近年來全球的糖尿病盛行率仍繼續在迅速上升，根據行政院衛生署2009年資料顯示，台灣糖尿病盛行率9.2%，糖尿病醫療費用占健保支出第五位。糖尿病控制好壞將影響病患之未來各種急性及慢性併發症之發生，進而影響病患之健康。影響糖尿病患血糖控制之因素很多，飲食因素對血糖影響很重要。飲食習慣與攝食行為往往是糖尿病患血糖控制好壞之決定因子。從臨床經驗發現糖尿病患可能因為藥物、血糖之影響，常有易餓情形發生。若糖尿病患有夜間攝食習慣，可能導致其血糖控制不佳，進而增加其合併症的發生。本研究目的為檢視第2型糖尿病患的夜間攝食行為之盛行率，並探討其夜間攝食熱量及營養素與相關代謝因子之關係。以夜間攝食問卷（Night Eating Questionnaire）及夜間攝食症候群診斷條件標準（Diagnostic criteria for night eating syndrome）作為評估是否符合夜間攝食症候群之工具，使用24小時飲食回憶法記錄飲食狀況，並內附簡易夜間攝食頻率，以調查夜間攝食行為頻率及每次進食的攝取量。夜間攝食之定義為：晚餐後離開餐桌30分鐘以上有進食行為，且一星期至少一次以上，並夜間攝食行為至少維持1個月以上。受試者由醫師診斷為第2型糖尿病患，並且已經接受固定口服藥物治療或合併胰島素治療者，且年齡必須大於等於18歲以上。結果顯示 200位第2型糖尿病患（平均年齡為61.1±11.5歲；106位男性，94位女性） 接受調查，糖尿病患之夜間攝食行為盛行率為49.5%（n＝99），其夜間攝食行為頻率平均為5.1±2.3天／週，其中男性佔七成（n=69；69.7%）。有夜間攝食行為病患其夜間之平均熱量攝取為276.2±218.0大卡，佔總熱量之12.3±8.2%，每日總熱量顯著較無夜間攝食行為者高（2132.2±513.4 vs. 1770.5±374.6大卡，p<0.001），且其空腹血糖值亦顯著較高（155.0±47.9 vs. 140.9±42.3 mg/dL，p <0.05）。當以性別區別分析時，發現在男性有夜間攝食行為者，空腹血糖值有顯著較無夜間攝食行為者高（164.4±49.4 vs. 142.0±54.6 mg/dL，p <0.05）之現象，且有較高的降血脂藥物使用情形（63.8% vs. 40.5%，p <0.05）；而女性有夜間攝食行為者，有顯著較無夜間攝食行為者低的糖化血色素（7.3±1.2 vs. 7.8±1.2 %，p <0.05）與三酸甘油脂（119.7±40.3 vs. 156.9 ±102.5 mg/dL，p <0.05）。進一步分析糖尿病患之神經病變、視網膜病變、腎病變及心血管病變等合併症方面，結果並無發現與夜間攝食行為之相關性。研究結果顯示，國人第2型糖尿病患有相當高之比例有夜間攝食行為，且有夜間攝食行為的男性會有較高的血糖及血脂異常。日後可研究利用行為改變方式能否改變夜間攝食行為並改善相關代謝指數。 In recent years, the global prevalence of diabetes is increasing rapidly. According to the data published by Taiwan’s Department of Health in 2009, the prevalence of diabetes in Taiwan was 9.2% and the medical expense was ranked number five in the expenditures of National Health Insurance. Diabetes control will affect the occurrence of either acuteor chronic complications. Thus it will affecthealth. There are many reasons affect the glycemic control. However, diet is the most important factor in controlling their blood sugar. Dietary habits and eating behaviors are the crucial factors to the glycemic control. Based on clinical observations, diabetic patients might be easy to feel hungry due to the medicine treatment or glycemic fluctuation. Diabetic patients who like to eat at night might cause glycemic dysregulationand followed by complications. The aim of this study was to investigate the prevalence of nighttime food intake of patients with type 2 diabetes as well as calories, macronutrient and other related metabolic factors during food intake. Night Eating Syndrome was evaluated by using the Night Eating Questionnaire and diagnostic criteria for Night Eating Syndrome. Dietary assessments were completed by using 24 hours food intake record and the frequence of nighttime food intake . The definition of nighttime food intake was have foods again 30 minutes later after dinner and at least once a week during the period of one month least. 200 subjects were diagnosed with Type 2 diabetes and have been treated with the combination therapy of medicines and insulin (the mean age of these subjects was 61.1±11.5 years; 106 males, 94 females). The result showed that Ninety-nine subjects (49.5%) were nighttime eaters (NEs) and the mean frequency of nighttime food intake was 5.1±2.3 days per week and about 70% of these subjects were males (n=69). The average of their nignttime carolic intake was 12.3±8.2% (276.2±218.0 kcal) of their daily carolic intake. NEs gained more calories per day (2132.2±513.4 kcal) than non-NEs (1770.5±374.6 kcal,p<0.001). The concentration of their fasting blood glucose was higher (155.0±47.9 mg/dL) than non-NEs (140.9±42.3 mg/dL,p<0.05). Using gender as an analyzing factor, The fasting blood glucose concentration of male NEs was higher (164.4±49.4 mg / dL) than non-NEs (142.0±54.6 mg / dL,p<0.05). The male NEs were also treated with lipid lowering drugs more often (63.8%) than non-NEs (40.5%,p <0.05). The female NEs had lower HbA1C levels (7.3±1.2%) than non-NEs (7.8±1.2%,p <0.05) and so as the triglycerides concentrations (119.7±40.3 mg / dL vs. 156.9±102.5 mg / dL,p <0.05). However, further analysis showed that there was no significant difference in diabetes complications between NEs patients and control subjects. The result showed that there was high percentage of type 2 diabetic patients regarding the nighttime eating behavior. Furthermore, male NEs’ glycemic control and lipid values might be affected by their nighttime eating behavior. Further research could be focused on whether nighttime eating behavior modification can improve glycemic control and lipid control.
