| 摘要: | 心臟血管疾病（cardiovascular disease, CVD）是國人主要死亡原因之一。糖尿病、血液透析治療（hemodialysis, HD）患者為CVD的高風險族群。飲食為影響CVD的重要因子，良好評量指標（dietary index）是為評估飲食型態的簡易工具。因此，本研究目的為探討飲食指標對於糖尿病及HD患者之CVD風險因子影響。研究分為二階段，第一階段為評估以2011年每日飲食指南更新台灣版替代健康飲食評量（Alternate Healthy Eating Index-Taiwan, AHEI-T）簡稱為AHEI-T 2011之效度，並與2010年版之替代健康飲食評量指標（Alternate Healthy Eating Index -2010, AHEI-2010）、美國糖尿病學會評量分數（American Diabetes Association dietary score, ADA dietary score）等比較其與營養素及CVD風險因子之相關性。研究結果得：124名未合併有糖尿病腎病變或慢性腎臟病的第2型糖尿病受試者之中，與AHEI-T相較之下，AHEI-T 2011及ADA dietary score有更多營養素及CVD風險因子呈顯著負相關性，其中風險因子包括中央型肥胖、高血糖、收縮壓、血清低密度脂蛋白膽固醇濃度、預測未來10年冠狀動脈心臟病風險皆呈負相關（p < 0.05）。接著以AHEI-T 2011套用於HD患者，結果得AHEI-T 2011與HD患者之CVD風險相關性不佳，因此第二階段研究依據美國腎臟基金會提出的飲食建議修改AHEI-T 2011為透析飲食評量指標（hemodialyisis dietary index,HDEI），結果得：HDEI與營養素之間為顯著正相關，並且與營養不良及高血糖風險呈顯著負相關性，但是與收縮壓並無顯著相關性。推測可能是因為HDEI鼓勵HD患者多攝取紅肉，但是未能區分新鮮紅肉或加工肉品，加工肉品為高鈉含量食物。因此研究繼續把紅肉分成新鮮紅肉與加工肉品分開討論，結果得：104名長期HD患者每增加1份加工肉品攝取量，顯著增加收縮壓大於140 mmHg（odds ratio為2.51，95%信賴區間介於1.15及5.47之間，p < 0.05）及舒張壓大於90 mmHg風險（odds ratio為2.10，95%信賴區間介於1.03及4.30之間，p < 0.05）；但若是改以1份未加工紅肉取代等量蛋白質含量之加工肉品，則收縮壓大於140 mmHg之風險顯著降低（p < 0.05）。表示新鮮紅肉及加工肉品對於血壓的影響呈相反結果，所以HDEI其中紅肉攝取量部份應區分為新鮮紅肉及加工肉。綜合上論，飲食評量指標需要根據最新的飲食指南及考量影響CVD飲食因子，以加強與糖尿病或HD患者之CVD風險因子之負相關性。
Cardiovascular disease (CVD) is the leading cause of death in Taiwan. Patients with diabetes or chronic kidney disease receiving hemodialysis treatment are the higher CVD risk populations. Diet is one of the major risk factos of CVD. A good dietary index is the easy tool to evaluate the dietary pattern. Therefore, this study tried to establish a dietary index for reducing the CVD risk factors in diabetes and hemodialysis patients in Taiwan. At first, in type 2 diabetes patients, we modified the Alternate Healthy Eating Index-Taiwan (AHEI-T) according to Daily Food Guide for Taiwanese in 2011 to AHEI-T 2011. Comparing with AHEI-T, AHEI-T 2011and American Diabetes Association dietary index were higher correlated with the CVD risk factors and nutrients. The CVD risk factors included central obesity, hyperglycemia, systolic blood pressure, low-density-lipoprotein cholesterol, and 10 year risks for coronary artery disease (p < 0.05). A poor association between AHEI-T 2011 and CVD risk factors in hemodialysis patients, we developed the hemodialysis eating index (HDEI) according to the recommendation from Nation Kidney Foundation and AHEI-T 2011. However, HDEI does not associate with systolic blood pressure because of HDEI score might encourage HD subjects’ eating more red meat, and the red meat included fresh red meat and processed meat. Consequently, to evaluate the association between fresh red meat and processed meat protein foods and hypertension seperately. Each increasing 1 serving of process meat is associated with higher risk of systolic blood pressure ≥ 140 mmHg (p < 0.05). Substituting 1 serving of process meat with equal protein of fresh red meat and the risk of systolic blood pressure ≥ 140 mmHg were significantly reduced. In conclusion, dietary index need to monitor the change daily food guide to reflect dietary pattern and to reduce CVD risk factors in DM and HD subjects. |
