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] | สุริยุปราคา 5 ธันวาคม พ.ศ. 2591
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 5 ธันวาคม พ.ศ. 2591 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 5 ธันวาคม พ.ศ. 2591
ภาพเคลื่อนไหวแนวเส้นทาง |
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] | สุริยุปราคา 25 พฤศจิกายน พ.ศ. 2592
สุริยุปราคาผสมจะเกิดขึ้นในวันที่ 25 พฤศจิกายน พ.ศ. 2592 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 25 พฤศจิกายน พ.ศ. 2592
สุริยุปราคานี้สามารถเห็นได้เป็นสุริยุปราคาบางส่วนในประเทศไทยในช่วงกลางวัน แนวคราสเริ่มสัมผัสผิวโลกเป็นสุริยุปราคาวงแหวนในทะเลแดง ผ่านประเทศซาอุดีอาระเบียและประเทศเยเมน จากนั้นแนวคราสจะพาดผ่านพื้นที่ส่วนมากในมหาสมุทรอินเดีย และเริ่มเปลี่ยนเป็นสุริยุปราคาเต็มดวงทางทิศตะวันตกเฉียงใต้ของประเทศอินเดียในมหาสมุทรอินเดีย จากนั้นแนวคราสเต็มดวงจะผ่านจุดที่คราสบดบังมากที่สุด บริเวณนอกชายฝั่งประเทศอินโดนีเซีย ห่างจากเกาะซิเบรุตไปทางทิศตะวันตกเฉียงใต้ประมาณ 500 กม. จากนั้นแนวคราสจะพาดผ่านตอนใต้ของเกาะสุมาตรา ตอนใต้ของเกาะบอร์เนียว ตอนกลางของเกาะซูลาเวซี ตอนกลางของจังหวัดมาลูกูเหนือ และเปลี่ยนกลับมาเป็นสุริยุปราคาวงแหวนอีกครั้ง ก่อนจะไปสิ้นสุดในมหาสมุทรแปซิฟิก |
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] | สุริยุปราคา 25 พฤศจิกายน พ.ศ. 2592
ภาพเคลื่อนไหวแนวเส้นทาง |
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หมู่เกาะอามามิ () เป็นหมู่เกาะในหมู่เกาะเซ็ตสึนะซึ่งเป็นส่วนหนึ่งของหมู่เกาะรีวกีวและอยู่ทางตะวันตกเฉียงใต้ของเกาะคีวชู ในทางปฏิบัติกลุ่มนี้เป็นของจังหวัดคาโงชิมะของประเทศญี่ปุ่น หน่วยงานภูมิสารสนเทศของญี่ปุ่นและหน่วยยามฝั่งญี่ปุ่นตกลงกันเมื่อวันที่ 15 กุมภาพันธ์ 2010 เพื่อใช้ชื่อ "อามามิ-งุนโต" (奄美群島) สำหรับหมู่เกาะอามามิ ก่อนจากนั้นก็มีการใช้ชื่อเป็น "อามามิ-โชโต" (奄美諸島) ชื่อของอามามิอาจเกี่ยวข้องกับอามามิคีว (阿摩美久) เทพธิดาแห่งการสร้างตามตำนานของศาสนารีวกีว |
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] | ไนน์บายนาย
ไนน์บายนาย (อังกฤษ: Nine By Nine) เขียนเป็น 9x9 เป็นโปรเจกต์พิเศษของศิลปินสัญชาติไทย ซึ่งเป็นโปรเจกต์พิเศษที่รวมศิลปินจำนวนทั้งหมด 9 คนมารวมตัวกันเพื่อพัฒนาการเป็นศิลปิน ไม่ว่าจะเป็น การแสดง การร้อง การเต้น ฯลฯ โดยได้สมาชิกมาจาก 3 ค่าย ประกอบไปด้วย โฟร์โนล็อก, นาดาวบางกอก และจีเอ็มเอ็ม แกรมมี่ โดยจะดำเนินกิจกรรมและจบลงด้วยคอนเสิร์ตใหญ่ 4 ภาค โดยไนน์บายนาย ได้ประกาศชื่อแฟนคลับอย่างเป็นทางการในชื่อ NIGHT (ไนต์) ปัจจุบันวงอยู่ภายใต้การบริหารของโฟร์โนล็อก |
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คุณอนุวัติ วิเชียรณรัตน์ ประธานบริหาร บริษัท โฟร์โนล็อก จำกัด ได้กล่าวไว้ว่า โปรเจกต์นี้ใช้เวลาในการพัฒนามากว่า 2 ปี ได้คิดกลยุทธ์เพื่อสร้างสรรค์และผลิตคอนเทนต์ออกมาให้ทุกคนได้ติดตามแบบปูพื้นเต็มทุก Platform ครั้งแรกในประเทศไทย เริ่มจากการแสดงในซีรีส์ทางช่อง Digital TV ที่ได้ทรงยศ สุขมากอนันต์มารับหน้าที่ผู้กำกับ ทางฝั่งออน์ไลน์และโซเชียลมีเดียนั้น จะผลิตชิ้นงานเพื่อสื่อสารกับกลุ่มแฟนคลับ และการสื่อสารคอนเทนต์ผ่านพาร์ทเนอร์ชื่อดัง ส่วนงานด้าน Music Content จะมีการทำงานร่วมกับพาร์ทเนอร์ทั้งในไทยและต่างประเทศ อาทิ JYP Entertainment, LOVEiS ฯลฯ และปิดจบด้วยคอนเสิร์ตใหญ่ 4 ภาค เป็น Full IMC Campaign สำหรับ Teen Target รูปแบบใหม่ที่ครอบคลุมการตลาดครบทุกช่องทางมากที่สุดครั้งแรกในประเทศ |
