長壽與成功老化

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ၡāāࢋ

ᙯᔣෟĈܜု ( Longevity )

јΑҁ̼ ( Successful aging )

ૄЯ ( Gene )

Ϡ߿௫ၚ ( Lifestyle )

Ꭾঽഇᑅᒺ ( Compression of morbidity ) ҁˠা࣏ཏ ( Geriatric syndrome )

͔֏

Б͵ࠧˠ˾ϒдҁ̼Ąд̂кᇴ̍ຽ઼̼

छĂѐ᛬෹࿅ 85 ໐۰Ă˫Ⴭ "౵ҁҁˠ ( the old- est old )"Ăᛳٺˠ˾ᇴᆧܜ౵ԣ۞ѐ᛬ᆸĂ֭ͷ ߏᗁᒚྤ໚۞੼ޘֹϡཏĄ тң߿଀ܜ˳ͷܲ

޺ઉ૵ăѣ߿˧ă൑Ϡ߿ΑਕᅪᘣĂ̏གྷјࠎࢦ

ࢋ۞ኝᗟĂܕѐֽᙯٺјΑҁ̼ ( successful aging )̝ࡁտ˵ѣ෸ֽ෸к̝ᔌ๕Ąώቔტኢ͹ࢋ

ፋ྆˞ˠᙷ၆ٺܜု׶јΑҁ̼፟ᖼ۞˞ྋĂͽ ܮѣӄٺޙϲܳซܜု׶јΑҁ̼۞ඉரĂ֭ͷ

၆Ϗֽࡁտ۞͞Ш׶ᓜԖ၁ચ̝൴ण೩ֻޙᛉĄ

ܜု ( longevity )

Ϡۏ۞ု׻צૄЯ׶ᒖဩᇆᜩĄ˘ีΔለᗕ ࡪࡩ۞ࡁտ¹޽΍πӮု׻۞᏷็ّ ( heritability ) ࠎ 20% ז 30% Ąٽ֏̝Ă˘ཏˠдု׻͞ࢬ۞

តளĂҌ͌ѣ 7 0 % ߏЯᒖဩमҾٙౄјĄтڍ

˘ਠˠ᏷็ז˘इΞͽѣπӮု׻۞ૄЯតள ( polymorphisms )Ă΁ࣇ۞௫ၚ׶ᒖဩ૟ߏՙؠ ܜုᄃӎ̝ᙯᔣĄ˘ีࡁտពϯĂ౵ָ۞ઉ૵࠹

ᙯҖࠎĂ૟ࠎ࿰ഇု׻ᆧΐ 10 ѐ²Ą˘тధкኑ

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ᗔ۞়ঽĂု׻פՙٺк჌ૄЯ׶ᒖဩ۞к͞ࢬ

࠹̢үϡĄԱ΍᏷็Я৵ѣӄٺሏ୻Ϡۏ၆ࢦࢋ

ᒖဩו፬۞ͅᑕĂֹԧࣇਕૉ੫၆˘࣎ˠ᏷็ጯ

۞௡ј೩΍࣎Ҿ̼۞౵ָᒖဩԼච̝ޙᛉĄּ

тĂтڍ˘࣎ˠૄЯ௡јᛳٺൺု׻۞੼Пᐍ ཏĂԧࣇᑕΞЪந۞ഇ୕฼ࢴԼតΞਕࢫҲ׎П ᐍ඀ޘćтڍૄЯ۞௡ј̏གྷᛳҲПᐍཏĂࢋͽ

฼ࢴ۞ԼតΝซ˘Վഴ͌ПᐍޘĂड़ڍ૟࠹༊ѣ ࢨĄ

˘ăု׻۞ૄЯՙؠЯ৵

ညޝк়ঽ˘ᇹĂଣ৶ု׻۞ૄЯՙؠЯ

৵ĂΞͽଂࡁտܑனໂൺု׻۞᏷็়ّঽٕု

׻ໂܜ۞ංѣछ୉ฟؕĄ

(˘)ѝҁা ( progeroid syndrome )

ѝҁা³ͽ࿅ѝ۞ҁ̼̈́ု׻ൺࠎপᕇĄ׎

̚Ăරৼা ( Werner syndrome, WS ) ߏវߖҒវ ᔳّ ( autosomal recessive ) ᏷็۞᏷็়ঽĂ׎

ͽൺ۞ု׻ࠎপᕇ ( πӮΪѣ 47 ѐ۞ု׻ )Ă֭

Ꭾଈᇃھ۞௡ᖐ෇ᒺăજਔඓېർ̼ăѷᐝጀă ௐ˟ݭᎤԌঽăϨ̰ᅪ׶੻ኳழᗫ³ĄጱҌරৼ

া۞ૄЯள૱Ăߏ˘࣎Щࠎ WRN ( RecQ helicase family ) ۞ૄЯ൴Ϡࡎត҃ಉεΑਕĂ͔੓ధк јវ௡ᖐΐిซҖኑᄦّ਽ҁ ( replicative senescence )³Ąኑᄦّ਽ҁ۞௟ࡪĂЯࠎ௟ࡪฉഇ፬ Ժᄦ጗ ( cyclin-dependent kinase inhibitors ) ۞ үϡ҃൑ڱซҖѣක̶ෘĂጱ࡭௟ࡪᔵх߿ҭГ

