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題名：臺灣中老年人體能活動、蔬果攝取、與憂鬱之相互關聯
作者：紀淑凰
作者(外文)：Shu-Huang Chi
校院名稱：亞洲大學
系所名稱：健康產業管理學系健康管理組
指導教授：蔡仲弘
王俊毅
學位類別：博士
出版日期：2015
主題關鍵詞：合併效應；憂鬱症狀；蔬菜；水果；體能活動；蔬果攝取；老年人；combined effect；depressive symptoms；vegetables；fruits；leisure-time physical activity (LTPA)；fruit and vegetable consumptions；older adults
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背景：憂鬱症狀、蔬果攝取不足、及缺乏體能活動是中老年人常見的問題。這些因素的相互關聯在社區的居家老人尚未受到深入的研究。
目的：本研究的目的在探討台灣53歲以上中老年人在體能活動、蔬果攝取和憂鬱症狀之間的獨立和合併和相互的關聯。
方法：本研究分析1999年和2003年的「臺灣地區中老年身心社會生活狀況長期追蹤調查研究」資料庫。本研究分三個部分。第一部分探討體能活動和蔬果攝取與四年後新發的憂鬱症狀的關聯；第二部分，探討憂鬱症狀和蔬果攝取與四年後體能活動的關聯；第三部分探討憂鬱症狀和體能活動對蔬果攝取的橫斷關聯。本研究以流行病學研究中心憂鬱量表 (Center for Epidemiological Studies Depression Scale, CES-D)評估憂鬱症狀 (0-30；≥10為具憂鬱症狀)；體能活動以參與者的日常體能活動頻率、時間、強度之乘積評估；蔬果攝取以食物攝取頻率來評估。第一部分研究 (探討與新發的憂鬱症狀的關聯)，排除於基準點具有憂鬱症狀者；第二部分研究 (探討與體能活動的關聯)，排除於基準點不運動、無法行走200-300公尺、或有中風或癌症者。第三部分研究 (探討與蔬果攝取的橫斷關聯)，排除蔬果攝取資料不全者。研究以多變項羅輯迴歸分析 (multivariable logistic regression analysis) 檢測其關聯。
結果：高體能活動和較多的蔬果攝取與四年後呈現較低的新發憂鬱症狀的趨勢，但只有體能活動具統計上顯著影響，蔬果攝取則不顯著。高體能活動同時也較多的水果攝取 (OR =0.61,95 %CI=0.41-0.89, p=0.010)，較多的蔬菜攝取 (0.49, 0.26-0.93, p=0.029) 或較多的蔬果攝取 (0.39, 0.20-0.77, p=0.006)等皆較只有高體能活動與降低四年後的新發憂鬱症狀更具關聯。
憂鬱症狀與隨後體能活動的降低呈關聯，但蔬果攝取則不顯著。相較於沒有憂鬱症狀者，具長期憂鬱症狀者其隨後四年的體能活動趨低的風險為沒有憂鬱症狀者的2.06倍 (OR =2.06, 95 %CI=1.22-3.47, p=0.007)，憂鬱症狀減輕者為1.57倍 (1.57, 1.18-2.07, p=0.002) ，而憂鬱症狀變差者為1.75倍 (1.75, 1.31-2.35, p<0.001)。
體能活動或憂鬱症狀與蔬果攝取亦呈橫斷關聯。憂鬱症狀與蔬果攝取呈負關聯，憂鬱症狀高者蔬果攝取為正常者的0.62倍 (0.62, 0.50-0.76, p<0.001)。體能活動則與蔬果攝取呈正關聯。中度體能活動者的蔬果攝取為低體能活動者的1.44倍 (1.44, 1.18-1.77, p<0.001)，而高度體能活動者為1.83倍(1.83, 1.52-2.21, p<0.001)。
結論：體能活動、蔬果攝取、與憂鬱症狀有不同程度的相互關聯或影響。體能活動與蔬果攝取可影響隨後四年的新發憂鬱症狀。同時高體能活動又高蔬果攝取可更有效減少老年人新發憂鬱症狀的風險。因此，鼓勵老年人有較多的良好生活方式為減少老人憂鬱症狀風險的良方。本研究的結果可作為老人健康促進政策擬定之參考。
Background: Depression, inadequate fruit and/or vegetable (F/V) consumptions, and reduced leisure-time physical activity (LTPA) are common in the elderly. The associations among these factors have not been examined in community living older persons.
