| Abstract: | 前言：衰弱是老化過程常見的問題，營養狀況好壞是導致衰弱的重要因素之一。本研究旨在探討飲食因子、飲食情境、生活習慣、體位因素、疾病等，對老年衰弱之影響。
材料與方法：使用「中老年身心社會生活狀況長期追蹤調查」之1999年、2003年、2007年、2011年四次資料進行分析。以減維度迴歸(RRR: Reduced Rank Regression)，區分出與衰弱分數相關之飲食型態，並進一步分析此飲食型態與衰弱之橫斷面相關或對後續衰弱之影響。
結果：RRR分析之結果顯示，與衰弱分數相關之飲食型態，其各飲食項次之factor loading為茶( -0.50)、水果(-0.43)、魚類(-0.40)、肉/禽(-0.35)、海鮮(-0.29)。RRR分數依三分位差區分為低/中/高傾向三組，分析結果顯示調整人口學、飲食情境、體位變項、疾病變項、身體功能障礙與IADL後，1999年高傾向之不健康飲食型態者(T3組)，與當年度1999年、四年後2003年、八年後2007年之衰弱顯著相關，OR分別為OR=2.67、OR=1.72、OR=1.89。1999年沒有衰弱(non-frailty)及已衰弱(frailty)者，1999年高傾向之不健康飲食型態者(T3組)，與四年後2003年之衰弱顯著相關，OR分別為3.06、6.12。1999年食慾好的人，其1999年高傾向之不健康飲食型態者(T3組)與2003年衰弱顯著相關；1999年食慾不好的人，飲食型態者與2003年衰弱無統計顯著相關性。1999年健康膳食模式(dietary pattern, T1組)之特徵為: 女性、年紀較輕、教育程度較高、客家及外省族群、收入較滿意、菸酒及體能活動習慣、飲食足量、食慾佳、不獨自用餐、一年體重未減少3公斤、未因腸胃問題而吃得少、BMI/臂圍/小腿圍/小腿長較高、罹患較少疾病、較佳身體功能、較少失能、及各年度較低之衰弱盛行率。
結論：膳食型態為低茶、低水果、低魚類、低肉/禽類、低海鮮攝取者，較容易衰弱。已有衰弱症狀者比沒有衰弱者，更需注意飲食攝取之品質；食慾好者應注意飲食品質，食慾不好者則應以達到足量飲食攝取為優先。Objectives: Frailty is one of the common problems during the aging process. The quality of nutrition is one of the important factors that may result frailty. This study aims to explore the effects of dietary, lifestyles, anthropometric, and health factors on frailty in the elderly.
Methods: Four waves data in year 1999, 2003, 2007 and 2011 were analyzed from ’Taiwan Longitudinal Study on Aging’. Using Reduced Rank Regression (RRR) to construct frailty-related dietary patterns. Further analyses the cross-sectional and longitudinal effects of dietary pattern on frailty.
Results: Reduced Rank Regression (RRR) shows the frailty-related dietary pattern, their food items and factor loadings are: tea (-0.50), fruit (-0.43), fish (-0.40), meat / poultry (-0.35), seafood (-0.29). The tertile of RRR score categorize dietary pattern as low/medium/high groups. After adjusting demographics, lifestyles, dietary situation, anthropometric, health status, physical impairment, and IADL (Instrumental Activities of Daily Living) disability, unhealthy dietary patterns (T3 group) in year 1999 was highly associated with the frailty in four years later (year 2003) and eight years later (year 2007), OR=1.72, OR=1.89, accordingly. For those non-frailty and pre-frailty subjects, unhealthy dietary patterns (T3 group) in year 1999 was significantly associated with the pre-frailty and frailty in year 2003, OR= 3.06 and OR=6.12, accordingly. In those people with good appetite, unhealthy dietary pattern (T3) in year 1999, were found to be highly associated with the frailty in year 2003; in those people with poor appetite, dietary pattern have no significant effect with frailty in year 2003. Characteristics of the healthy dietary pattern (T1 group) in year 1999 were: female, young age, high-education level, hakka or mainlander, satisfied income, alcohol drinking, taking exercise, having enough food intake, good appetite, not eating alone, no loss of 3 kg in one year, no lower food intake due to gastrointestinal problems, higher BMI/arm circumference/calf circumference/calf length, less disease sufferings, better physical function, less IADL disability, and lower prevalence of frailty in year 1999, 2003, 2007, 2011.
Conclusion: Frailty-related dietary pattern identified as less consuming of tea, fruit, fish, meat/poultry, and seafood. These food items are highly suggested to intake enough. People with good appetite should pay attention to the quality of dietary intake for frailty prevention; but in people with poor appetite, achieve an adequate amount of daily dietary intake is the most important strategy to prevent frailty. |