˵൑ڱ̶ෘֹ҃௡ᖐᆧϠĂ҃ͷซˢኑᄦّ਽ҁ ഇ۞௟ࡪົдૄЯܑன˯൴ϠԼតĂЯ҃யϠᆐ

̂۞ܑݭԼត ( phenotypic changes )⁴Ąјវ௟ࡪ

۞ኑᄦّ਽ҁĂΞਕΞͽྋᛖ˘ਠҁˠ൴Ϡᇃھ

௡ᖐ෇ᒺ҃ጱ࡭௡ᖐጡءΑਕੜ̼̝ன෪³Ą ݣܛ഑-РႬҢѝ਽ҁা ( Hutchinson-Gilford progeria, HGP ) ߏΩ˘჌វߖҒវᔳّ᏷็۞ѝ ҁ া Ă ᓜ Ԗ ܑ ன જ ਔ ඓ ې ർ ̼ ă ҉ ҇ ഴ ͌ া ( sarcopenia )ă੻ኳழᗫඈ³Ą࡭ঽૄЯࠎЩࠎͯ

ᆸకϨ A ૄЯ ( lamin A, LMNA ) ̝ពّԺט ( dominant negative )ࡎតĂጱ࡭८̰ቯͯᆸకϨ ( nuclear lamina)ள૱҃ᇆᜩϒ૱ૄЯ̝ᖼᐂᄃᖼ ᛌ̈́ߖҒវኑᄦĂซ˘Վֹ௡ᖐ௟ࡪΐిซҖࣟ

˸ ( apoptosis ) ҃ΐి௡ᖐ௟ࡪ۞ฉᖼ ( turnover )Ă

ֹ௡ᖐ௟ࡪΐిซˢ˯̝ࢗኑᄦّ਽ҁ³Ąѣ኷

۞ߏĂдϒ૱ҁ̼۞ˠវ௡ᖐ௟ࡪ˵Ξͽ൴னᙷ Ҭ۞ͯᆸకϨ A ૄЯតள҃ҡᐌ८̰ቯͯᆸకϨ

̝ඕၹள૱⁵ĂЯѩᙷҬ۞ૄЯ፟ᖼΞਕΞͽྋ ᛖҁ̼۞ߙֱன෪Ą

(˟)Ѻ໐ˠ༄ ( centenarians )

ѣ˘ֱૄЯ૱֍ٺѺ໐ˠ༄҃Ⴭࠎܜုૄ

ЯĄ̙࿅Հࣃ଀ڦຍ۞Ăˠ༄ྵ͌ᇷᜨٺ֖ͽጱ

࡭೩ѝѪ˸̝ᒖဩĄధкᙋፂӘ෦ԧࣇܜုߏΞ ͽ᏷็۞ĂѺ໐ҁˠ۞ͭϓѣ੼ٺ၆໰௡˝ࢺ۞

፟ົΞͽ߿ז˘Ѻ໐⁶ĂѺ໐ҁˠ۞Έԙؗ؏˵

ѣ੼ٺ၆໰௡˩ˣࢺ۞፟ົΞͽ߿ז࠹Т඀ޘ۞

੼᛬Ă֭ͷѪ˸தਕ௣Ϡ޺ᜈгҲٺ၆໰௡۞˘

Ηͽ˭⁷ĄѺ໐ҁˠᄃ׎Έԙؗ؏ΞਕдϠ׻۞

ѝഇᇷᜨٺᙷҬ۞ᒖဩ׶ҖࠎЯ৵Ă̙࿅఼૱ᐌ

඾ॡมĂᒖဩ׶ҖࠎЯ৵ĂּтۤགྷгҜăϠ߿

ሀёăاҝгડඈĂౌ૟ు႙൴Ϡ̶ڡĄЯѩĂ тڍѺ໐ҁˠ۞Έԙؗ؏۞Ϡхᐹ๕͹ࢋϤٺᒖ ဩЯ৵Ăᐹ๕ᑕྍᐌ඾ѐ᛬˭ࢫĄҭ࠹ͅ۞ĂϠ хᐹ๕̙֭ົᐌॡมᅍഴĂΞ֍଀ѩᐹ๕̙Ⴝ൒

৷ϤᒖဩЯ৵ՙؠĂ҃ѣ᏷็Я৵۞ᇆᜩĄ ܜုព҃ٽ֍г׶পҾ੼۞়ঽԩّ࠹ᙯĄ ЯѩĂ൴னૄЯᄃܜု۞࠹ᙯّĂ༊൒૟ົֹ଀

ˠ༄੼ٺ૱ˠ۞়ঽԩّ̝፟ᖼՀΐځ६̼Ą੫ ၆Ѻ໐ˠ༄ซҖ۞࠹ᙯّࡁտ ( New England American, Mormon, Ashkenazi Jewish, Islandic, Okinawan, Japanese, Italian, Irish, DutchඈЧี඾

Щ۞ࡁտ )^{6, 8-11}Ă̏གྷពϯೀ჌Ξਕ۞ܜုૄЯٕ

Ϡநੈि็ᅍྮश̝֎ҒĂּт HLA -DR1¹²ă PON1¹³ă IGF-1¹⁴ă PAPR-1¹⁵ă superoxide dismu- tases¹⁶ ׶਌ኳ΃ᔁྮश̚۞̶̄¹⁷ĄΩγĂЯࠎ Ѻ໐ˠ༄ᄃΈԙؗ؏ѣ࠹༊ᙷҬ۞ܜု้ШĂԧ ࣇϺΞͽᖣϤࡁտˠ༄̈́׎Έԙؗ؏ٙВТጾѣ