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ทางค่ายโฟร์โนล็อกนั้น ได้มีการเปิดตัว Teaser ของวงมาอย่างเป็นทางการครั้งแรกเมื่อวันที่ 20 กุมภาพันธ์ 2018 จึงเป็นการเริ่มต้นโปรเจกต์พิเศษนี้นับตั้งแต่นั้นมา โดยได้สมาชิกที่เป็นศิลปินทั้งหมด 9 คนที่มาจากการคัดเลือก มารวมตัวกันเพื่อฝึกการเป็นศิลปิน โดยได้เปิดตัวในฐานะศิลปินเป็นทางการในวันที่ 8 พฤษภาคม 2561 ณ พาร์คพารากอน |
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] | ไนน์บายนาย
ต่อมา ทางวงก็ได้เปิดตัวมินิอัลบั้มตัวแรกชื่อว่า En Route และได้เดบิวต์ด้วยเพลงแรกที่มีชื่อว่า NIGHT LIGHT โดยได้ร่วมงานกับ Rachel Cl Lee จาก YG Entertainment ผู้เคยร่วมงานกับ BIGBANG, 2NE1, iKON ฯลฯ และกำกับ MV โดย Lee Sang Deok ผู้อยู่เบื้องหลังการทำงานของศิลปินเกาหลีอย่าง Twice และอื่นๆอีกมากมายจากประเทศเกาหลีมาเป็นผู้กำกับมิวสิควิดีโอให้อีกด้วย |
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] | ไนน์บายนาย
หลังจากที่ มิว ชิษณุชา ได้ถอนตัวออกจากวง ทำให้ ริว วชิรวิชญ์ ได้เข้ามาแทนในวันที่ 21 มีนาคม 2561 |
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] | สุริยุปราคา 20 พฤษภาคม พ.ศ. 2593
สุริยุปราคาผสมจะเกิดขึ้นในวันที่ 20 พฤษภาคม พ.ศ. 2593 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 30 มีนาคม พ.ศ. 2595
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 30 มีนาคม พ.ศ. 2595 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 12 กันยายน พ.ศ. 2596
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 12 กันยายน พ.ศ. 2596 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 24 กรกฎาคม พ.ศ. 2598
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 12 กันยายน พ.ศ. 2596 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | โรอัสโซ คูมาโมโตะ
โรอัสโซ คูมาโมโตะ () เป็นสโมสรฟุตบอลของญี่ปุ่น ก่อตั้งในคูมาโมโตะ ซึ่งเป็นเมืองเอกของจังหวัดคูมาโมโตะ โรอัสโซ คูมาโมโตะได้เลื่อนชั้นสู่เจลีก ดิวิชัน 2 เป็นครั้งแรกในตอนท้ายของฤดูกาล 2007 และเล่นฤดูกาลแรกของพวกเขาในปี 2008 ซึ่งจบด้วยอันดับที่ 12 สีประจำทีมคือสีแดง |
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] | มิโนะรุ ฮะตะ
มิโนะรุ ฮะตะ (, เกิด 30 มีนาคม 1989 ที่มะชิกิ) เป็นนักฟุตบอลชาวญี่ปุ่นที่เล่นให้กับ Roasso Kumamoto |
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] | สุริยุปราคา 5 มกราคม พ.ศ. 2600
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 5 มกราคม พ.ศ. 2600 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 26 ธันวาคม พ.ศ. 2600
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 26 ธันวาคม พ.ศ. 2600 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 11 พฤษภาคม พ.ศ. 2602
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 11 พฤษภาคม พ.ศ. 2602 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 30 เมษายน พ.ศ. 2603
