大林住民代謝症候群之流行病學與健康生活型態介入之成效

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Title:	大林住民代謝症候群之流行病學與健康生活型態介入之成效
Other Titles:	Epidemiology of Metabolic Syndrome and the Effectiveness of a Healthy Lifestyle Intervention among Residents in Dalin, Taiwan
Authors:	王聖棻 Wang, Sheng-fen
Contributors:	自然醫學研究所辜美安 Mei-an Gu
Keywords:	代謝症候群;流行病學;公共衛生;健康生活型態介入 epidemiology;public health;lifestyle intervention;metabolic syndrome
Date:	2008
Issue Date:	2015-03-19 15:42:19 (UTC+8)
Abstract:	近年來台灣地區經濟繁榮，醫藥衛生進步，國人零歲平均餘命持續延長，加上出生率下降，台灣人口結構邁向老化。因慢性疾病如代謝症候群與老年人口有著密切的關係，因此有需要了解代謝症候群之流行病學與健康生活型態介入之成效。　　　本研究在探討代謝症候群之流行病學的部分是以2003年7月至2006年10月期間嘉義縣大林地區的住民有參加複合式篩檢者為對象，採用當面發放及回收問卷的方式，配合身體及血液檢查的結果，共收集有效樣本2684人，發現參加篩檢活動者以女性較多1575人（58.7%），平均年齡為59.4歲。符合代謝症候群診斷標準者共922 人（34.4%）。　　　　羅吉斯迴歸分析之結果顯示年齡、教育程度、婚姻狀況、身體質量指數、骨質密度、嚼食檳榔、喝咖啡與代謝症候群呈顯著的關聯。女性的年紀愈大，患上代謝症候群的盛行率愈高，尤其是50歲以後，女性盛行率開始超越男性。教育程度愈高者得代謝症候群的機率愈低，大專及以上者比不識字者得代謝症候群的勝算比為0.57（95%信賴區間=0.43, 0.76）。而已婚者得代謝症候群比未婚、離婚或鰥寡者為低（勝算比＝0.74；95%信賴區間=0.59, 0.94）。在身體質量指數方面，肥胖者有代謝症候群比理想者為多（勝算比＝10.00；95%信賴區間=7.91, 12.67）。腰圍異常者有代謝症候群比正常者為多（勝算比＝9.25；95%信賴區間=7.69, 11.14）。骨質密度異常者有代謝症候群較正常者為多（勝算比＝1.31；95%信賴區間=1.01, 1.71）。生活習慣方面，嚼檳榔者有代謝症候群比較多（勝算比＝1.53；95%信賴區間=1.08, 2.16），但偶而或有喝咖啡者患有代謝症候群則比沒有喝咖啡者為少（勝算比＝0.79；95%信賴區間=0.66, 0.95）。　　　　健康生活型態介入的成效探討採用實驗設計，從參加2005年大林鎮複合式篩檢而有血壓、血糖、血脂其中一項異常者中選取60名研究對象。實驗組進行健康生活型態促進活動，包含疾病認知、運動體能及營養保健之介入。比較實驗組與對照組前測與後測差異值發現腰圍（p<0.001）、舒張壓（p=0.006）、膽固醇（p=0.003）及三酸甘油脂（p=0.041）皆有顯著下降情形，表示健康生活型態促進活動可改善代謝症候群的危險因子。若能降低代謝症候群的發生率及盛行率，則可以減低代謝症候群的併發症，如糖尿病和心血管疾病的危險，同時降低醫療系統的負荷與開支。　　In recent decades, with Taiwan's blooming economy and improvements in medical and public health, the average life expectancy at birth has increased steadily. Along with a decrease in birth rates, Taiwan has reached the threshold of an aging population. Since an aging population is associated with the development of many chronic diseases such as metabolic syndrome, there is a need to study the epidemiology of metabolic syndrome and the effectiveness of using lifestyle intervention to reduce its burden. 　　　　The present study recruited residents in the Dalin Township of the Chiayi County and who participated in the comprehensive health screenings held during the period from July 2003 to October 2006. A total of 2684 subjects who had completed the face-to-face interviews and had data obtained from physical examinations and blood tests were recruited in the study. Of them, 1575 (58.6%) were females with an average age of 59.4 years. A total of 922 participants (34.4%) met the diagnostic criteria for metabolism syndrome.　　　　Results from the logistic regression indicated that age, education level, martial status, body mass index, waist circumference, bone mineral density, habit of betel nut chewing, and coffee drinking were associated with metabolic syndrome. The prevalence of metabolic syndrome in females increased with age and it surpassed that of males, especially in those who were over 50 years old. In addition, higher education level was associated with lower prevalence of metabolic syndrome (odds ratio=0.57; 95% confidence interval=0.43, 0.76). Participants who were married was associated with lower prevalence of metabolic syndrome (odds ratio=0.74; 95% confidence interval=0.59, 0.94). Obesity (odds ratio=10.00; 95% confidence interval=7.91, 12.67) and abnormal waist circumference (odds ratio=9.25; 95% confidence interval=7.69, 11.14) were associated with higher prevalence of metabolic syndrome. Abnormal bone mineral density was associated with higher prevalence of metabolic syndrome (odds ratio=1.31; 95% confidence interval=1.01, 1.71). In terms of lifestyle, betel nut chewing was associated with higher prevalence of metabolic syndrome (odds ratio=1.53; 95% confidence interval=1.08, 2.16). However, coffee drinkers, both regular drinkers and occasional drinkers were associated with lower prevalence of metabolic syndrome (odds ratio=0.79; 95% confidence interval=0.66, 0.95). 　　　　The effectiveness of a lifestyle intervention program called the “Healthy Grocery Store”was evaluated using an experimental study design. Sixty individuals were sampled from those who participated in the screening program held in the Dalin Township during 2005. Participants in the experimental group received lifestyle intervention including dietary modification, exercise, and health education. Results indicated that the changes in waist circumference (p<0.001), diastolic blood pressure (p=0.006), blood cholesterol (p=0.003), and triacylglycerol (p=0.041) were significant in the intervention group compared to the control group. The results suggested that lifestyle intervention program could reduce the risk factors of metabolic syndrome. If the incidence and prevalence of metabolic syndrome can be lowered, the occurrence of illnesses associated with it such as diabetes and cardiovascular diseases can be reduced and in turn, the burden and the cost of the health care system can be lessened.
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