̝ૄЯតளĂֽԱזܜုૄЯ¹⁸Ąາࡻॾᜋˠ༄

ࡁտ̚Ăˠ༄۞ૄЯಶజोֽྫྷ׎Έԙؗ؏ซҖ

ͧྵĂᓁВѣᛳٺ 137 ࣎छल۞ 308 ࣎ˠ۞ૄЯ జৼˢ̶ژĄॲፂ൑ϓᇴ̶ژĂαཱིߖҒវ˯۞

˘࣎ડાѣ඾᏷็ాᗆ ( linkage ) ̝ன෪¹⁹Ą౅࿅

੼૜ޘ SNP ̶ژĂ຋௕វᖼொకϨኳ ( microsomal transfer protein ) ۞ߙপؠγព̄ૄЯݭ ( exonic genotype )జᄮࠎᄃܜု࠹ᙯ²⁰ĄҭߏĂ ྋᛖ఺ֱ៍၅ّኳ۞ঽּ၆໰ࡁտ ( case-control

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association studies )ٙ଀ז۞ඕڍᑕྍᖰຕĄੵ˘

ਠྍݭࡁտ̝૱֍યᗟγĂืڦຍࡁտనࢍ˯ߏ ӎᏴፄ˞Ъዋ۞ˠүࠎ၆໰௡Ąٙͽࠎ˞រᙋ఺

ֱܐՎ۞ࡁտඕڍĂซ˘Վ੫၆̙Тˠ჌ซҖՀ

̂ఢሀ̝ᙯాّࡁտߏυࢋ۞ĄϏֽ۞ࡁտ˵ื

ሏ୻ྍૄЯ̈́׎ٙயϠ̝కϨኳ۞Ϡۏ߿ّĂͽ

ֹԧࣇ၆ٺܜု۞፟ᖼՀΐᒢྋ²¹Ą

˟ăု׻۞ᒖဩՙؠЯ৵

(˘)฼ࢴΙྮ֧༼ט ( calorie restriction )

฼ࢴΙྮ֧༼ט૟ѣӀٺܜုϫᇾ۞྿јĄ ధкજۏ၁រ޽΍Ăٺѐᅅٕјѐજۏ۞฼ࢴΙ

ྮ֧ഴ͌ 3 0 % ٕͽ˯Ă૟Ξͽ࿰֨ధкᄃҁ̼

ѣᙯ۞ၙّঽ̝൴ϠĂ֭ͷព඾ؼܜྍۏ჌̝౵

ܜု׻²²Ą฼ࢴΙྮ֧༼ט۞ҁဂĂ΃ᔁిதྵ

ၙĂវ໢ྵҲĂకϨኳ̈́Νউ८Ꭴ८ᅕউ̼̝ଐ ڶྵᅅ຋ĂТॡѣྵҲ۞ҕ୵਍फ৵̈́ D H E A

፧ޘ²³Ąࡶ૟Тᇹ۞ܜഇ฼ࢴΙྮ֧༼טϡٺˠ ᙷٕߏ׎΁Ϡ׻ഇޝܜ۞ࣲ֯જۏĂߏӎΞͽய ϠᙷҬ۞ඕڍĂϫ݈̪൑ۡତᙋፂĄᔵᄲтѩĂ ϫ݈ቁ၁̏ѣ˘ֱมତᙋፂ͚޺฼ࢴΙྮ֧༼ט ਕૉдˠវயϠᄃ၁រજۏᙷҬ۞ඕڍĄ

͟ώল஧ ( ՞ᘰĂ Okinawa ) اҝ඾͵ࠧ˯͌

֍ܜု۞ˠ˾Ă Kagawa^{2 4}੫၆͟ώ՞ᘰاϔ۞

฼ࢴซҖ̶ژĂ൴னѐᅅጯϠ฼ࢴ۞Ιྮ֧ᇴ่

ѣ͟ώ׎΁гડጯϠᛷפณ̝ 6 2 % Ą՞ᘰјˠ

۞฼ࢴĂಶకϨኳ̈́਌ኳ۞ᓁณֽᄲĂᄃ͟ώ׎

΁гડߏ˘ᇹ۞ćҭߏಶΙྮ֧ᇴ҃֏Ăݒྵ͟

ώ઼छπӮࣃ͌˞ 2 0 % Ą՞ᘰاϔЯࠎཝҕგ

়ঽăᒛাٕ͕᝙ঽ҃Ѫ˸۞ˠᇴ̶Ҿ่ѣ͟ώ

׎΁г͞۞ 59% ă 69% ă 59% Ą՞ᘰاϔࡶߏ ᗓฟ՞ᘰ҃ז͟ώ׎΁г͞اҝĂ֭ͷ٦ୢ΁ࣇ

ࣧѣ۞Ϡ߿͞ёĂ׎Ѫ˸த૟̪ͧاҝٺ՞ᘰ۞

ˠֽ଀੼²⁵Ą

Ϡۏ઻ 2 ཱི ( Biosphere 2 ) ۞၁រ˵ຍγг೩

ֻ˞˘Ѩᙯٺ฼ࢴΙྮ֧༼ט۞ˠវྏរĄϠۏ

઻ߏ˘࣎ࢬ᎕੼྿ 12750 π͞Ѽ֭ͽࠟሬ̈́ܛᛳ ᄃγࠧ࿣඗۞ˠౄᒖဩĂ྆ࢬ۞Ϡၗೀͼҋගҋ

֖Ăྫྷγ̝ࠧมೀͼ՟ѣۏኳ۞߹఼Ąଂ 1991 ѐ 9 ͡ 26 ͟ז 1993 ѐ 9 ͡ 26 ͟Ă 8 Щઉ૵јѐ ˠ ( 4 ЩշˠĂ 4 Щ̃ˠ ) ҝдϠۏ઻ 2 ཱི྆ࢬĂ д఺߱ॡม̰ĂϠۏ઻ ( Β߁఺ཏˠ)ᄃγࠧԆБ