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 30 เมษายน พ.ศ. 2603 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | สุริยุปราคา 20 เมษายน พ.ศ. 2604
สุริยุปราคาเต็มดวงจะเกิดขึ้นในวันที่ 30 เมษายน พ.ศ. 2603 สุริยุปราคาเกิดขึ้นเมื่อดวงจันทร์ โคจรผ่านระหว่างโลกและดวงอาทิตย์ โดยวิธีนั้นจะเห็นสุริยุปราคาแบบเต็มดวงและแบบบางส่วนเมื่อมองจากโลก สุริยุปราคาเต็มดวงเกิดขึ้นเมื่อขนาดเชิงมุมของดวงจันทร์ มีขนาดใหญ่กว่าดวงอาทิตย์ โดยจะบดบังแสงโดยตรงทั้งหมดจากดวงอาทิตย์ ทำให้เวลากลางวันเข้าสู่ความมืด สุริยุปราคาแบบเต็มดวงเกิดขึ้นในแนวแคบผ่านบนพื้นผิวโลก และสุริยุปราคาบางส่วนสามารถมองเห็นได้เหนือบริเวณรอบ ๆ ภูมิภาคนั้นกว้างหลายพันกิโลเมตร |
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] | ห้องรมแก๊ส
ห้องรมแก๊ส เป็นเครื่องมือสำหรับการสังหารมนุษย์หรือสัตว์อื่นๆด้วยแก๊ส ประกอบไปด้วยห้องที่ปิดสนิทเพื่อให้แก๊สเข้าไป ซึ่งเป็นแก๊สพิษหรือสารที่ทำให้เกิดภาวะขาดออกซิเจน สารพิษที่ถูกใช้มากที่สุดคือไฮโดรเจนไซยาไนด์ คาร์บอนไดออกไซด์ และคาร์บอนมอนอกไซด์ ซึ่งชนิดหลังสุดยังคงใช้อยู่ การรมแก๊สเป็นวิธีหนึ่งในการประหารชีวิตนักโทษในสหรัฐอเมริกาตั้งแต่ปี ค.ศ. 1920 และยังคงเป็นวิธีการประหารชีวิตตามกฏหมายในสามรัฐ ในช่วงฮอโลคอสต์ ห้องรมแก๊สขนาดใหญ่ที่ได้รับการออกแบบสำหรับการสังหารหมู่ซึ่งนาซีเยอรมนีใช้เป็นส่วนหนึ่งของการฆ่าล้างเผ่าพันธุ์ มีรายงานว่า เกาหลีเหนือ เป็นประเทศหนึ่งที่ยังใช้ห้องรมแก๊ส |
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] | ภูมิแพ้ข้าวสาลี
ภูมิแพ้ข้าวสาลี () เป็นภูมิแพ้ต่อข้าวสาลีที่มักปรากฏเป็นอาการแพ้อาหาร แต่ก็อาจเป็นการแพ้เพราะถูกต้อง/ได้รับ (contact allergy) เนื่องกับงานที่ทำ
เหมือนกับภูมิแพ้ทั้งหมด การตอบสนองของอิมมิวโนโกลบูลินอี () และแมสต์เซลล์ในร่างกายทำให้เกิดอาการแพ้
ปกติแล้ว ภูมิแพ้จะเกิดจำกัดต่อโปรตีนสะสมในเมล็ดข้าวสาลี (seed storage protein) เท่านั้น
แต่ก็มีภูมิแพ้ที่เกิดต่อทั้งเมล็ดและส่วนต่าง ๆ ของพืชต่าง ๆ อีกด้วย
ภูมิแพ้ข้าวสาลีมีน้อยมาก
เช่น งานศึกษาในญี่ปุ่นปี 2012 พบความชุกโรคในผู้ใหญ่ที่ 0.21% |
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] | ภูมิแพ้ข้าวสาลี
"ภูมิแพ้ข้าวสาลี" อาจเป็นชื่อที่ตั้งไม่ดี เพราะมีองค์ประกอบต่าง ๆ ที่ทำให้แพ้ในข้าวสาลี เช่น serine protease inhibitor, กลูเตลิน (glutelin) และโปรลามิน (prolamin) โดยปฏิกิริยาภูมิแพ้ก็จะเกิดต่อโปรตีนต่าง ๆ กัน
มีสารก่อภูมิแพ้ 27 อย่างในข้าวสาลีที่ได้ระบุแล้ว
ปฏิกิริยาภูมิแพ้ที่หนักสุดคือแอนาฟิแล็กซิสที่การออกกำลังกายหรือยาแอสไพรินจุดชนวน โดยเนื่องกับโปรตีนไกลอะดินโอเมกา (ω-gliadin) ที่คล้ายกับโปรตีนที่เป็นเหตุของ coeliac disease
อาการที่สามัญกว่าอื่น ๆ รวมทั้งคลื่นไส้ ลมพิษ และความโน้มเอียงทางกรรมพันธุ์ที่จะเกิดภูมิแพ้ (atopy) |
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] | ภูมิแพ้ข้าวสาลี
ความไวโปรตีนกลูเตน (gluten sensitivity) ปกติจะไม่จัดเป็นภูมิแพ้ข้าวสาลี
การรักษาก็คือให้งดทานอาหารที่มีข้าวสาลีและธัญพืชที่มีกลูเตนอย่างเด็ดขาด |
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] | ภูมิแพ้ข้าวสาลี
มีโปรตีนสะสมในเมล็ดข้าวสาลีกลุ่มหลัก ๆ 4 อย่าง คือ แอลบิวมิน (albumin), โกลบูลิน (globulin), โปรลามิน และกลูเตลิน
ในข้าวสาลี โปรตีนในกลุ่มโปรลามินเรียกว่า ไกลอะดิน (gliadin) และในกลุ่มกลูเตลิน เรียกว่า กลูเตนิน (glutenin)
