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以重疊病例研究方式,探討飲食與血漿中葉酸與中風及不同形式中風間的相關性

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以重疊病例研究方式,探討飲食與血漿中葉酸與中風及不同形式中風間的相關性 - PowerPoint PPT Presentation


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以重疊病例研究方式,探討飲食與血漿中葉酸與中風及不同形式中風間的相關性. 翁履珍. Introduction. Stroke (World Health Organization). A focal ( or at times global) neurological impairment sudden onset, and lasting more than 24 hrs (or leading to death) and of presumed vascular origin.

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stroke world health organization
Stroke(World Health Organization)
  • A focal ( or at times global) neurological impairment sudden onset, and lasting more than 24 hrs (or leading to death) and of presumed vascular origin.
  • 5.5 million deaths that occur every year world wide is due to stroke.
  • Stroke is the second leading cause of death after ischemic heart disease.
slide4
中風的型式
  • Ischemic stroke

Caused by a blood clot that blocks a blood vessel or artery in the brain

  • Hemorrhagic stroke

A blood vessel in the brain ruptures and spills blood into the surrounding tissue

(National Institute of Neurological disorder and stroke,

http://www.ninds.nih.gov/index.htm)

treatable risk factors
Treatable Risk Factors
  • High blood pressure
  • Heart disease
  • Cigarette smoking
  • Diabetes
  • Warning signs or history of stroke

TIAs( Transient ischemic attacks )

(National Institute of Neurological disorder and stroke,

http://www.ninds.nih.gov/index.htm)

slide6
中風的飲食保護因子
  • Difference of stroke mortality in Japanese emigration

(SYME , 1975)

  • ω-3 fatty acid ( Iso et al.2001 )
  • Antioxidants

Vitamin C ( Vokó et al.2003) Vitamin E (Yochum et al.2000)

Carotenoids (Hirvonen et al.2000)

Flavonoids (Keli et al.1996)

  • Minerals

Potassium Magnesium (Ascherio et al.1998)

  • Others

Cereal fiber(Ascherio et al.1998)

Folate (He et al.2004) Vitamin B6 (Kelly et al.2003)

Vitamin B12 (He et al.2004)

folate folic acid
Folate (Folic acid)
  • Water Soluble
  • Functions i. Red blood cell formation

ii. New cell division

iii. Protein metabolism

  • Deficiencies Anemia, diarrhea, depression, heartburn
  • Toxicity Insomnia, irritability, diarrhea, may mask B12 deficiency
  • Recommended Intakes (RDA):400 µg/day for adults
  • Food Sources Green leafy vegetables, liver, legumes, seeds, and enriched breads, cereals, rice, and pasta.

http://nutrition.about.com/cs/supplements/l/blvitbfolate.htm

slide8
Folate metabolism

http://www.snof.org/maladies/homocystinurie.html

homocysteine
Homocysteine
  • Homocysteine & CVD
  • Homocysteine level CVD(Bautista et al.2002)
  • Homocysteine level stroke(Brattstrom, et al.1992)
  • Elevated homocysteine level
  • Genetic defects

MTHFR(677C-->T)(Brattstrom, et al.1998)

  • Low intake

Folate, vitamin B6 vitamin B12(Verhoef, et al.1996)

folate
Folate
  • Folate and CVD
  • Folate and stroke

Serum folate stroke (Wayne H. et al)

>9.2mmol/L vs. ≤9.2mmol/L

RBC folate stroke ( Killian Robinson )

Folate intake & stroke

Inverse correlation

NHEFS (Lydia A. Bazzano et al.)

Ischemic stroke in men(Ka He ,et al.)

No significant association

women (QAael K, et al.)

folate1
Folate
  • 葉酸缺乏狀況(93-96國民營養調查)
  • 2003十大死因排名(衛生署)
slide12
研究目的
  • 使用重疊病例對照研究方式,以竹東朴子心臟血管疾病追蹤研究之參與者為實驗對象,研究飲食中的葉酸及血漿中葉酸濃度與中風或不同形式中風間的相關性
study population
Study population
  • 竹東及朴子地區心臟血管疾病長期追蹤研究

CVDFACTS (CardioVascular Disease risk Factor Two-township Study)

新竹縣竹東鎮(客家) 嘉義縣朴子鎮(閩南)

  • 5個cycle

1989-1991

1991-1993

1993-1997

1997-1999

1999-2002

  • 每一個cycle都會進行生活型態的問卷調查,cycle2.cycle3進行抽血檢驗
  • 第2個cycle時進行飲食紀錄
  • Until cycle 4

共 8011人

age 1-90

men 3727 人 women 4284 人

slide15
中風的分類
  • Ischemic stroke

433,434,435,436,A292,A293

  • Hemorrhagic stroke

431,432,A291

  • Subarachnoid hemorrahage

430,A290

  • 沒有疾病分類編號,但有服用以下藥物任一種者,視為ischemic stroke

Aspirin, ticlopin, heparin, warfarin, piracetam,

pentoxifylline

case control
Case & control
  • Case: 在CVDFACTS追蹤開始後,至最後

一次收案為止,發生中風之病例,以

隨機抽樣方式選出

  • Control:以性別、年齡、及居住地做為

matching factors,尋找在追蹤過

程中,未發生中風之受試者,作為

control

slide18
飲食葉酸估計
  • 飲食頻率問卷
  • 時間 : 1991-1993年
  • 包括(1)乳漿類(2)蔬菜類(3)水果類(4)肉類

(5)蛋豆腐類(6)海產類(7)主食類(8)飲料類

(9)保力達、B類(10)其他類

  • 頻率 : 6+/年、每一至三個月一次到6+/天,等十種。
  • 飲食中葉酸的攝取量則以攝取頻率代入飲食資料庫後,加以

估計。

  • 若有>13項為空白之受試者,予以排除
biochemistry analysis
Biochemistry analysis

以加入heparin之採血管採血

離心15min後(3000rpm;4000rpm)

取上清液(血漿)

置入-70℃冰箱保存

slide20
Plasma Folate

Immunoassay

  • Plasma vitamin B6

HPLC

  • Plasma vitamin B12

Immunoassay

risk factor
Risk factor
  • Age
  • Sex
  • 居住地 (竹東,朴子)
  • Smoking

(never,past smoker,current smoker[1-10,10-20,>20支煙/天])

  • Hypertension (yes, no)
  • BMI (≦25, >25)
  • Alcohol intake (yes, no)
  • Physical activity
  • Education ( ≦12年,>12年)
  • Total energy
  • Hypercholesterolemia (<240mg/dl, ≧ 240mg/dl)
  • Plasma vitamin B6
  • Plasma vitamin B12
statistics
Statistics
  • Mean± SD
  • t-test

Difference of variables between case and control

  • Cox proportional hazard model

RR and 95%CI

Stratifying sex, 居住地

(folate vs. stroke & subtype of stroke)

  • SAS v8.1
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