࿣඗Ąҭߏ̙ض۞Ă఺߱ॡม჌ങ۞ࢴۏдณ˯

͌ٺ౵ܐ۞ҤზĂٺߏ఺ 8 Щјѐˠགྷ።˞ຍफ़

̝γ۞฼ࢴΙྮ֧༼טĂॡมܜ྿׌ѐ²⁶Ąགྷ࿅

˞఺߱ॡม۞฼ࢴΙྮ֧༼טĂ఺ 8 Щјѐˠੵ

˞൴Ϡព඾۞វࢦഴᅅγĂ̙ኢߏдϠநጯăҕ

୵ጯă፬৵͞ࢬٕߏϠۏ̼ጯ޽ᇾ˯࠰Ξͽ࠻ז ត̼²⁷Ă҃ͷ఺ֱត̼ᄃ̝݈ҁဂ၁រ۞ඕڍ࠹

༊ćপҾߏĂ఺ 8 Щјѐˠវ̰ѣྵҲ۞ҕᎤă ҕ୵਍फ৵ăϥېཛྷ፬৵ ( T3 ) ፧ޘ̈́ DHEA ፧ ޘĄ

౵ܕĂд઼઼࡚छ኎Ϡࡁտੰ̂˧۞ྤӄ

˭Ă Heilbronn ඈˠ²⁸ϒซҖ˘ีᚑᖰ۞฼ࢴΙ

ྮ ֧ ༼ ט ۞ ᐌ ፟ ᓜ Ԗ ၆ ໰ ྏ រ Ă ᖎ Ⴭ CALERIEĄ׎ௐ˘ล߱۞၁រјڍϺٺ 2006 ѐ Ώ൳ٺ J A M A Ă׎͹ࢋϫᇾߏຐۢ྽វࢦ࿅ࢦ

۞ઉ૵ˠдซҖܜ྿̱࣎͡۞฼ࢴΙྮ֧༼ט ޢĂߏӎົдវ໢ăϥېཛྷΑਕăউ̼۞ᑅ˧˯

ͽ̈́˘ֱᄃܜု࠹ᙯ۞Ϡநણᇴ͞ࢬ൴ϠԼតĄ

఺྆ "ᄃܜု࠹ᙯ۞Ϡநણᇴ" ޽۞ߏҕ୻਍फ

৵፧ޘăវ໢̈́ Dehydroepiandrosterone ( DHEA )

፧ޘĂЯࠎॲፂ઼࡚˘ี̂ఢሀ۞݈ᖀّ੠ᖸ៍

၅၁រ- Baltimore Longitudinal Study of Aging ( BLSA )²³Ăඕڍ޽΍ҕ୻۩ཛ਍फ৵ࣃҲăҕ

୵̚ D H E A ፧ޘҲٕߏវ໢ྵҲ۞ˠĂྵѣΞ ਕ߿۞˳ĂЯѩ఺ˬ࣎޽ᇾ૱జүࠎˠᙷܜု̝

޽ᇾĄ

CALERIEྏរ̚ѣ 48 Щઉ૵շّ׶ّ̃జ ᐌ̶፟੨זα௡Ă၆໰௡ତצ۞฼ࢴΙྮ֧ณࠎ ਕณᅮՐ۞ 100% Ă˘௡۞฼ࢴΙྮ֧͌˞ᅮՐ ณ۞ 2 5 % Ă˘௡۞฼ࢴΙྮ֧͌˞ᅮՐณ۞

1 2 . 5 %̝γᔘ଀ᗝγᖣϤྻજঐਈ 12.5% ۞ਕ ณĂΩγ˘௡ՏˠΪᛷפܧ૱ҲΙ۞฼ࢴ ( 890 kcal /d ) ۡזវࢦ˭ࢫ྿ֽࣧ۞ 15% Ă̝ޢ݋ᛷ פ֖ͽჯ޺ѩវࢦ̝Ιྮ֧ณĄඕڍ޽΍Ă฼ࢴ Ιྮ֧༼טቁ၁ਕૉࢫҲҕ୻۩ཛ਍फ৵ࣃ׶វ

໢Ă׌۰ౌᄃˠᙷܜုѣᙯܼĄགྷ።฼ࢴΙྮ֧

༼ט۞צྏ۰Ă˵ѣྵҲ۞΃ᔁిதҡᐌྵҲ۞

ҕ୻ϥېཛྷ፬৵ ( T3 ) ፧ޘͽ̈́ྵ͌۞ DNA উ̼

ّຫच ( oxidative damage of DNA )Ąԧࣇϫ݈̙

ۢ฼ࢴΙྮ֧༼ט۞ॡมՀܜͷצྏ۰ᇴϫՀк

۞ᓜԖྏរĂΞӎயϠᙷҬ۞ඕڍĂࠤҌߏѣؼ

(4)

ܜု׻۞ड़ڍĄҭ฼ࢴሤณ۞༼טΞͽ྿јܜု

ٙᅮጾѣ۞Ϡந޽ᇾĂ̙ߏΪѣሴ֗ഴ۲҃̏Ą (˟)Ϡ߿ݭၗ ( lifestyle factors )

