民國九十三年衛生署統計資料顯示肺癌位居台灣癌症死亡原因的第一位，雖然目前有很多研究發現維生素A在肺癌預防上扮演非常重要的角色，然而在台灣針對含維生素A及其先驅物飲食與肺癌關聯性的研究相當少，因此我們利用病例對照的研究方法，來探討攝取富含維生素A及其先驅物食物與罹患肺癌危險性之關係。病例組是組織病理確診的原發肺癌新病人，共301位。對照組有兩組，一組是醫院對照組602位，另一組是鄰居對照組602位。資料的收集是依結構式飲食頻率問卷的內容來面訪受試者，以評量13種食物和維他命補充劑之攝取量。資料的分析是先控制具影響力之干擾因子後，再以條件式邏輯回歸（conditional logistic regression），來分析其調整後勝算比值（adjusted odds ratio：AOR）和百分之九十五的信賴區間（95% confidence interval：95% CI）。結果顯示：依據食物類別來看，凡攝取各類食物中的維生素A、α胡蘿蔔素和β胡蘿蔔素頻率或量愈高者，其罹患肺癌的危險性愈低，但水果除外。但依據食物個別項目來看，僅有兩種食物會隨其維生素A、α胡蘿蔔素和β胡蘿蔔素攝取量的增加，而降低罹患肺癌的危險性，它們分別是茼蒿和地瓜葉。相反地，依據食物類別或個別項目合計，發現攝取視網醇(retinol)量的多寡與肺癌的發生是不相關的。此外，以每週攝取量的多寡來分析，攝取較多份數之蔬菜(病例組分別與醫院對照組和鄰居對照組之高vs.低四分位之AOR分別為0.70和0.67，95% CI分別為0.46-1.06和0.42-1.08，趨勢P值皆為0.04)、茼蒿(病例組分別與醫院對照組和鄰居對照組之高vs.低三分位AOR分別為0.74和0.58，95% CI分別為0.48-1.14和0.37-0.93，趨勢P值分別為0.04和0.01)或地瓜葉(病例組分別與醫院對照組和鄰居對照組之高vs.低三分位AOR分別為0.65和0.43，95% CI分別為0.45-0.96和0.28-0.66，趨勢P值分別為0.03和小於0.01)者，其罹患肺癌的危險性是成劑量效應下降。總之，攝取富含維生素A、α胡蘿蔔素與β胡蘿蔔素的食物具保護效果，可降低罹患肺癌的危險性，而蔬菜的保護成效高於水果，尤其是茼蒿與地瓜葉兩種蔬菜。因此，建議多攝取茼蒿或地瓜葉可降低罹患肺癌之危險性。

In 2004, lung cancer has been the leading cause of cancer death in Taiwan. Many studies demonstrate that vitamin A plays a crucial role in the prevention of lung cancer. However, few epidemiologic studies have examined the association of dietary vitamin A/precursors and lung cancer in Taiwan. Therefore, a case-control study was conducted to investigate the relationship between the consumption of local common foods that are rich in vitamin A/precursors and the risk of lung cancer. The cases were 301 newly diagnosed patients with histopathologically confirmed primary lung cancer. Two control groups were recruited: 602 hospital controls and 602 neighborhood controls. The consumption of 13 food items and vitamin supplements was estimated with the use of a structured food-frequency questionnaire in face-to-face interviews. Adjusted odds ratios (AOR) and the corresponding 95% confidence intervals (CI) were evaluated with controlling for potential confounders, using the conditional logistic regression model. It was found that reduced risk for lung cancer was associated with increased intakes of vitamin A, a-carotene, or b-carotene from various food groups except fruits. However, inverse associations were not observed for vitamin A, a-carotene, or b-carotene intake from various food items, except garland chrysanthemum and sweet potato leaves. On the other hand, retinol intake from food groups or items was not correlated with lung cancer development. Additionally, more servings of vegetables (AOR for the highest versus the lowest quartile = 0.67-0.70, 95% CI = 0.42-1.08, plinear trend = 0.04), garland chrysanthemum (AOR for the highest versus the lowest tertile = 0.58-0.74, 95% CI = 0.37-1.14, plinear trend = 0.01-0.04) and sweet potato leaves (AOR for the highest versus the lowest tertile = 0.43-0.65, 95% CI = 0.28-0.96, plinear trend £ 0.03) were associated with the reduced risk for lung cancer. In conclusion, there were protective effects of dietary intake of vitamin A, a-carotene and b-carotene. The vegetables provided higher potential protection against development of lung cancer than the fruits, especially for garland chrysanthemum and sweet potato leaves. Therefore, our findings suggest that more consumption of garland chrysanthemum and sweet potato leaves might reduce the risk of lung cancer in Taiwan.

