代謝症候群在生物心理社會模式之考量

Biopsychosocial Issues in the Metabolic Syndrome

代謝症候群(metabolic syndrome)與以後導致第二型糖尿病、心臟血管疾病及整體死亡率有極強的相關性，因此是近年來受到全世界重視的主題之一，更是國民健康局預防國人十大死因特別要強調的主題。其成因可能與先天遺傳、胎兒的營養失調(fetal malnutrition)、人口學等生物因素有關，但最重要的還是全世界靜態生活型態(sedentary lifestyle)、肥胖人口增加、生活壓力及其他不良健康行為等心理社會因素所造成，因此其應被視為是一種典型涵蓋生物心理社會(biopsychosocial; BPS) 層面的疾患。BPS model對疾病而言，提供一個現代醫學整體觀的(holistic)概念，此模式可解釋目前非治癒性或心理精神為主的疾病形態，因此目前是考量疾病病因最好的模型，然為了教學方便，或許可將健康行為(healthy behavior)獨立出來，將其列在精神心理（個體）與社會面向之間，將BPS model修改為BPHS model，更可彰顯健康行為(healthy behavior; lifestyle)對代謝症候群的重要性。本文嘗試以預防醫學中重要的代謝症候群，以生物心理社會模式進行病因及處置之探討，以提供臨床應用及畢業後一般醫學訓練(PGY)全人醫療的教學參考。

The metabolic syndrome is a typical biopsychosocial (BPS) disorder that results from genetic predisposition, fetal malnutrition, demographic factors, enormous growth of obesity individuals over the world, life-stress, sedentary lifestyle and abnormal healthy behaviors. The importance of the metabolic syndrome is to predict the intentioned development of type 2 diabetes mellitus and cardiovascular disease, so it was highlighted by the world health care and the Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan). The biopsychosocial model is an approach to medicine which stresses the importance of a holistic approach in the modern medicine. It considers factors outside the biological process of illness when trying to understand health and disease. This article addressed the etiology and management of the metabolic syndrome with the biopsychosocial dimensions. The biopsychosocial model has provided a modern holistic interpretation of medical disease and illness and a framework for future studies that will increase our understanding and knowledge of the relationship between psychological processes, the metabolic syndrome susceptibility, and clinical outcomes. The BPS model may be modified to BPHS model due to the importance of healthy behavior in the metabolic syndrome for teaching purposes. We explored the etiology and management of the metabolic syndrome in biopsychosocial dimensions to offer the reference of clinical usage and post-graduate-year (PGY) teaching program of total care.