เป็นโปรตีนสองกลุ่มอันเป็นองค์ประกอบคลาสสิกของกลูเตน
แม้กลูเตนจะเป็นเหตุของ coeliac disease (CD) ด้วย แต่การตอบสนองของเซลล์ภูมิคุ้มกันและสารภูมิต้านทานเนื่องกับโรคก็ต่างกัน และโรคภูมิแพ้ข้าวสาลีก็มีสารก่อภูมิแพ้นอกเหนือไปจากกลูเตน |
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] | ภูมิแพ้ข้าวสาลี
Non-celiac gluten sensitivity (NCGS) หรือความไวกลูเตน ()
นิยามว่า เป็นโรค/ภาวะทางคลินิกที่เกิดจากการทานกลูเตน แล้วก่ออาการทางลำไส้และ/หรือนอกลำไส้ซึ่งดีขึ้นเมื่อเอาส่วนผสมที่มีกลูเตนออกจากอาหาร โดยได้กันโรค celiac disease และภูมิแพ้ข้าวสาลีออกแล้ว
NCGS รวมอยู่ในกลุ่มความผิดปกติเกี่ยวกับกลูเตน (gluten-related disorders) |
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] | ภูมิแพ้ข้าวสาลี
การเกิดโรค NCGS ยังไม่เข้าใจดี
มีหลักฐานว่า นอกเหนือจากโปรตีนไกลอะดินซึ่งเป็นแอนติเจนหลักของกลูเตนที่เป็นพิษต่อเซลล์ โปรตีนอื่น ๆ ที่มีในกลูเตนและธัญพืชที่มีกลูเตน (ข้าวสาลี ข้าวไรย์ ข้าวบาร์เลย์ และสิ่งที่ทำมาจากข้าว) ก็อาจก่ออาการด้วย
อนึ่ง คาร์โบไฮเดรตประเภท FODMAPs
มีอยู่ในข้าวที่มีกลูเตน และพึ่งระบุเมื่อไม่นานว่าอาจเป็นเหตุของอาการกระเพาะลำไส้ในคนไข้ NCGS
แม้จะไม่สามารถอธิบายอาการนอกระบบย่อยอาหารได้ |
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] | ภูมิแพ้ข้าวสาลี
เพราะเหตุเหล่านี้ NCGS จึงยังเป็นอาการที่สร้างความขัดแย้ง
นักวิชาการบางพวกสงสัยว่ามีอาการเช่นนี้โดยเฉพาะจริง ๆ
และมีผู้เสนอชื่อว่า "non-celiac wheat sensitivity" ที่อาจเหมาะกว่า โดยให้เข้าใจด้วยว่าธัญพืชที่มีกลูเตนอื่น ๆ ก็โทษว่าก่ออาการด้วย |
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NCGS เป็นอาการสามัญที่สุดของกลุ่มความผิดปกติเกี่ยวกับกลูเตน
คือความชุกโรคอยู่ที่ระหว่าง 0.5-13% ในกลุ่มประชากรทั่วไป |
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] | ภูมิแพ้ข้าวสาลี
เนื่องจากไม่มีตัวบ่งชี้ทางชีวภาพ (biomarker) สำหรับอาการนี้ แพทย์จึงวินิจฉัยโรคโดยกันความผิดปกติเกี่ยวกับกลูเตนอื่น ๆ คือกัน celiac disease และภูมิแพ้ข้าวสาลี |
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] | ภูมิแพ้ข้าวสาลี
โปรลามิน (เรียกว่าไกลอะดินในข้าวสาลี) คล้ายกับกลูเตลิน (เรียกว่ากลูเตนินในข้าวสาลี) มาก
งานศึกษาในญี่ปุ่นพบว่า กลูเตนินก่อภูมิแพ้บ่อยครั้งกว่า แต่ไกลอะดินก่ออาการหนักกว่า
งานศึกษาทาง proteomics ได้ค้นพบยีนแบบไอโซฟอร์ม (isoform gene) คือ γ-gliadin |
994695#10 | [
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กลูเตนิน (คือโปรตีนกลุ่มกลูเตลินในข้าวสาลี) เป็นสารก่อภูมิแพ้หลักในข้าวสาลี
ในปัจจุบัน ยังมีสารก่อภูมิแพ้บางอย่างในข้าวสาลีที่ยังไม่ได้ระบุรายละเอียด
แต่งานศึกษาต้น ๆ ได้พบสารก่อภูมิแพ้หลายอย่างในกลุ่มแอลบิวมิน |
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] | ภูมิแพ้ข้าวสาลี
ส่วนงานศึกษาในยุโรปปี 2007 ได้ยืนยันว่ามีภูมิแพ้ต่อ amylase/trypsin inhibitor (serpin)
และ lipid transfer protein (LPT) ที่เพิ่มขึ้น
แต่มีปฏิกิริยาน้อยกว่าต่อส่วนที่เป็นโกลบูลิน |
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ภูมิแพ้ที่เป็นมักจะต่างกันในกลุ่มประชากรต่าง ๆ (เช่น ชาวอิตาลี ชาวญี่ปุ่น ชาวเดนมาร์ก หรือชาวสวิส)