致謝辭 (Acknowledgements)
List of Contents
中文摘要 ------------------------------------------------------------------------------------- 1
Abstract --------------------------------------------------------------------------------------- 3
Chapter 1 Introduction --------------------------------------------------------------------- 5
1.1 Lung Cancer ----------------------------------------------------------------------------- 5
1.2 Epidemiology of Lung Cancer ------------------------------------------------------- 6
1.2.1 Worldwide ----------------------------------------------------------------------------- 6
1.2.2 Taiwan --------------------------------------------------------------------------------- 7
1.3 Risk factors ------------------------------------------------------------------------------ 7
1.3.1 Sex -------------------------------------------------------------------------------------- 7
1.3.2 Age ------------------------------------------------------------------------------------- 8
1.3.3 Race ------------------------------------------------------------------------------------ 8
1.3.4 Previous respiratory diseases ------------------------------------------------------ 8
1.3.5 Family history ------------------------------------------------------------------------ 8
1.3.6 Genetic susceptibility --------------------------------------------------------------- 9
1.3.7 Tobacco use -------------------------------------------------------------------------- 9
1.3.8 Occupational exposure ------------------------------------------------------------ 10
1.3.9 Environmental pollution ----------------------------------------------------------- 10
1.3.10 Diet and vitamin A ---------------------------------------------------------------- 11
1.4 Epidemiologic studies of vitamin A and lung cancer --------------------------- 12
1.5 Vitamin A ------------------------------------------------------------------------------- 15
1.5.1 The History of Vitamin A ---------------------------------------------------------- 15
1.5.2 Chemistry ----------------------------------------------------------------------------- 15
1.5.3 Vitamin A in Foods ----------------------------------------------------------------- 16
1.5.4 Absorption, distribution and metabolism --------------------------------------- 16
1.5.5 Transport------------------------------------------------------------------------------ 17
1.5.6 Storage -------------------------------------------------------------------------------- 17
1.5.7 Units of Measurement -------------------------------------------------------------- 18
1.6 b-carotene ------------------------------------------------------------------------------- 18
1.6.1 Chemistry ----------------------------------------------------------------------------- 18
1.6.2 Natural occurrence ------------------------------------------------------------------ 19
1.6.3 Occurrence in Foods, Food Supplements and Medicines -------------------- 19
1.6.4 Functions ----------------------------------------------------------------------------- 19
1.6.5 Absorption and Bioavalability ---------------------------------------------------- 20
1.6.6 Distribution and Metabolism ------------------------------------------------------ 20
1.7 α-carotene ------------------------------------------------------------------------------- 21
1.8 Vegetables, fruits and Lung Cancer ------------------------------------------------ 21
Chapter 2 Materials and Method --------------------------------------------------------- 23
2.1 Study Design --------------------------------------------------------------------------- 23
2.2 Cases ------------------------------------------------------------------------------------- 23
2.3 Controls ---------------------------------------------------------------------------------- 23
2.4 Data Collection ------------------------------------------------------------------------- 24
2.5 Other Participant Characteristics ----------------------------------------------------- 24
2.6 Dietary Intake and Assessment ------------------------------------------------------ 25
2.7 Statistical analysis ---------------------------------------------------------------------- 25
Chapter 3 Results ---------------------------------------------------------------------------- 27
Chapter 4 Discussion and Conclusions -------------------------------------------------- 31
References ------------------------------------------------------------------------------------ 37
Tables ------------------------------------------------------------------------------------------ 56
Figures ----------------------------------------------------------------------------------------- 68
Appendix -------------------------------------------------------------------------------------- 75

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