1.ᔖҺ੼Пᐍ̝Җࠎ

̙Ӏٺܜုϫᇾ۞੼ПᐍҖࠎѣ٩ඵă̙։

฼ࢴ௫ၚă͌ྻજăಅ੧ă຋Ϡۏຏߖăତᛈᒖ ဩ߲ۏăПᐍّҖࠎă߉ϡ߲ݡĄଂ͵ࠧ˯̍ຽ

઼̼छ۞௚ࢍ ( Β߁ᄂᝈд̰ )ĂΞͽ൴னౄј ˠᙷѝీ۞ࣧЯ̙γͼᄃѩ૜̷࠹ᙯĄέ៉ඵᝒ

۰ѣ 480 ༱ˠĂ̂ࡗՏѐѣ 19,000 ˠѪٺᄃӛඵ ѣᙯ۞়ঽ^{2 9}Ąҋଂ 1982 ѐͽֽĂᒛা˘ۡߏ έ៉ˠϔѪЯ۞͹ࢋࣧЯĄӛඵົጱ࡭۱ᒛĂ҃

۱ᒛ˘ۡߏέ៉̣჌૱֍ᒛা̝˘²⁹ĄܕѐֽЯ ᎤԌঽă੼ҕᑅ̈́ཝҕგ়ঽ҃Ѫ˸۞ˠᇴϒԣ

ిᆧΐ²⁹Ă఺ˬ჌়ঽϒрౌᄃ฼ࢴ׶৿ͻ߿જ ѣᙯĄ̍ຽ̼׶ౌξ̼ٙ૲ֽ۞Ϲ఼൴ण̏གྷጱ

࡭ЯᖚຽٕϹ఼ְ߇Ѫ˸ˠ˾۞ԣిۊ̿²⁹Ąд έ៉ੵ˞ඵă੧׶ᕠຼ̝γĂ˵ѣ෸ֽ෸к۞ѐ ᅅˠӛࢴ߲ݡĂּтщܧ΁׻ă flunitrazepam ٕ ۰ FM2 ă MDMA ٕ۰ ecstacy²⁹Ą఺ֱ੼Пᐍ۞

ҖࠎĂܳјధкˠࡻѐѝీćຐܜ׻Ѻ໐Ăυื

ᔖҺߖ˯ѩᙷೋ௫Ą

2.ଂְઉ૵۞Ϡ߿үि߿જ ( healthy lifestyle )

ଂְઉ૵۞Ϡ߿үिĂΞͽܳซܜုϫᇾ۞

྿јĄ׎̚۞ઉ૵Ϡ߿үि߿જ޽۞ߏઉ૵۞฼

ࢴăѣఢޠ۞ଂְܡ˧ ( resistance ) ᄃѣউ ( aer- obic )ྻજăᘦؠгჯ޺ྵҲ۞֗វኳณ޽ᇴ ( B- MI )ͽ̈́ᔖҺӛඵĄ

ಶͽд՞ᘰซҖ۞ࡁտֽᄲĂ׎اϔܜု۞

ࣧЯࠎңĉࡁտ޽΍՞ᘰاϔ۞ܜုᄃઉ૵۞Ϡ

߿ሀёѣᙯܼĄ՞ᘰاϔ۞฼ࢴͽങۏّࢴՄࠎ

͹ĂͷҲៃăҲ਌۹Ă਌۹݋ͽಏ̮̙࿸׶਌۹ ( monounsaturated fat ) ࠎ͹ćѩγĂѣఢޠ۞֗

វ߿જ ( ྺг̍ү׶็௚ᄅᔏ ) ˵ߏ΁ࣇϠ߿۞

˘ొЊ³⁰Ą

˘ ี ੫ ၆ ࡚ ઼ ΐ э ۞ ૄ ༛ ೇ ᓜ щ ि ͟ ົ ( Seventh Day Adventist )јࣶ۞ઉ૵ࡁտĂ൴ன

׎ିົјࣶ̝ٙͽѣྵ˘ਠˠܜ۞ု׻ĂߏЯࠎ ѣઉ૵۞Ϡ߿үि߿જĄඕڍ޽΍Ăಏ৷۞ઉ૵

฼ࢴăྻજ̈́ᔖҺӛඵ૟Ξͽࠎ࿰ഇ۞ု׻ؼܜ 7Ҍ 10 ѐ²Ą

ΩγĂ˘ี੫၆ᑪࢶֲཱྀ̋اϔซҖ۞ܜ྿

4 0ѐ̝݈ᖀّ៍၅၁រ ( H o n o l u l u H e a r t Program/Honolulu Asia Aging Study )³¹Ăඕڍ޽΍

Ϊࢋߏ̚ѐฟؕಶѣઉ૵۞Ϡ߿௫ၚĂপҾߏצ

੼ඈିֈăѣૻ۞೪˧ ( high grip strength ) ͷ՟

ѣ࿅ࢦ ( overweight )ă੼ˬᅕϟڵ਌ҕা ( hy- pertriglyceridemia )ă੼ҕᎤ ( hyperglycemia)ă੼

ҕᑅ ( hypertension )ăӛඵͽ̈́฼੧࿅ณ۞ଐ ڶĂಶΞͽֳצྵܜ˳ͷઉ૵۞˘ϠĄ఺ֱ൴ னĂᄃ՞ᘰࡁտԆБ௑ЪĂளѡТ̍Ą

ᓁ̝Ăܜု֭ܧѺ໐ˠ༄̈́׎छ୉ٙপѣĂ Ϊࢋߏ̈́ѝଂְઉ૵۞Ϡ߿үिͷᅈᗓ̙Ӏܜု

۞੼ПᐍҖࠎĂˠˠѣ፟ົ߿۞˳ͷઉ૵Ąଂ݈

ѣήྖᄲ "ˬ໐ؠ˘Ϡ"Ăனѣ۞ࡁտ࠻ֽĂ̚ѐ ॡഇ۞˘ֱϠந޽ᇾĂ֖ͽ࿰ീϏֽܜု้̝

ШĄ

јΑҁ̼ ( successful aging )