ซึ่งระบุว่าพันธุกรรมอาจมีส่วนให้เกิดภูมิแพ้ |
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] | ภูมิแพ้ข้าวสาลี
ภูมิแพ้ทางเดินหายใจเป็นโรคเกี่ยวกับอาชีพที่มักเกิดกับพนักงานบริการอาหาร
งานศึกษาก่อน ๆ ได้พบสารก่อภูมิแพ้ถึง 40 อย่างจากข้าวสาลี
แต่บางคนก็ยังแพ้โปรตีนข้าวไรย์ และบางคนก็แพ้เรณูหญ้าอย่างข้ามพันธุ์ด้วย
งานศึกษาภายหลังหนึ่งแสดงว่า ภูมิแพ้ของคนทำขนมปัง (baker's allergy) จะขยายเป็นกับหญ้าและธัญพืชมากมายหลายหลาก (ข้าวสาลี ข้าวทริทิเคลี ข้าวไรย์ ข้าวบาร์เลย์ หญ้าไรย์ ข้าวโอ๊ต สกุลข้าว ข้าวโพด สกุลข้าวฟ่าง เป็นต้น) แม้ภูมิแพ้ต่อข้าวสาลีและข้าวไรย์ดูจะใกล้กันที่สุด
และภูมิแพ้เหล่านี้ก็ดูจะเป็นปฏิกิริยาต่อทั้งโปรตีนเมล็ด (seed) และโปรตีนเรณู (pollen)
รวมทั้งปฏิกิริยาข้ามพันธุ์ต่อเรณูหญ้าไรย์และกลูเตนในข้าวสาลี |
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] | ภูมิแพ้ข้าวสาลี
โปรตีนเป็นโซ่กรดอะมิโนที่เอาน้ำออก
เมื่อเอนไซม์ตัดโปรตีนเป็นชิ้น ๆ มันก็จะเติมน้ำใส่จุดที่ตัดด้วย เป็นกระบวนการที่เรียกว่า enzymatic hydrolysis (การแยกสลายด้วยน้ำอาศัยเอนไซม์) หรือการสลายโปรตีน (proteolysis)
ผลผลิตเบื้องต้นของกระบวนการนี้คือ โพลีเพ็ปไทด์ โดยที่มีขนาดเล็กกว่าก็จะเรียกว่า เพ็ปไทด์
ซึ่งเรียกว่า wheat protein hydrolysate (ผลผลิตการแยกสลายโปรตีนข้าวสาลีด้วยน้ำ)
ผลผลิตเช่นนี้อาจเป็นสารก่อภูมิแพ้ที่มาจากโปรตีนข้าวสาลีที่ตอนแรกไม่เป็น เพราะได้เปิดจุดที่ก่อภูมิต้านทาน (antigenic) ของโปรตีน |
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] | ภูมิแพ้ข้าวสาลี
เมื่อโปรตีนแยกออกเป็นโพลีเพ็ปไทด์ต่าง ๆ ส่วนที่ปิดมาก่อนก็จะเปิด ส่วนที่เปิดใหม่นี้อาจก่อภูมิต้านท้าน
ผลผลิตการแยกสลายโปรตีนข้าวสาลีด้วยน้ำดังว่า อาจใช้เป็นสารเติมแต่งอาหารและเครื่องสำอาง
เพ็ปไทด์เหล่านี้บ่อยครั้งมีชนาด 1 kD (มีเรซิดิวกรดอะมิโน 9 อันต่อกัน) ซึ่งอาจเพิ่มปฏิกิริยาภูมิแพ้
ในคนที่แพ้ อาจก่อลมพิษเพราะถูกต้องโดยทันที |
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ภูมิแพ้ข้าวสาลีไม่ได้ต่างกับภูมิแพ้อาหารหรือภูมิแพ้ทางเดินหายใจอื่น ๆ
แต่ก็มีอาการสองอย่างที่เกิดบ่อยกว่า คือ (1) การออกกำลังกายและยาแอสไพรินอาจจุดชนวนปฏิกิริยาแอนาฟิแล็กซิส (2) ลมพิษ |
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] | ภูมิแพ้ข้าวสาลี
อาการสามัญรวมทั้ง sacroiliitis,
ผื่นแดง (eczema) หรือผิวหนังอักเสบเหตุภูมิแพ้ (atopic dermatitis), ลมพิษ, หืดหอบ, เยื่อจมูกอักเสบเหตุภูมิแพ้, angioedema (เนื้อเยื่อบวมเพราะน้ำที่รั่วออกจากหลอดเลือด), ตะคริวท้อง, คลื่นไส้ และอาเจียน
อาการที่มีไม่บ่อยรวมทั้ง
ช็อกเพราะแอนาฟิแล็กซิส, วิตกกังวล, ข้ออักเสบ, ท้องเฟ้อ, ปวดหน้าอก, ซึมเศร้า หรืออารมณ์เปลี่ยนแปลงง่าย, ท้องร่วง, เวียนศีรษะ, ปวดหัว, ปวดตามข้อและกล้ามเนื้อ (แต่ก็อาจเป็นอาการที่เกิดกับข้ออักเสบที่ลุกลาม), ใจสั่น, สะเก็ดเงิน, ลำไส้ไวเกินต่อการกระตุ้น (), ลิ้นหรือคอบวม, เหนื่อยหรือง่วง และไอโดยไร้เหตุ |
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ปฏิกิริยาอาจแรงขึ้นเมื่อได้รับสารก่อภูมิแพ้ซ้ำ ๆ |
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] | ภูมิแพ้ข้าวสาลี