Aims: The objectives of the present study were to determine the independent and combined relationships among LTPA, fruit and/or vegetable consumptions, and depressive symptoms in ≥53-year old Taiwanese.
Methods: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Study on Aging (TLSA), a population-based cohort study. The study was conducted in three parts in this study. In part I, we examined the associations of baseline LTPA and F/V consumptions with new-onset depressive symptoms status four-years later; In part II, we examined the associations of depressive symptom status and F/V consumptions with subsequent LTPA; and in part III, we examined the cross-sectional associations of depressive symptoms and LTPA with F/V consumption status. We evaluated the depressive symptoms status using the Center for Epidemiologic Studies Depression scale (CES-D, score range 0-30; ≥10 as having depressive symptoms); LTPA was evaluated by multiplying the frequency, duration, and intensity of participant's routine physical activity; and F/V consumptions were rated using semi-quantitative food frequency method. We excluded participants who had depressive symptoms at the baseline in Part I study; those who were physically inactive, unable to walk 200-300m, or had stroke or cancer in Part II study, and those who had incomplete F/V consumption data in Part III study. Multiple logistic regression analyses were conducted to determine the associations.
Results: High LTPA and higher fruit and vegetable consumptions appeared to be independently associated with reduced new depressive symptoms four years later, however, only LTPA was significantly (OR=0.75, 95%CI=0.57-0.99, p=0.043) associated with increased depressive symptoms status, higher fruit or vegetable consumption was not. Combining higher fruit (0.61, 0.41-0.89, p=0.010), higher vegetable (0.49, 0.26-0.93, p=0.0029), or higher fruit and vegetable (0.39, 0.20-0.77, p=0.006) consumptions with high LTPA all reduced the likelihood of developing new depressive symptoms four-years later beyond high LPTA alone.
Depressive symptoms status was associated with subsequent LTPA decline, while fruit and vegetable consumptions were not. Persons with constant depressive symptoms were 206% (2.06, 1.22-3.47, p=0.007); those who had lessened symptoms were 157% (1.57, 1.18-2.07, p=0.002), and those who had worsening depressive symptoms were 175% (1.75, 1.31-2.35, p<0.001) as likely to experience a decline in LTPA as those who had no depressive symptoms. Persons with depressive symptoms status were 38% (0.62, 0.50-0.76, p<0.001) less likely to experience a high frequency of fruit-vegetable consumption compared to those who had no depressive symptoms; subjects who were physically moderately active were 1.44 times (1.44, 1.18-1.77, p<0.001), and those who were physically active were 1.83 times (1.83, 1.52-2.21, p<0.001) as likely to have higher frequency of fruit-vegetable consumption compared to those who were inactive.
Conclusion: Simultaneous presence of good lifestyle habits increases the beneficial effect of reducing the risk of developing depressive symptoms in older adults. Depressive symptoms and cognitive decline, but not fruit and vegetable consumptions were longitudinally associated with LTPA decline in older adults. Depressive symptoms and LTPA were associated with concurrent fruit-vegetable consumption in older Taiwanese. Depressive symptoms were associated with lower whereas higher LTPA was associated with higher frequency of fruit-vegetable consumption. These findings suggest that it is important to encourage older adults to have as many good lifestyle habits as possible in order to reduce the risk of depressive symptoms. Our results should be useful for designing effective health promotion strategies for reducing the risk of depressive symptoms in older adults.
Chapter 1
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Chapter 2
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