ˠࣇԓ୕щֳ୎ѐĂӈֹˠϠ̏ߏ́วĂݒ

ֶ൒ਕҺੵϠநണᅪĂჯ޺ྵ੼۞ᄮۢă֗វ׶

ۤົΑਕĂ఺ߏјΑҁ̼³²ĄјΑҁ̼۞ҁˠĂ ӈֹ൑ڱܜုĂ୎ѐ̂ొЊ۞ॡมౌਕჯ޺ઉ

૵Ă̙҃Тٺ˘ֱҁˠᔵ߿଀˳ݒ߿଀̙рĄѐ

᛬ߏޝкၙّঽ۞ПᐍЯ̄ĂధкҁˠᎮଈ˘჌

ࠤҌᇴ჌ၙّঽĄ༊̂кᇴҁѐˠЯЧёЧᇹ۞

ၙّঽٙࡴĂ҃ѣ඀ޘ̙˘۞Ϡ߿Αਕᅪᘣ̈́Ϡ

߿ݡኳָ̙۞ଐԛॡĂ ݒ˵ѣ˘ཏҁˠֶ൒ਕ

ૉჯ޺ೀͼϒ૱۞Ϡ߿ΑਕĂͷ޺ᜈрೀѐĂۡ

זତܕϠ׻Ⴝᐝ۞݈˘߱ॡม̖΍னΑਕಉε̝

ଐԛ³²Ąೱ֏̝Ăҁˠ̝มхдໂ̝̂मளّĂ

҃јΑ۞ҁ̼ឰ໐ᇴᆧ୹˞Ϡ׻۞ຍཌྷ׶ಈॆĄ ࡁ տ ޽ ΍ ј Α ҁ ̼ ۞ ҁ ˠ ࡗ ҫ ҁ ˠ ۞ 35.8%Ă׎၁ࠎᇴ̙͌³³ĄјΑҁ̼ҁˠ۞хдĂ ҥᙋ˞ Fries ٺ 1980 ѐٙ೩΍۞Ꭾঽഇᑅᒺ઄ᄲ ( Compression of Morbidity Paradigm )³⁴ĂϺӈт ڍਕૉؼቤϠநᅪᘣٕ۰׎΁ঽې۞൴ϠĂ҃ͷ ؼቤ۞ѐᇴ̂ٺϠ׻ഇؼܜ۞ѐᇴĂ˘࣎ˠд୎

ѐٚצ়ঽٙࡴ۞ॡม૟ΞͽజᑅᒺĂಶтТဦ

˘ ( d ) ٙϯĄ࠹ͅ۞Ă઄т่ѣϠ׻ഇ۞ؼܜ҃

՟ѣؼቤϠநᅪᘣٕ۰׎΁ঽې۞൴ϠĂٕߏޢ ۰ؼቤ۞඀ޘ̙̈́Ϡ׻ؼܜ۞඀ޘĂ૟ົֹ଀˘

(5)

࣎ˠд୎ѐٚצ়ঽٙࡴ۞ॡม̙ҭ՟ѣഴ͌ࠤ ҌߏؼܜĂಶтТဦ˘ ( b ) ( c ) ٙϯĄ

F r i e s༊ॡ೩΍ѩีᎮঽഇᑅᒺ઄ᄲॡĂ֭

̙ࠎ༊ॡ̂кᇴጯ۰ᄮТĂЯࠎ֭՟ѣ͚޺۞ᙋ ፂĄ൒҃Ϥٺܕֽᗁጯԣి۞൴णĂֹ଀ధкၙ

ّঽ଀ͽజѣड़ଠטĂּт੼ҕᑅăᎤԌঽă݄

ېજਔ়ঽăᙯ༼ۆ۞ଠטăˠ̍ᙯ༼ആೱఙ ඈĂͽ̈́ԧࣇ၆ٺ˘ֱ૱֍়ঽ̏൴ण΍ѣड़۞

࿰֨͞ёĂּт̂བᒛᎡᑭă߹ຏ׶۱ۆ஧ෂ۞

ࠪࡺăͽܠ೻̽ڒ࿰͕֨᝙়ঽඈĂԧࣇϒϫ༜

Ꭾঽഇᑅᒺ۞ᔌ๕³⁵Ąଂధк̂ఢሀ۞አߤ³⁵Ă Β߁ National Long-Term Care Survey ̈́ National Health Interview SurveyĂౌΞͽ൴னҋ 1982 ѐ ฟؕҁˠ֗វണᅪϒͽ̂ࡗՏѐ 2% ۞ిத̙ᕝ