ไกลอะดิน โดยอาจรวมโปรตีนอะเวนิน (avenin) ในข้าวโอ๊ต สัมพันธ์กับกับอาการแอนาฟิแล็กซิสเหตุข้าวสาลีที่การออกกำลังกายกระตุ้น () ซึ่งคล้ายกับภูมิแพ้ของคนทำขนมปังเพราะอำนวยโดยการตอบสนองของอิมมิวโนโกลบูลินอี
แต่ใน WDEIA ไกลอะดินโอเมกา (ω-gliadin)
หรือหน่วยย่อยของกลูเตนินที่มีมวลโมเลกุลสูงในข้าวสาลี หรือโปรตีนที่คล้าย ๆ กันในพืชสกุล "Triticeae" อื่น ๆ จะเข้าไปในกระแสเลือดระหว่างออกกำลังกายแล้วก่อปฏิกิริยาเป็นหืดหอบหรือแพ้อย่างฉับพลัน |
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] | ภูมิแพ้ข้าวสาลี
งานศึกษาปี 2007 แสดงว่า ไกลอะดินโอเมกาคล้ายกับส่วนของอะเวนินในข้าวโอ๊ตมากกว่าไกลอะดินอัลฟา/บีตา หรือแกมมา อย่างไรก็ดี อะเวนินก็ยังไม่พบว่าสัมพันธ์กับ WDEIA
ข้าวสาลีโดยเฉพาะอาจกระตุ้น WDEIA และลมพิษเรื้อรังอื่น ๆ เพราะ จะตรวจจับไกลอะดินโอเมกา (ω-gliadin) ที่อัลลีล Gli-B1 ของข้าวสาลีโดยมากแสดงออก
แต่โปรลามินที่สกัดจากข้าวไรย์ หรือข้าวสาลีที่สับเปลี่ยนโครโมโซมจากข้าวไรย์แทบจะไม่ทำให้ตอบสนอง
ยีน Gli-B1 ในข้าวสาลีพันธุ์ "Triticum aestivum" เป็นยีนอนุพันธ์จากสปีชีส์หนึ่งของบรรพบุรุษ 3 สปีชีส์ คือ "Aegilops speltoides" ทำให้เห็นได้ว่า มีการกลายพันธุ์ที่เกิดไม่นานที่จีโนมบีของข้าวสาลี หรือเป็นยีนจากพืชเพาะปลูกเผ่า triticeae จำนวนน้อยส่วนหนึ่ง |
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] | ภูมิแพ้ข้าวสาลี
งานศึกษาเรื่อง ปี 2007 พบว่า ทั้งแอสไพรินและการออกกำลังกาย จะเพิ่มไกลอะดินในเลือด
และการตอบสนองเรื้อรังดังที่ว่าอาจขยายเป็นกับยาแก้อักเสบชนิดไม่ใช่สเตอรอยด์ (), สารชูรส, benzoate และสารเติมแต่งอาหารสังเคราะห์อื่น ๆ |
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] | ภูมิแพ้ข้าวสาลี
ภูมิแพ้ของคนทำขนมปัง (baker's allergy) เกิดจากไกลอะดินโอเมกา และ thioredoxin hB
อนึ่ง สารก่อภูมิแพ้ในแป้งนอกเหนือจากกลูเตนที่ได้ระบุแล้วก็คือ aspergillus amylase ซึ่งใส่เพื่อให้อบขนมได้ดี
ลมพิษเพราะถูกสารก่อภูมิแพ้ (contact urticaria)
ผิวหนังอักเสบเหตุภูมิแพ้ (atopic dermatitis)
ผื่นแดง และลมพิษ ดูเหมือนจะเป็นปัญหาที่เกี่ยวข้องกัน คือโดยทั่วไปเชื่อว่ามีเหตุจากโปรลามินที่ไม่ชอบน้ำของหญ้าเพาะปลูกเผ่า Triticeae บางอย่าง และหญ้าเผ่า Aveneae บางอย่าง
ในข้าวสาลี โปรตีนอย่างหนึ่งดังที่ว่าก็คือไกลอะดินโอเมกา ซึ่งเป็นผลผลิตของยีน Gli-B1
งานศึกษาในมารดาและทารกที่ทานอาหารไร้สารก่อภูมิแพ้ได้แสดงว่า อาการเช่นนี้สามารถเลี่ยงได้ถ้ากลุ่มประชากรที่ไวแพ้ข้าวสาลีไม่ทานข้าวสาลีในช่วงปีแรกของชีวิต |
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] | ภูมิแพ้ข้าวสาลี
คล้ายกับแอนาฟิแล็กซิสเหตุข้าวสาลีที่การออกกำลังกายจุดชนวน (WDEIA) แอสไพริน (แต่ก็รวม tartrazine, sodium benzoate, สารชูรส, sodium metabisulfite, tyramine ด้วย) ก็อาจทำให้ไวแพ้ข้าวสาลีเพิ่มขึ้น
งานศึกษาเรื่อง WDEIA แสดงว่า ความโน้มเอียงทางกรรมพันธุ์ที่จะเกิดภูมิแพ้ (atopy) และ WDEIA อาจเกิดเมื่อทานแอสไพริน หรือ แล้วทำให้โปรตีนข้าวสาลีเข้าไปในเลือดได้ โดย จะมีปฏิกิริยาต่อสารก่อภูมิแพ้ในเนื้อเยื่อผิวหนัง
บางคนอาจจะไวจนกระทั่งแม้แอสไพรินเพียงเล็กน้อยก็อาจเพิ่มความเสี่ยงต่อทั้ง atopy และ WDEIA |
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] | ภูมิแพ้ข้าวสาลี
ภูมิแพ้ข้าวสาลียังเกิดอย่างสามัญพร้อมกับผิวหนังอักเสบเหตุถูกสาร (contact dermatitis) อีกด้วย
