| 摘要: | 背景：肥胖症是個日益嚴重的全球性健康問題，普遍流行於已開發及開發中國家。肥胖衍生的醫療資源開銷以及公共衛生問題，是目前許多研究所探討的議題。在台灣地區，??人肥胖的盛??逐?增加中，肥胖與??病及心血管疾病等多項慢性疾病有高?的相關，本研究目的在探討年齡40歲以上的成年人其身體質量指數與生活型態、疾病史以及死亡原因之相關性。
材料與方法：本研究為一世代追蹤研究。資料來源為中部某醫學中心執行國民健康局成人預防保健健康檢查之民眾，收案期間為民國89年1月1日至12月31日止，共計4225人。研究依國健局之標準，所有受檢者皆填寫問卷，內容含有基本人口學資料、疾病史與健康行為，人體測量數據(身高體重)與血壓使用標準方式測量，空腹血液採集後執行生化分析。將受檢者依年齡分為三組：40-50歲有1657人(39.2%)、51-64歲有1276人(30.3%)及65歲以上有1290人(30.5%)。依BMI定義將受檢者分為肥胖者(BMI≧27)有750人(18%)，非肥胖者(BMI<27) 有3475人(82%)。本研究截至死亡日期為民國98年12月31日止，死亡原因利用國際疾病分類代碼ICD-9做分類，死亡檔取自行政院衛生署。以Cox proportional hazard regression analysis分析死亡率並校正性別年齡與身體質量指數，統計分析利用統計軟體SAS 9.1.3版分析，P值小於0.05定義為統計顯著水準。
結果：肥胖組有高血壓、高膽固醇及糖尿病的比例皆高於非肥胖組(依序分別為29.9% vs. 16.5%；9.6% vs. 5.9%；8.5% vs. 6.1%)；肥胖組罹患高血壓的風險為非肥胖組的2.37倍(95% CI：1.96-2.88)、罹患高膽固醇血症是非肥胖的1.71倍(95% CI：1.29-2.27)、罹患糖尿病是非肥胖組的1.47倍(95% CI：1.09-1.98)，以上都達到統計學上的顯著差異。在受檢者生活習慣也發現，肥胖組嚼食檳榔的習慣(5.8%)顯著高於非肥胖組(3.0%) (P<0.01)，嚼食檳榔習慣的人肥胖的風險是不嚼檳榔者的1.94倍(95% CI：1.33-2.85)。另外，每天喝牛奶的習慣為肥胖組(36.6%)顯著低於非肥胖組(42.7%) (P<0.01)，沒有喝牛奶習慣的人口，肥胖的風險高於有喝牛奶者的1.28倍(95% CI：1.08-1.53)。追蹤十年期間共計354人死亡(8.4%)。BMI分層與死亡原因的分析發現，在全死因的部分BMI<18.5為過輕者，校正年齡性別後，其死亡風險為正常族群的1.56倍(95% CI：1.02-2.40)，其他組別則未達到統計上的顯著。
結論：本研究發現肥胖者有較高的風險罹患高血壓、高膽固醇及糖尿病等疾病，肥胖與嚼食檳榔及沒有每日飲用牛奶的習慣也有顯著的相關；但在身體質量指數與死亡原因之間的關係，除了過輕體重會造成較高風險的全原因死亡率之外，其餘死亡原因與肥胖之間的關係並不顯著，但仍可看出在老年人口中，體重增加與死亡率之間，有略微下降的趨勢。
Background: Obesity is an increasing health issue globally, prevalent in both developed and developing countries, which associated with the medical resources utilization, as well as public health problem. It is the focus of epidemiological researches nowadays. In Taiwan, obesity prevalence increases year by year in older people. Obesity is highly associated with a number of chronic diseases such as diabetes and cardiovascular diseases . The aims of this study were to explore the relation of body mass index and life style with diseases status and causes of death in people aged 40 years and older.
Methods: This was a cohort study. The cohort composed of 4225 subjects recruited from people attending China Medical University Hospital for preventive health services during January to December in 2000. Each participant fulfilled a structured questionnaire, which consisted of sociodemographic data, medical history and health behaviors. Anthropometric data and blood pressure were measured using standard methods. Fasting blood samples were collected for biochemical analysis. Subjects were categorized into 3 age groups: 40-50 years (39.2%), 51 to 64 years (30.3%) and over 65 years (30.5%). Subjects were divided into obese (BMI≧27) and non-obese (BMI<27) groups, accounted for 18% and 82% individual. The ICD-9 code was used to classify the causes of death for analysis. Mortality data was from the Department of Health in Taiwan. Cox proportional hazard regression analysis was used to estimate the HRs of mortality adjusted for age, sex and BMI category These statistical analyses were performed using the PC version of SAS statistical software (SAS 9.1.3). The p-value of less than 0.05 was considered significant.
Results: Our study found that obese group had higher proportion of hypertension, hypercholesterolemia and diabetes mellitus than non-obese group (sequence were 29.9% vs. 16.5%, 9.6% vs. 5.9%, 8.5% vs. 6.1%). Compared to the non-obese group, the odds ratios of having hypertension, hypercholesterolemia and diabetes mellitus for obese group were 2.37 (95% CI: 1.96-2.88), 1.71 (95% CI: 1.29-2.27), 1.47 (95 % CI: 1.09-1.98) respectively. Also we found obese group had higher prevalence of betel nut chewing behavior (5.8%) than of non-obese group (3.0%), which was statistically significant (P <0.01). Compared with non-chewers, the odd ratio of being obese for betel-nut chewers was 1.94 (95% CI: 1.33-2.85). In addition, the habit of drinking milk everyday for the obese group (36.6%) was significantly lower than that for non-obese group (42.7%) (P <0.01). Compared with subjects drinking milk everyday, the odds ratio of being obeses for those who did not drink milk was 1.28 (95% CI: 1.08-1.53). During the 10 years of follow-up, there were 354 deaths (8.4%). After adjusting for age and sex, the underweight group (BMI<18.5) had hazard ratio of 1.56 (95% CI: 1.02-2.40) for all cause mortality than did subjects with normal weight. Other comparison analysis did not reach statistical significant.
Conclusion: Our study confirmed that obese subjects have higher risk to have hypertension, hypercholesterolemia and diabetes. In addition, subjects with habit of betel quid chewing and without habit of drinking milk everyday are tend to be obese. Considering the relation of mortality and body mass index, there exists the association of under weight and a higher all cause mortality rate. The elder subjects with higher body mass index have the trend to decrease mortaliy rate slightly. |
