A community-based study on the association between metabolic syndrome and the quality of air and drinking water

目的：透過收集社區民眾健康篩檢資料、空氣及飲用水品質資料，以瞭解空氣及飲用水品質與罹患代謝性症候群之關連。 方法：研究對象為2002年至2003年間來自二十四個分區曾參與社區性整合式健康篩檢模式之民眾，共有26166名。此二十四個分區之飲用水資料來源為1996年至2001年環保署八項飲用水品質抽驗資料，包括大腸桿菌群、總菌落數、濁度、亞硝酸鹽氮、硝酸鹽氮、硫酸鹽、硬度(碳酸鈣)、及pH值；另外從中選取其中八個有空氣品質監測的分區，共有民眾7566名，並收集環保署1993年至2001年五項空氣品質監測資料，包括二氧化硫、一氧化碳、臭氧、懸浮微粒（PM10）及二氧化氮。代謝性症候群採用亞洲版NECP ATP III之定義，統計方式採用一般線性混合型模式（Genralized Linear Mixed-effects Model），在校正了代謝性症候群之其他危險因子，包括固定效應性別、年齡、抽菸、飲酒、運動習慣、素食飲食習慣、主食份量、蔬菜份量、肉食份量、及BMI等變項，並以環境品質分區為隨機效應，分別探討空氣品質及飲用水品質各項目與罹患代謝性症候群之關連性。 結果：二十四個飲用水品質分區代謝性症候群之平均盛行率為19﹪，各區盛行率介於15﹪至34﹪之間，八個飲用水品質項目中，只有亞硝酸鹽氮、硫酸鹽、及硬度（碳酸鈣）三項與罹患代謝性症候群有正相關，亞硝酸鹽氮高濃度地區（5∼6μg/L）較低濃度地區（1∼3μg/L）之勝算比為2.22（95%信賴區間1.86~2.66）；硫酸鹽高濃度地區（38∼84mg/L）較低濃度地區（13∼32mg/L）之勝算比為1.34（95%信賴區間1.04~1.73）；總硬度高濃度地區（103∼224mg/L）較低濃度地區（24∼99mg/L）之勝算比為1.30（95%信賴區間1.00~1.68）。五個空氣品質項目中空氣品質中，只有二氧化硫及二氧化氮與罹患代謝性症候群有正相關，二氧化硫高濃度地區（4∼15ppb）較低濃度地區（2∼3ppb）之勝算比為1.90（95%信賴區間1.09~3.31）；二氧化氮高濃度地區（27∼29ppb）較低濃度地區（13∼23ppb）之勝算比為2.37（95%信賴區間1.75~3.23）。 結論：空氣品質中的二氧化硫及二氧化氮，以及飲用水品質中的亞硝酸鹽氮、硫酸鹽及總硬度中的碳酸鈣與罹患代謝性症候群有顯著正相關。目前環境品質與代謝性症候群之關係尚無其他研究探討，確切的劑量效應及生物機轉，需要進一步的研究來釐清。Purpose: The purpose of this study was to investigate the association between metabolic syndrome and the quality of air and drinking water. Method: Our study subjects included 26166 residents of 24 communities in Taiwan, who have participated in community-based integrated screen for multiple diseases during 2002-2003. The quality of drinking water in each community including total Coliform count、heterotrophic plate count、turbidity、nitrite、nitrate、sulfate、hardness(calcium carbonate), and pH value were obtained from routine monitoring of the Taiwan Environmental Protection Agency (TEPA) during 1996-2001. The air quality including sulfur dioxide, carbon monoxide, ozone, particulate matter, and nitric dioxide in 8 out of 24 communities were obtained from 8 TEPA’s air-quality monitoring stations during 1993-2001. There were 7566 residents in the 8 communities with air quality data. The Asian modified National Education Cholesterol Program Adult Treatment Panel Third defined the metabolic syndrome of screened population. Generalized Linear Mixed-effect models were used to investigate the association between metabolic syndrome and the quality of air and drinking water by adjusting gender, age, body mass index, smoking, drinking, exercise, and diet as fixed effects and the community as a random effect. Result: The prevalence of metabolic syndrome averaged at 19%, ranging 15% to 34% among our 24 study communities. Among 8 water quality indices, only nitrite, sulfate, and calcium of hardness were found to be associated with metabolic syndrome. By comparing the residents in the areas of nitrite levels between 5 and 6μg/L, sulfate levels between 38 and 84 mg/L, and calcium levels of hardness between 103 and 224 mg/L to those in the area with nitrite levels between 1 and 3 μg/L, sulfate levels between 13 and 32 mg/L, and calcium levels of hardness between 24 and 99 mg/L, the adjusted odds ratios (95% confidence interval) were 2.22 (1.86 to 2.66) for nitrite, 1.34 (1.04 to 1.73) for sulfate, and 1.30 (1.00 to 1.68) for hardness, respectively. Among the 5 air quality indices, only nitric dioxide and sulfur dioxide were found to be associated with metabolic syndrome. By comparing the residents in the areas of nitric dioxide levels between 27 and 29 ppb, and sulfur dioxide levels between 4 and 15 ppb to those in the areas of nitric dioxide levels between 13 and 23 ppb, and sulfur dioxide levels between 2 and 3 ppb, the adjusted odds ratios (95% confidence interval) were 2.37 (1.75 to 3.23) for nitric dioxide, and 1.90 (1.09 to 3.31) for sulfur dioxide. Conclusion：Environmental quality including nitric dioxide and sulfur dioxide in air, and nitrite, sulfate, and calcium of hardness in drinking water were significantly associated with increase in metabolic syndrome.誌謝 II 摘要 III 英文摘要 V 目 錄 VII 表目錄 IX 圖目錄 XI 第一章 前言 12 第二章 文獻探討 14 2.1 環境因子長期流行病學研究 14 2.1.1飲用水品質 14 2.1.1.1飲用水品質長期健康效應 14 2.1.1.2飲用水品質與代謝性症候群之相關研究 15 2.1.2空氣品質 16 2.1.2.1空氣品質對健康的長期效應研究 16 2.1.2.2空氣品質對代謝性症候群之相關研究 18 2.2 代謝性症候群研究 20 第三章 材料與方法 23 3.1 研究流程 23 3.2 研究設計 24 3.2.1 研究對象 24 3.2.1.1 代謝性症候群定義及量測 28 3.2.1.2 其他重要危險因子量測 28 3.2.2 飲用水品質監測 29 3.2.3空氣品質監測 30 3.2.4 統計分析 31 第四章 結果 34 4.1 飲用水品質分區 38 4.1.1 二十四個飲用水品質分區之飲用水質概況 38 4.1.2飲用水品質分區個案重要危險因子分佈情形 41 4.1.3飲用水品質分區個案代謝性症候群盛行情形 46 4.1.4飲用水品質與代謝性症候群之模式探討 55 4.2 空氣品質分區 63 4.2.1 八個空氣品質分區之空氣品質概況 63 4.2.2空氣品質分區個案重要危險因子分佈 65 4.2.3空氣品質分區個案代謝性症候群盛行情形 68 4.2.4空氣品質與代謝性症候群之模式探討 74 4.3 飲用水、空氣品質與代謝性症候群之模式摘要 78 第五章 討論 81 5.1 研究限制 81 5.2飲用水、空氣品質與代謝性症候群 84 5.3 結論 88 參考文獻 8