| 摘要: | 研究背景：目前全球約有15-30％輪班人口，其相較於日班者暴露於更高的心血管疾病、糖尿病、代謝症候群、腸胃道疾病、骨質疏鬆、癌症及心理障礙等風險。輪班者因暴露於夜間工作而改變了飲食行為，其中的飲食行為改變包含了質與量的變化，輪班者的周邊飲食訊號與中央晝夜節律不一致，導致生理時鐘紊亂而可能增加上述疾病風險。過去研究針對輪班者攝食能量及微量營養素攝取量（鈣、鐵、維生素A、維生素B1、維生素C）是否有異於日班者仍無一致結論。研究目的：探討輪班者與日班者攝食能量及微量營養素攝取量之差異。研究方法：本研究為系統性文獻回顧與統合分析，透過8個中、英文資料庫搜尋文獻至2021年09月29日。研究對象為年滿19歲之全職工作者，研究暴露為規則或不規則的輪班工作，對照組為規則日班工作，研究結果包含攝食能量或微量營養素攝取量。使用美國飲食協會初級研究質量標準清單(The American Dietetic Association’s Quality Criteria Checklist for Primary Research)進行文獻品質評估，並使用Comprehensive Meta-Analysis(CMA) version 3.0(CMA 3.0)套裝統計軟體進行統合分析，以隨機效應模式計算Hedges’ g及信賴區間(confidence interval, CI)評定主要成效指標（攝食能量）及次要成效指標（微量營養素攝取量）的效果量，以Cochran Q及I2值評估異質性，再以次群組分析探討異質性來源，以敏感度分析測試研究綜合效果的穩健性，並以漏斗散佈圖、Egger’s test及trim and fill方法評估出版偏差。研究結果：本研究共納入23篇?斷性研究進行統合分析。針對主要成效指標（攝食能量），研究結果顯示輪班者(shift work)與日班者(regular daytime work)的攝食能量(energy intake)無統計上差異，整體效果量為0.082(95% CI: -0.033 - 0.196, p = .161)。次群組分析結果顯示男性輪班者(shift work) 的攝食能量(energy intake)較男性日班者(regular daytime work)高，其整體效果量為0.168(95% CI: 0.092 - 0.243, p < .001)；營養評估工具若使用食物頻率問卷者，則輪班者(shift work) 的攝食能量(energy intake)會較日班者(regular daytime work)高，整體效果量為0.164 (95% CI: 0.019 - 0.308, p = .026)。針對次要成效指標（微量營養素攝取量），輪班者(shift work)與日班者(regular daytime work)的鈣攝取量無統計上差異，整體效果量為-0.107(95% CI: -0.259 - 0.044, p = .166)；日班者(regular daytime work)的鐵攝取量較輪班者(shift work)高，整體效果量為-0.155(95% CI: -0.292 - 0.017, p = .027)，且年齡越大兩組間鐵攝取量的差距越大 (p < .001)；輪班者(shift work)與日班者(regular daytime work)維生素C攝取量無統計上差異，整體效果量為-0.094 (95% CI: -0.202 - 0.014, p = .089)；輪班者(shift work) 的維生素B1攝取量較日班者(regular daytime work)高，整體效果量為0.123(95% CI: 0.041 - 0.206, p = .003)；輪班者(shift work)的維生素A攝取量較日班者(regular daytime work)低，整體效果量為-0.104(95% CI: -0.168 - 0.041, p = .001)。敏感度分析結果顯示鐵及維生素B1攝取量之結果的穩健性有待商榷。漏斗圖(Funnel plot)及Egger’s regression檢定結果顯示本研究不存在出版偏差。結論：輪班者其攝食能量與日班者無顯著差異，然不同性別及不同營養評估工具可能會影響研究結果，建議未來將研究對象之性別及營養評估工具的選擇納入考量。輪班者鐵及維生素A攝取量低於日班者，但維生素B1攝取量輪班者卻高於日班者。
Background: About 15-30% of the global population is shift workers. Shift workers have higher risks of cardiovascular disease, diabetes, metabolic syndrome, gastrointestinal disorders, osteoporosis, cancer, and psychological disorders compared to regular daytime workers. Exposing to shift work may alter dietary behavior and consequently change dietary quality and quantity. The peripheral eating signals of shift workers are not consistent with the central day-night rhythm, resulting in disruptions of the circadian rhythm and hence the above-mentioned diseases. There is no consistent conclusion on whether energy and micronutrient intakes (calcium, iron, vitamin A, vitamin B1, and vitamin C) are different between shift workers and regular daytime workers in previous studies.Objective: To investigate whether there are any differences in energy and micronutrient intakes between shift workers and regular daytime workers.Methods: The study was a systemic review and meta-analysis of observational studies. Two Chinese and six English databases were searched from inception until September 29, 2021. Participants were full-time workers aged 19 years or older who were exposed to regular or irregular shift work, whereas the control group was regular daytime workers. The American Dietetic Association's Quality Criteria Checklist for Primary Research was used to assess the quality of the literature, and a Comprehensive Meta-Analysis version 3.0 (CMA 3.0) suite of statistical software was used to conduct the statistical analysis. Hedges' g and confidence interval (CI) were calculated using a random effects model to summarize the effects for the primary outcome (energy intake) and secondary outcomes (micronutrient intakes). Cochran Q and I2 values were used to assess heterogeneity, and subgroup analysis was conducted to explore the source of heterogeneity. The robustness of the combined effect was tested by sensitivity analysis, and publication bias was assessed by funnel plot, Egger's test, and trim and fill method.Result: In total, 23 cross-sectional studies were included in this study for quantitative analysis. The results showed no statistical difference in energy intake between shift workers and regular daytime workers, with an overall effect size of 0.082 (95% CI: -0.033 - 0.196, p = .161). The results of the subgroup analysis showed that the energy intake of male shift workers was higher than that of male regular daytime workers, with an overall effect size of 0.168 (95% CI: 0.092 - 0.243, p < .001). Among the subgroup of studies using a food frequency questionnaire as the dietary assessment tool, the energy intake of shift workers was higher than that of regular daytime workers, with an overall effect size of 0.164 (95% CI: 0.019 - 0.308, p = .026). There was no statistically significant difference in calcium intake between shift workers and regular daytime workers, with an overall effect size of -0.107 (95% CI: -0.259 - 0.044, p = .166); the iron intake of regular daytime workers was higher than that of shift workers, with an overall effect size of -0.155 (95% CI: -0.292 － -0.017, p = .027). The size of the difference in iron intake between the two groups increased with increasing age (p < .001). There was no statistically significant difference in vitamin C intake between shift workers and regular daytime workers, with an overall effect size of -0.094 (95% CI: -0.202 - 0.014, p = .089). Shift workers had higher vitamin B1 intake than regular daytime workers, with an overall effect size of 0.123 (95% CI: 0.041 - 0.206, p = .003); shift workers had lower vitamin A intake than regular daytime workers, with an overall effect size of -0.104(95% CI: -0.168 - 0.041, p = .001). Sensitivity analyses revealed that the robustness of the effects on iron and Vitamin B1 intakes was questionable. The results of funnel plot and Egger's regression showed that there was no publication bias in this study.Conclusion: There was no significant difference in energy intake between shift workers and regular daytime workers. Of note, different genders and different dietary assessment tools may affect the study results. It is recommended that the gender of the study subjects and the choice of dietary assessment tools be taken into consideration in future studies. Iron and vitamin A intakes were lower in shift workers than in regular daytime workers. Conversely, vitamin B1 intakes were higher in the shift workers than in daytime workers. |