เหตุหลักอย่างหนึ่งก็คือแป้งที่ใช้กับถุงมือยางก่อนคริสต์ทศวรรษ 1990 แต่ปัจจุบันถุงมือมักใช้กับแป้งไร้โปรตีน |
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] | ภูมิแพ้ข้าวสาลี
โรคข้ออักเสบรูมาทอยด์/เหตุภูมิต้านตนเอง (rheumatoid arthritis, RA) ดูจะสัมพันธ์กับทั้งโรคลำไส้ไวต่อกลูเตน (gluten sensitive enteropathy, GSE) และการแพ้กลูเตน
ข้ออักเสบรูมาทอยด์ใน /CD อาจมาจากภูมิต้านเอนไซม์ tissue transglutaminase (tTG) ของตนเอง |
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] | ภูมิแพ้ข้าวสาลี
งานศึกษาปี 2006 ในประเทศตุรกี คนไข้ RA 8 คนจาก 20 คนมีปฏิกิริยาต่อข้าวสาลีเมื่อทดสอบด้วย radioallergosorbent test (RAST)
เมื่อเอาอาหารที่ผสมข้าวสาลีและอาหารอื่น ๆ ที่คนไข้แพ้ (ดังกำหนดด้วย RAST) ออก คนไข้ครึ่งหนึ่งมีตัวบ่งชี้ RA ในน้ำเหลืองที่ดีขึ้น
ในคนไข้ที่แพ้ข้าวสาลี ก็สามารถให้ทานข้าวไรย์อย่างไม่มีปัญหา
ซึ่งอาจชี้ว่า ผู้มีอาการ RA สำหรับโรค GSE/CD มาจากการตอบสนองเป็นภูมิแพ้ในลำดับต่อ ๆ มา (downstream effect)
อนึ่ง แอนติบอดีต้านคอลลาเจนเนื้อวัวคืออิมมิวโนโกลบูลินจี () ที่ก่อปฏิกิริยาข้ามตัวก่อภูมิแพ้ (cross-reactive) อาจเป็นเหตุของ RA โดยบางส่วน |
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] | ภูมิแพ้ข้าวสาลี
ในปลายคริสต์ทศวรรษ 1970 มีรายงานว่าคนไข้ไมเกรนมีปัญหากับอาหารก่อภูมิแพ้ โดยมีปฏิกิริยาสามัญที่สุดต่อข้าวสาลี (78%) ส้ม ไข่ ชา กาแฟ ช็อกโกแลต นม เนื้อวัว ข้าวโพด น้ำตาลจากอ้อย และยีสต์ โดยคล้ายกับคนไข้ RA
เมื่องดอาหาร 10 อย่างที่ก่อปฏิกิริยามากที่สุด ไมเกรนจะลดลงอย่างมาก และความดันโลหิตก็ลดลงด้วย
มีบางกรณีที่โทษข้าวสาลีโดยเฉพาะ |
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แต่ข้อมูลที่ตีพิมพ์ในเรื่องนี้ก็มีน้อยมาก โดยงานศึกษาแบบอำพรางสองฝ่ายงานเดียวที่มีก็รายงานว่าไม่มีความสัมพันธ์ |
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การวินิจฉัยโรคนี้อาจต้องทำเป็นพิเศษ
ไกลอะดินโอเมกา-5 ซึ่งเป็นสารก่อภูมิแพ้ที่มีฤทธิ์มากที่สุดของข้าวสาลี ไม่สามารถตรวจจับได้ในข้าวที่ไม่ขัดสี
เพราะต้องสกัดออกมาแล้วสลายเป็นบางส่วน (เช่นกับที่เกิดในลำไส้) จึงจะมีฤทธิ์สูงสุด
งานศึกษาต่าง ๆ ได้แสดงว่า การย่อยโปรตีนข้าวสาลีจนเป็นกรดอะมิโน 10 อย่างอาจเพิ่มการตอบสนองเป็นภูมิแพ้เป็น 10 เท่าตัว
การทดสอบภูมิแพ้บางอย่างอาจไม่สามารถตรวจพบภูมิแพ้ข้าวสาลีได้ทุก ๆ แบบ จึงทำให้แสดงผลไม่ชัดเจน |
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] | ภูมิแพ้ข้าวสาลี
เพราะอาการที่สัมพันธ์กับภูมิแพ้ข้าวสาลี เช่น sacroiliitis, ผื่นแดง และหืดหอบ อาจเป็นหรืออาจไม่เป็นเพราะภูมิแพ้ข้าวสาลี แพทย์อาจต้องอนุมานเหตุโดยนิรนัยอาศัยอาการ
ถ้ายาระงับระบบภูมิคุ้มกัน เช่น Prednisone กำจัดอาการทั้งหมด เหตุเนื่องกับภูมิแพ้ก็เป็นไปได้
ถ้ามีอาการที่สัมพันธ์กับภูมิแพ้ข้าวสาลีเมื่อไม่ได้ยาระงับภูมิคุ้มกัน ภูมิแพ้ข้าวสาลีก็เป็นไปได้ |
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การรักษาโรคนี้รวมการงดอาหารที่มีข้าวสาลีและธัญพืชที่มีกลูเตนอื่น ๆ คือให้ทานอาหารปลอดกลูเตน
แต่คนไข้บางคนก็สามารถรับข้าวบาร์เลย์ ข้าวไรย์ หรือข้าวโอ๊ตได้ |
