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系統識別號 U0026-3108201314340800
論文名稱(中文) 台灣地區中老年人糖尿病前體重變化之軌跡:18年長期追蹤研究
論文名稱(英文) BMI Change Trajectories Before Development of Diabetes for Taiwanese Elderly Population: An 18-years Follow-up Study
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 101
學期 2
出版年 102
研究生(中文) 李筱翎
研究生(英文) Siao-Ling Li
學號 TC6001023
學位類別 碩士
語文別 中文
論文頁數 66頁
口試委員 指導教授-邱靜如
口試委員-盧豐華
口試委員-吳至行
中文關鍵字 糖尿病診斷  身體質量指數  體重變化  軌跡  中老年人 
英文關鍵字 Diabetes diagnosis  Body Mass Index (BMI)  Weight change  Trajectory  Middle-aged and older adults 
學科別分類
中文摘要 研究目的:糖尿病之發生率隨著年齡而上升,因此糖尿病為老化社會中不可忽視之議題。在許多影響糖尿病發生的因素當中,過重與肥胖為重要之危險因子。然而將會發展糖尿病之中老年人,其體重變化如何有異於一般不會發展出糖尿病之中老年人,尚缺少此方面的實證之研究。本研究目的為描繪中老年人長期的體重變化軌跡,並比較得到糖尿病者與未發病者的不同,此外,我們亦考慮性別及不同體重對於上述關係之影響。研究方法:本研究資料來源為1989-2007年「台灣中老年身心社會生活狀況長期追蹤調查」。研究對象為在首次訪查後開始追蹤,直到2007年才發生糖尿病之樣本(平均首次訪查年齡:58.24歲),此外亦加入同一追蹤期間內,皆未發生糖尿病之相同年齡者為參考組(平均首次訪查年齡:58.42歲)。運用階層線性模型,估計在此18年期間內各年度的BMI的變化狀況,以比較發生糖尿病者在發病前BMI水平及變化與一般人是否有顯著差異。結果:在18年的追蹤中,一般不會發生糖尿病的中老年人,隨著年齡增加BMI軌跡呈現緩慢上升且上升速度逐漸趨緩的趨勢(βtime=0.08,p<0.001;βtime2=-0.002,p=0.0016)。而會發展出糖尿病者,不但有較高的BMI(βdiabetes =1.294,p=0.0064),且一開始的BMI上升速度較不會發病者快,之後逐漸趨緩,但在接近自我報告有糖尿病前6.5年時,BMI開始轉為下降之趨勢(βdiabetes*time=0.15,p=0.0327;βdiabetes*time2=-0.008,p=0.0065)。結論:長期體重上升較快可能與未來發生糖尿病的風險有正相關,但若相較於同年齡者,體重在較年輕時有更快速的上升,且後續出現下降的情況,需注意是否為未被診斷糖尿病的訊號,並進一步做抽血檢測或是給予適當的介入。
英文摘要 Objective: Little is known about weight changes preceding diagnosis of diabetes in middle-aged and older adults. We examine long-term trajectories in body mass index (BMI) of those who do and do not develop diabetes. Study Design and Setting: This study utilized retrospective cohort study design with participants aged 50+ from the Taiwan Longitudinal Study of Aging (TLSA, 1989-2007). Individuals who developed diabetes in 2007 (n=200) were compared to adults without diabetes throughout the observational period (n=3,576). Multilevel modeling was used to examine annual levels and rates of change in BMI before diabetes. Results: We found an overall trend of increasing BMI (βtime=0.08, p<.001), and the trend slowed as the participants aged (βtime2= -0.002, p<.001). Participants who developed diabetes exhibit higher BMI scores (βdiabetes =1.294, p<.01) and a faster rate of weight gain (βdiabetes*time=0.15, p<0.05) until approximately 6.5 years before physician-diagnosed diabetes. Diabetes associated with the higher level of BMI was especially evident in women; and the faster rate of weight gain was especially prominent in men or individuals with BMI≥24. These results has controlled for time-varying comorbidities and behavioral factors. Conclusions: Our study support that diabetes is associated with a faster rate of weight gain, even in middle-aged and older adults. The finding that middle-aged and older adults who develop diabetes experience an unplanned weight loss prior to self-reported diagnosis has practical implications that unplanned weight loss may be an alarm for under-diagnosed diabetes or a precursor to developing diabetes.
論文目次 第壹章、 研究背景與目的 1
第一節、 糖尿病的盛行率與影響 1
第二節、 早期診斷的重要性與未診斷糖尿病的盛行率 2
第三節、 發展糖尿病前體重趨勢的益處 3
第四節、 研究目的 4
第貳章、 文獻回顧 5
第一節、 體重變化對糖尿病相對風險影響之文獻 5
第二節、 糖尿病與體重變化軌跡之文獻 7
第三節、 影響體重與糖尿病之間關係的共變量(covariate)探討 8
第四節、 不同肥胖程度測量指標之文獻 10
第五節、 階層線性模式成長曲線模型適用性探討 11
第參章、 研究方法 13
第一節、 資料來源 13
第二節、 樣本選取 14
第三節、 變項測量 18
第四節、 統計方法 19
第肆章、 研究結果 22
第一節、 研究對象特性 22
第二節、 決定糖尿病前BMI變化之最佳適配曲線 24
第三節、 階層線性模式固定及隨機效果係數決定之BMI軌跡 25
第伍章、 討論 35
第一節、 結果與討論 35
第二節、 研究優點 39
第三節、 研究限制與未來方向建議 40
第四節、 結論 42
第陸章、 參考文獻 43
附錄、投稿論文手稿(manuscript) 47
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