۞ഴ͌Ă࠹ྵٺѪ˸தՏѐ 1% ۞˭ࢫిதߏԣ

଀кĂ֖ͽᙋځҌ͌д઼࡚Ꭾঽഇᑅᒺϒు႙ซ Җ̚ĄᎮঽഇᑅᒺਕࠎன̫͟ৈᚑࢦ۞ҁˠઉ૵

યᗟ೩΍ྋՙ͞ёĂЯࠎ׎ਕֹۤົ̚ᅮࢋତצ ᗁᒚ૜̷໰ᜪ۞ҁˠഴ͌ĂЯѩԧࣇڟᇐ࠻זᎮ ঽഇᑅᒺ۞ᔌ๕ϒд˯ႊĄ

൒҃Ă఺ᇹ۞ᔌ๕Ξͽ޺ᜈк˳ĉଂ 1 8 5 0 ѐͽֽˠᙷ࿰ഇု׻ಶ̙ᕝͽۡቢ˯̿۞͞ёᆧ ΐĂ҃ͷϏֽ˵Ҭͼ՟ѣഴቤᆧΐ۞ᔌ๕³⁶ĂΪ

ࢋု׻ؼܜ۞ిத෹࿅Ꭾঽؼቤ۞ిޘĂ˵ಶߏ ᙷҬဦ˘ ( b ) ۞ଐԛĂᎮঽഇᑅᒺ૟ົঐεĄٙ

ͽԧࣇϫ݈ࢵࢋ̝ચĂߏࢋԱ΍Հѣड़۞ؼᏵᎮ ঽ̝͞ڱĂͽჯ޺ٕࠤҌΐిᎮঽ۞ؼޢిޘĂ ͽ྿Ꭾঽഇᑅᒺ̝ඕڍĄ

јΑҁ̼۞ҁˠ૱ѣͽ˭পᇈ³³Ĉ̙٩ඵă

֗វ߿જณ̂ăྵкۤϹ߿જăр۞ઉ૵ҋԧෞ

ᆊăྵ͌۞֗វ়ঽă՟ѣᇎ៭াă՟ѣᄮۢΑ ਕᅪᘣă՟ѣᙯ༼ۆ׶ᎤԌঽĄ݈ᖀّ៍၅၁រ Ә෦ԧࣇĂઉ૵۞Ϡ߿௫ၚቁ၁Ξͽѣड़гֹᎮ ঽؼቤ൴ϠĄྻજăᔖҺ٩ඵăᅈᗓ۲ࡡăᛷפ ઉ૵฼ࢴᙋ၁ΞͽࢫҲ֗វᅪᘣ ( disability ) ۞൴ Ϡ^{3 3}Ąࢦࢋ۞ߏĂ఺ֱϠ߿௫ၚౌߏΞͽԼត

