mold, decrease breast feeding and preference for high fat, high protein and high calorie diet. If asthma is not being managed properly, it could affect patient’s quality of life, such as sleep quality, ability to exercise etc. In the worst case scenario, asthma could lead to death of patient. Method The Taiwan Children Health Study is an ongoing cohort study which investigates influences between environmental factors, respiratory diseases in children and dietary patterns. Data from 2397 fourth-grader was collected from fourteen Taiwanese communities in 2010 for this cohort study. Subjects were asked to complete a questionnaire containing information on demographic data, life style, environmental and household exposure, respiratory disease, and diet frequency. Result Children without allergic rhinitis had a lower weekly frequency of intake of fruits (3.59 vs 3.90 days), dairy products ( 1.75 vs 1.96 days), meat ( 1.94 vs 2.11 days) than allergic rhinitis groups. Food intake frequency showed no significant difference between asthma group and non- asthmatic group; the same result is noted in current-wheeze group and current-wheeze free group. Also, children without bronchitis had a lower weekly intake of dairy products (1.79 vs 2.09 days) than bronchitis group. The Odds ratios between respiratory disease and diet pattern in TCHS2 evaluated by factor analysis are listed as below. Children with “High protein/ high fat/ western diet” had high risk in allergic rhinitis (OR=1.10, CI=1.01-1.20) and p for trend is significant. However, the “Healthy diet” group were only at high risk for allergic rhinitis (OR=1.13, CI=1.04-1.24). Lower odds ratio in current wheeze, ever asthma and bronchitis is noted than the “High protein/ high fat/ western diet” group. Then Odds ratios between respiratory disease and dietary pattern from 7 groups of food in TCHS2 analyzed by reduced rank regression are listed as followed. Children with “High protein/high fat diet” had high risk in allergic rhinitis (OR=1.17, CI=1.07-1.27), current wheeze (OR=1.22, CI=1.03-1.45), bronchitis (OR=1.26, CI=1.09-1.45) and p for trend is significant. However, it is not significant in ever asthma (OR=1.07, CI=0.94-1.22). Conclusion In this cross-section study, we studied dietary pattern and risk for respiratory disease in ten-year-old children in Taiwan. Our study concluded that “High protein/ high fat diet” was positively associated with increased risk of current wheeze and allergic rhinitis. These results indicate that a diet rich in fat and protein may increase risk for respiratory disease in children. Therefore, we can modify children’s dietary habits to reduce risk of respiratory disease.