魚類是良好的蛋白質來源，同時也是n-3多元不飽和脂肪酸主要來源。美國心臟協會建議每週至少攝取2份魚類，可以降低心血管疾病的發生。魚類攝取與第2型糖尿病目前研究結果不一致，歐美國家研究發現吃魚會增加第2型糖尿病發生的風險，然而中國與新加坡研究則發現吃魚有助於預防第2糖尿病發生。本研究使用世代研究，探討30-64歲成人及65歲以上老人魚類攝取與第2型糖尿病、心血管疾病與全死因之相關。以「1993-1996國民營養健康狀況變遷調查」之30-64歲成人及「1999-2000年臺灣地區老人營養健康狀況調查」之65歲以上老人為研究對象，連結「健保資料庫」及「全國死亡登記檔」，以獲取研究對象罹患第2型糖尿病、心血管疾病與死亡情形。資料以SUDAAN進行加權並調整抽樣效應，並以Cox比例風險迴歸分析。將研究對象魚類攝取情況分成四組，分別為：不吃、每週攝取至多2次、每週攝取2-4次及每週至少攝取四次，結果發現，不論30-64歲成人或是65歲以上老人，女性、年齡較長、客家或閩南、山地層、教育程度較低、未婚者，未攝取魚類比例較高；飲食品質分數隨著魚類攝取越多分數越高。校正可能之干擾因素時，魚類攝取與第2型糖尿病、心血管疾病與全死因，30-64歲成人，魚類攝取只在降低全死因有顯著意義。魚類攝取最高組 (每週攝取至少4次以上) 之全死因死亡風險，比起參考組 (每週攝取至多2次) 降低20%死亡風險 (95% CI: 0.66-0.97)。敏感度分析，刪除追蹤一年內死亡者，風險下降更大，達26% (95% CI: 0.60-0.90)；將男女分層分析，只在女性有顯著降低死亡風險。65歲以上老人，魚類攝取只在降低第2型糖尿病發生率有顯著意義，刪除追蹤一年內罹病者，並校正可能之干擾因素，魚類攝取最高組罹患第2型糖尿病風險，比起參考組降低42%罹病風險 (95% CI: 0.37-0.93)。進一步將男女分層分析後，發現魚類攝取僅在女性能降低第2型糖尿病發生風險。對臺灣地區成人而言，每週至少食用魚類四次，有助於降低全死因死亡率；對於老人，則有預防罹患第2型糖尿病發生風險。

Fish is a good source of protein, but also a major source of n-3 polyunsaturated fatty acids. The American Heart Association recommends at least weekly intake of 2 servings of fish to reduce cardiovascular disease incidence. Results of the relationship between fish intake and type 2 diabetes are inconsistent. Studeis of Europe and America found that fish intake increase the risk of type 2 diabetes, however, studies of China and Singapore found that fish intake may prevent type 2 diabetes incidentce. This thesis used a cohort study design to explore the associations of fish intake and that type 2 diabetes, cardiovascular disease incidences, mortality and all-cause mortality in adults (30-64 years), and the aged (65 years of age or older). Data for analyses were obtained from the 1993-1996 National Nutrition and Health Survey in Taiwan for adults and from the 1999-2000 National Nutrition and Health Survey in Taiwan for the older adults. These data have been linked to the National Health Insurance database and national death registration to obtain information of participants’ disease incidence and cause of death. Data were weighted and adjusted by SUDAAN to consider the survey deisng effect on sampling. The relative riks of fish intake on the study outcomes were assessed by using Cox proportional-hazards regression analysis. Participants’ fish intake frequencyes were classified into four groups, namely: do not eat, up to twice a week, 2-4 times a week and at least four times a week. Results showed that , regardless age, women, the aged, live in Hakka or mountainous areas, less educated, unmarried who ate less frequent fish. Those who ate more fish, those whose dietary diversity scores (DDS) were higher. Adjust for possible confounding factors, fish intake frequency can reduce the risks of type 2 diabetes, cardiovascular disease and all-cause mortality in adults aged 30-64 years. Compared to the reference group (intake up to twice a week), the risk of death of the highest fish intake group (intake of at least 4 times a week) was 20% significantly lowere (95% CI: 0.66-0.97). In the sensitivity analyses, excluded those who died within a year after follow-up, the risk of death was even lower 26% (95% CI : 0.60-0.90). Stratified analyses by gender, only women have significantly lower risk of death for fish intake. For the older adults, fish intake can significantly reduce the risk of type 2 diabetes incidence. Excluded those who died within a year of follow-up and adjused possible confounders, the highest fish intake group had a 42% (95% CI: 0.37-0.93) lower risk of type 2 diabetes incidence, compared to the reference group. Stratified analyses by gender, the protective effect on type 2 diabetes incidence was only found in women. In conlusion, we found that adults ate fish at least four times a week were at lower risk of all-cause mortality; for the older adults, higher frequency fish intake can lower the risk of type 2 diabetes incidence.

正文 І
表目錄 III
圖目錄 V
中文摘要 VI
Abstract VIII
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 糖尿病的定義與危險因子 4
第二節 魚類攝取與疾病之相關 8
壹、心血管疾病 8
貳、癌症 9
參、骨密度 9
肆、失智症 10
伍、發炎 10
陸、代謝症候群 10
柒、憂鬱 11
第三節 東、西方國家魚類與糖尿病之研究 12
壹、西方國家 12
貳、東方國家 13
參、臨床試驗 14
第四節魚類與糖尿病可能之原因 15
壹、降低罹患風險之機轉 15
貳、增加風險之因素 17
第三章 研究問題 19
第四章 研究材料與方法 20
第一節 研究架構 20
第二節 研究對象 21
壹、1993-1996年國民營養健康狀況變遷調查 21
貳、1999-2000年臺灣地區老人營養狀況變遷調查 21
第三節 研究工具 23
壹、基本資料 23
貳、飲食資料 23
參、體檢資料 23
肆、串聯兩次營養調查與疾病發生之檔案 24
伍、死亡 26
第四節 研究對象納入流程 27
壹、糖尿病 27
貳、心血管疾病 27
參、全死因 28
第五節 統計方法 35
第五章 結果 36
第一節 魚類攝取頻率之影響因素 36
壹、1993-1996年國民營養狀況變遷調查 36
貳、1999-2000年老人營養狀況變遷調查 38
第二節 魚類攝取頻率及飲食內容 41
壹、1993-1996年國民營養狀況變遷調查 41
貳、1999-2000年老人營養狀況變遷調查 42
第三節 魚類攝取頻率及血液生化值 43
壹、1993-1996年國民營養狀況變遷調查 43
貳、1999-2000年老人營養狀況變遷調查 43
第四節 魚類攝取頻率及糖尿病與心血管疾病相關 44
壹、1993-1996年國民營養狀況變遷調查 44
貳、1999-2000年老人營養狀況變遷調查 45
第五節 魚類攝取頻率及死亡率相關 47
壹、1993-1996年國民營養狀況變遷調查 47
貳、1999-2000年老人營養狀況變遷調查 47
第六章 討論 48
第一節 影響魚類攝取與第2型糖尿病與全死因之因素 48
壹、性別及年齡 48
貳、氏族及地區層別 48
參、體位測量 49
肆、生活型態 49
伍、疾病史 50
第二節魚類攝取與第2型糖尿病及心血管疾病 52
壹、糖尿病 52
貳、心血管疾病 54
第三節魚類攝取與全死因死亡率 56
第四節研究優點與限制 58
壹、優點 58
貳、限制 58
第七章 結論 59
第八章 文獻探討 61

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