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台灣中老年人飲食模式與腎臟功能障礙之關聯：2008年至2010年的橫斷研究

為了解決ro回歸2023的問題，作者盧卡思 這樣論述：

Objective: Chronic Kidney Disease (CKD), characterized by impaired kidney function, affects over 1.5 million individuals in Taiwan. Low testosterone levels, cardiovascular disease (CVD), dyslipidemia, anemia, and low-grade inflammation are commonly found in impaired kidney function CKD subjects. Si

nce diet plays an important role in the development of the outcomes of CKD aforementioned, our study was designed to investigate the association of dietary patterns with testosterone levels, cardiovascular risk factors, dyslipidemia, anemia, and the severity of impaired kidney function in middle-age

d and older adults in Taiwan.Methods: 41,128 participants aged more than 40 years old with an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m2 and positive urinary protein were recruited from Mei Jau Health Institute between 2008 and 2010. The dietary patterns were identified

using principal component analysis (PCA) and reduced rank regression (RRR) method was used to determine the kidney function-, inflammatory-, and metabolic syndrome (MetS) - related dietary pattern. A multivariable linear regression analysis was used to identify the association between dietary patter

ns derived by PCA with testosterone levels and kidney function biomarkers. While, a multivariable logistic regression analysis was used to identify the association between dietary pattern derived by RRR with the severity of impaired kidney function, cardiovascular risk factors, dyslipidemia, anemia,

and MetS components.Results: Males with higher tertile of fried-processed dietary pattern score was associated with decreased testosterone levels by 0.8 nmol/L (95% CI: -1.40, -0.16), reduced testosterone-to-TG (T/TG) ratio by 1.8 units (95% CI: -2.99, -0.53), and increased risk of moderate/severe

decline in kidney function (eGFR < 60 mL/min/1.73 m2) by 1.35 (95% CI: 1.15, 1.58). The kidney function-related dietary pattern characterized by frequent intakes of preserved or processed food, meats and organ meats, rice and flour products, and low intakes of fruit, dark-colored vegetables, bread,

and legumes or beans. In both genders, high adherence of dietary score was correlated with 2.07 times (95% CI 1.89–2.27) risk of obese weight status, 10 to 31% risk of cardiovascular risk, and 1.15 times (95% CI 1.02–1.29) risk of moderately or severely impaired kidney function. The higher adherence

of inflammatory dietary pattern (low intakes of seafood, grains, vegetables, and fruit but frequent intakes of meats, eggs, preserved or processed food, and sweet drinks) was associated with increased 21% risk of dyslipidemia in males and increased 35% - 47% risk of anemia in both genders. There wa

s an association between high consumption of inflammatory dietary pattern with reducing eGFR (males and females; β = -0.85 and -0.53, p < 0.05 respectively) and increased CRP level and/or neutrophil-to-lymphocyte (N/L) ratio in both genders. Moreover, compared with PCA method, RRR shows stronger sta

tistical associations with MetS.Conclusion: Our findings suggest that high intakes of processed and animal foods and low intake of seafood and plant foods predict the risk for developing hypogonadism, cardiovascular disease, dyslipidemia, anemia, and rapid kidney function decline.

糖尿病患者血糖變異、社經地位及共病與發生末期腎病之相關性探討

為了解決ro回歸2023的問題，作者楊雅斐 這樣論述：

背景：台灣透析發生率高，舉世第一。不僅成為全民健保沉重負擔，也是國民健康一大傷害。目前在台灣及許多以開發及開發中國家，糖尿病皆為腎衰竭最重要成因。找出糖尿病腎病變預測因子為當務之急。社經地位影響人們的罹病狀態及存活，常以就醫可近性及方便性解釋。過半糖尿病患者同時並有其他慢性病，尤其高血壓，其他慢性腎病，心臟病及中風。台灣全民健保實施十多年，形成全球少見進步且方便的醫療環境。藉健保資料庫分析探討糖尿病相較於健康對照組，社經地位及共病對罹患末期腎病變是否有不同影響。其二、血糖控制為預防糖尿病腎病變之重要方法，目前主要指標為糖化血色素及飯前血糖。但兩者皆無法妥善預測糖尿病腎病變發生。血糖變異為新興