۞Ă҃ͷӈֹߏѐࡔ̂˞̖ฟؕԼචϠ߿үिĂ

ֶ൒ົѣઉ૵˯۞ड़ৈ³³ĄϤѩΞ֍Ăઉ૵ܳซ ( health promotion ) ၆ٺјΑҁ̼̝ࢦࢋّĄѩ γĂଠטͷᔖҺ૱֍ၙّঽ̝ПᐍЯ̄Ξͽѣड़

࿰֨ၙّঽĂ༊൒˵ߏјΑҁ̼ࢦࢋ୧І³³Ą ࡁտ޽΍̚ѐॡഇ۞˘ֱઉ૵޽ᇾΞͽ࿰ۢ

୎ѐߏӎΞͽјΑҁ̼^{3 7 , 3 8}Ăּт͕ҕგ়ঽП ᐍЯ̄ă֗វኳณ޽ᇴă֗វ߿જΑਕ ( ͘ొ೪

˧ăᙔӱྏរ ( squatting test ) ) ඈĄΩγĂ˘ֱ

૱֍۞ҁˠયᗟ^{3 9}ĂညߏᄮۢΑਕᅪᘣăᇎ៭

াă฀ࣆăε༰ăវࢦ࿅ᅅăຶোăෛ˧ᅪᘣă

᝘˧ᅪᘣඈĂ࠰ᄃ֗វΑਕᅪᘣ۞΍னѣᙯĄЯ ѩଯજјΑҁ̼Ăੵ˞၆ٺၙّঽ೩ֻፋЪّᗁ ᒚ໰ᜪăઉ૵ܳซγĂՀυืචϡ૞ຽ೩ѝ൴ன

˯ࢗҁˠ૱֍યᗟĂ᎕ໂග̟ڼᒚٕԼචĂᔖҺ ᗁ໚ّયᗟĂՀࢦࢋ۞ߏ૟ϫᇾଂڼᕽ়ঽொᖼ זϠ߿Αਕ̈́ݡኳ۞೩̿ĂЯࠎ։р۞Ϡ߿Αਕ

̈́ݡኳ˜јΑҁ̼̝८͕Ą

ဦ̚ፖቢ΃ܑॡมĂνᙝ቏ᐝܑϯᎮঽฟؕ۞ॡมĂΠ ᙝ቏ᐝܑϯѪ˸۞ॡมĂѷҒ͞॰ܑϯ֗צၙّঽٙࡴ

҃ѣϠ߿Αਕᅪᘣ۞ॡഇĂ఺α࣎ဦϯ̶Ҿ۞ຍޥ̝̈́

ม۞मளт˭̝ࢗᄲځĈ(a)઄నனдҁˠπӮд 55 ໐ ฟؕಶЯၙّঽٙࡴ҃ѣ඀ޘ̙˘۞Ϡ߿Αਕᅪᘣ̈́Ϡ

߿ݡኳָ̙Ă҃πӮု׻ࠎ 75 ໐ć(b)ࡶԧࣇΪߏຐႽ Ᏹڱֹ଀ု׻ؼܜ(Π቏ᐝΠொ)҃ϏֹᎮঽؼޢ൴ϠĂ

૟ֹ଀ۤົ̂̚кᇴҁˠ߿۞˳ݒ߿̙рĂ୎ѐٚצ়

ঽٙࡴ۞ॡม҃ͅᆧΐ( ׌቏ᐝ෼ᗓត̂ĂᎮঽഇؼ ܜ)ć(c)ࡶԧࣇ̙ҭֹ଀ု׻ؼܜ(Π቏ᐝΠொ)Ăᔵ൒

˵ֹᎮঽؼޢ൴Ϡ(ν቏ᐝΠொ)Ăҭؼޢ۞ѐᇴᄃု׻

ؼܜ۞ѐᇴ࠹༊Ăҁˠ୎ѐٚצ়ঽٙࡴ۞ॡม֭՟ѣ Լត(׌቏ᐝ෼ᗓ̙តĂᎮঽഇ̙ត)Ăֶ൒ᅮࢋ࠹༊඀

ޘ۞ᗁᒚ໰ᜪć(d) ࡶԧࣇ̙ҭֹ଀ု׻ؼܜ(Π቏ᐝΠ

ொ)ĂՀֹᎮঽؼޢ൴Ϡ(ν቏ᐝΠொ)Ă҃ͷؼޢ۞ѐᇴ

ྵု׻ؼܜ۞ѐᇴܜĂҁˠ୎ѐٚצ়ঽٙࡴ۞ॡม૟

జᒺൺ(׌቏ᐝያܕĂᎮঽഇᑅᒺ)Ă߿଀˳ͷрĄᎮঽ ഇᑅᒺᄃӎפՙٺ׌቏ᐝ̝࠹၆ொજĄ

ဦ˘ĈᎮঽഇᑅᒺநኢ

³⁴

(6)

ඕኢᄃᅈഀ

јΑҁ̼׶ܜု૟ࠎ੼᛬̼ۤົ͟ৈᚑࢦ۞

ᗁᒚયᗟ೩ֻྋՙ۞͞ڱĄˠᙷု׻ϤૄЯ׶ᒖ ဩЯ৵ՙؠĂܜု่̙ᅮࢋઉ૵۞Ϡ߿௫ၚĂ҃

ͷѣᏥ֗វ̰д၆়ঽ۞ԩّĂޢ۰ᄃૄЯѣ࠹

༊۞ᙯܼĂͷΞͽᖣϤѺ໐ҁˠ᏷็ጯ۞ࡁտᒔ

଀Հஎˢ۞˞ྋĄѩγĂܜഇ੠ᖸࡁտˠ༄̈́׎

̝̄̃ૄЯݭ ( genotype ) ᄃܑݭ ( phenotype )Ă

૟ѣӄٺՀซ˘Վ˞ྋૄЯᄃᒖဩЯ৵۞Ϲ̢ү ϡĄ၆ٺ฼ࢴΙྮ֧༼טͽ̈́׎΁Ϡ߿௫ၚ၆ု

׻۞ᇆᜩĂ˵ᅮࢋซ˘Վ۞ࡁտֽរᙋĄѩγԧ ࣇ่̙ຐࢋ߿଀˳Ă˵ຐࢋ߿଀рĂјΑ۞ҁ̼

Ξͽቁܲன̫ᗁᒚซՎٙؼܜ۞Ϡ׻׍ѣр۞ݡ ኳĄࠎ˞ਕૉјΑ۞ҁ̼Ăܲ޺ઉ૵۞Ϡ߿௫ၚ

֭ͷᔖҺၙّঽ۞ПᐍЯ̄ߏυࢋ۞ĄϏֽᅮࢋ

ซ˘Վ۞ࡁտֽቁؠপؠ۞̬ˢԼតନ߉ߏӎΞ ͽܳซјΑҁ̼ĂপҾߏፋЪّгͽ֗វΑਕ̈́

Ϡ߿ݡኳࠎࢦᕇ۞ᗁᒚ໰ᜪሀёĄѩγĂԧࣇ˵

ᅮࢋޙϲᓜԖෞҤ޽ᇾĂϡͽᎡᏴ΍Ξਕ೩ѝ൴ Ϡ֗វΑਕੜ̼۞ˠĂͽӀӈѝ̬ˢĄ

ણ҂͛ᚥ

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Longevity and Successful Aging

I-Chien Wu, Liang-Cheng Hahn, and Xi-Zhang Lin

As the population ages worldwide, promoting the well being of the elderly is becoming an important public health issue. Centenarians, who live not only a long and productive life but also a good, vigorous and disability- free life, could be considered a model of longevity and successful aging. Longevity depends on both specific long- life genes and healthy lifestyles. For most people, lifestyles are modifiable factors that could be adopted into dai- ly activities. The components of healthy lifestyles are identified as regular exercise, appropriate diets, and avoid- ance of smoking. Recent studies indicate that the restriction of calorie intake, as well as genetic predispositions play major roles in longevity, which deserve further investigations. Successful aging in general population can be evaluated by the model of morbidity compression. In addition to the prevention and treatment of chronic diseases, implementation of healthy lifestyle and avoiding or alleviating common geriatric syndromes(depression, falls, in- continence, low body mass index, dizziness, vision and hearing impairment, etc) are all required for successful aging. Identifying valid aging clinical markers as well as improving the delivery of health services will ultimately facilitate successful aging for all generations, which is long-waited for our societies. ( J Intern Med Taiwan 2008;