血糖監測標，以糖化血色素及飯前血糖轉換變異係數臨床可輕易取得，但其與糖尿病末期腎病變的相關研究付之闕如。本研究亦使用全國糖尿病照護網登錄資料分析糖化血色素及飯前血糖變異係數與末期腎病變發生的風險之相關性。方法：本研究使用兩個研究設計來探討糖尿病相較於正常人在不同社經地位及共病狀況下是否對罹患末期腎病有不同影響，及糖化血色素、飯前血糖變異係數與發生末期腎病變的風險。首先使用全民健保資料庫百萬人檔中1997-2000 新發生糖尿病的患者，以其診斷糖尿病或納入研究時的共病和納保收入分層，評估糖尿病對發生末期腎病變的風險。其二，使用2002-2004全國糖尿病論質計酬方案中年齡等於大於 30歲患者資料

分析糖化血色素及飯前血糖變異係數與糖尿病末期腎病變的相關。利用患者首年糖化血色素及飯前血糖計算變異係數後分為五等分，以Kaplan-Meier 存活曲線及Cox 比例回歸風險模式比較各組產生末期腎病的風險。結果：在糖尿病和健康對照組社經地位及共病對罹患末期腎病變風險的影響研究中，總共納入26,351 糖尿病患者及105,404 無糖尿病對照組。職業別的糖尿病腎病變產生末期腎病的發生率比率以公務人員，教育人士及軍人最低，為23.8每萬人年, 漁業從業人員最高，為35.5每萬人年。收入別末期腎病的發生率比隨納保收入增加而降低，尤其大於28801-26300 新台幣納保級距。糖尿病患者發生末期腎病的

發生率為16.6每萬人年，健康對照組為2.00每萬人年。相對於無糖尿病患者，糖尿病患者衍生末期腎病的發生率比為8.3 (95% 信賴區間 6.45-10.6)。同時擁有糖尿病，高血壓及慢性腎病的患者罹患末期腎病變的機率最高 (每萬人年 95.8及 93.1)，但相對沒糖尿病卻擁有高血壓及慢性腎病的患者的發生率比最低，為 1.28 (95% 信賴區間 0.98-1.67)。在糖化血色素及飯前血糖變異係數與糖尿病末期腎病變的相關研究中，合計有31,841名第二型糖尿病患者納入研究分析。經過8.23年的追蹤，1642 人罹患末期腎病變，粗發生率為6.27每千人年。經調整後，糖化血色素及飯前血糖變異係

數皆呈現為可獨立預測末期腎病變之因子, 糖化血色素變異係數第四及第五五分位風險比分別為1.20 (95% 信賴區間 1.01, 1.41)及 1.24 (95%信賴區間 1.05, 1.46)，飯前血糖變異係數第五五分位的風險比為 1.23 (95%信賴區間 1.03, 1.47)。結論：全民健保提供進步及便利的醫療資源後，在不同社經地位及共病分層下，糖尿病患者有顯著較高的末期腎病風險。患者的社經地位及共病症仍為糖尿病患者衍生末期腎病變的重要相關因子。對於此點，未來可再研究如何對不同社會經濟地位的患者提供更有效的照顧。另外，糖尿病患衍生末期腎病的危險隨者高血壓及慢性腎病的加入而增加，但影響卻降

低。因此照護糖尿病患者除了顧及糖尿病，也要注意共病的照護。糖尿病首年糖化血色素及飯前血糖變異係數與糖尿病為可獨立預測末期腎病變之因，尤其在第四及第五五分位之血糖變異患者。顯示除了監測飯前血糖及糖化血色素之外，應考慮監測糖化血色素及飯前血糖變異係數。