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ถ้ามีแอนาฟิแล็กซิสเหตุข้าวสาลีที่การออกกำลังกายกระตุ้น () อย่างเบา ๆ การงดทานข้าวสาลีและสารที่ก่ออาการอื่น ๆ รวมทั้งยาแก้อักเสบชนิดไม่ใช่สเตอรอยด์ () และแอลกอฮอล์ก่อนออกกำลังกาย ก็อาจพอแล้ว |
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] | ภูมิแพ้ข้าวสาลี
อาหารต่าง ๆ อาจปนเปื้อนกับข้าวสาลีอย่างรู้ได้ยาก
ที่รู้ง่าย ๆ รวมทั้งเศษขนมปัง, maltodextrin,
รำข้าว, สารสกัดจากธัญพืช, แป้งหมี่บด (อาหารแอฟริกาเหนือ, couscous, semolina), แคร็กเกอร์ (ขนมปังอบกรอบ), แป้งเสริมสารอาหาร (enriched), กลูเตน, แป้งมีกลูเตนสูง, แป้งมีโปรตีนสูง, แป้งจีน/ญี่ปุ่นที่ใช้ทำเนื้อเจ/เส้นก๋วยเตี๋ยว (, ),
จมูกข้าว, มอลต์ข้าวสาลี, แป้งข้าวสาลี หรือแป้งข้าวสาลีไม่ขัดสี
ส่วนผสมที่รู้ได้ยากอาจรวมแป้งละลายในน้ำร้อนเพื่อทำเป็นซอส ซุป หรือปรุงกับไขมันเพื่อใส่ในอาหาร (gelatinized starch), โปรตีนพืชสลายด้วยน้ำ (hydrolyzed vegetable protein), แป้งอาหารแปรรูป, แป้งแปรรูป, สารแต่งรสธรรมชาติ (natural flavoring), ซอสถั่วเหลือง, แป้งถั่วเหลืองเปียก, ซอสจิ้มเนื้อจีน/เวียดนาม (, , ), แป้ง, ยางพืช โดยเฉพาะ beta-glucan และแป้งจากพืช |
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] | ภูมิแพ้ข้าวสาลี
ข้าวโอ๊ตที่ไม่มีโปรตีนกลูเตนจากข้าวสกุล "Triticeae" คือไม่มีข้าวสาลี ข้าวไรย์ หรือข้าวบาร์เลย์ อาจทานแทนเพื่อให้ได้ใยอาหารจากธัญพืชได้
บางคนสามารถทานข้าวไรย์/ขนมปังไรย์ได้
แป้งข้าวเจ้าใช้แทนแป้งสาลีอย่างสามัญ
แป้งอย่างอื่นที่ใช้แทนได้รวมทั้งข้าวฟ่าง ลูกเดือย บักวีต เมล็ดฝ้าย ข้าวโพด คีนวา ชีอา มันสำปะหลัง เป็นต้น |
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] | การสูญเสียปีสุขภาวะ
การสูญเสียปีสุขภาวะ (, อักษรย่อ: DALY) เป็นค่าแสดงภาระโรค (disease burden) โดยทั่วไป เป็นจำนวนปีที่เสียไปเพราะสุขภาพไม่ดี พิการ หรือเสียชีวิตก่อนวัย
เป็นค่าที่พัฒนาขึ้นในคริสต์ทศวรรษ 1990 เพื่อเปรียบเทียบสุขภาพทั่วไปและการคาดหมายคงชีพของประเทศต่าง ๆ
เป็นค่าที่ใช้อย่างสามัญขึ้นเรื่อย ๆ ในสาขาสาธารสุข และการประเมินผลต่อสุขภาพ ()
เพราะมัน "ขยายแนวคิดของจำนวนปีในชีวิตที่อาจเสียไปเพราะการตายก่อนวัย...
คือรวมปีที่เสียไปเพราะสุขภาพไม่ดีหรือพิการ"
ดังนั้น จึงรวมความตายและความเจ็บป่วยลงในค่าเดียวกัน |
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] | การสูญเสียปีสุขภาวะ
จำนวนปีที่เสียไปเพราะสุขภาพไม่ดี พิการ หรือเสียชีวิตก่อนวัย (DALY) เป็นค่าวัดภาระโรคและความพิการในกลุ่มประชากร
คำนวณโดยรวมค่าที่ลดลงของทั้งการคาดหมายคงชีพและคุณภาพชีวิตเพราะโรคหรือความพิการของกลุ่มประชากร
เป็นค่าที่สัมพันธ์กับค่า quality-adjusted life year (QALY)
แต่ค่า QALY วัดแต่ประโยชน์เมื่อมีหรือไม่มีการรักษาพยาบาล ดังนั้น จึงไม่ได้วัดภาระทั้งหมด
อนึ่ง QALY มักจะเป็นค่าวัดส่วนตัว ไม่ใช่ค่าวัดภาระต่องสังคม |
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] | การสูญเสียปีสุขภาวะ
ปกติแล้ว ความรับผิดชอบทางสุขภาพ (เช่น โดยองค์กรสุขภาพ) สามารถวัดใช้ค่า years of life lost (YLL) คือปีที่เสียไปเพราะเสียชีวิตก่อนวัย
แต่โรคที่ไม่ทำให้เสียชีวิตก่อนวัยก็ไม่ได้นับ
จึงมีค่าอีกค่าหนึ่งคือ years lost due to disability (YLD) ซึ่งวัดปีที่เสียไปเพราะโรคหรือความพิการ |
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] | การสูญเสียปีสุขภาวะ
DALY รวมค่าสองอย่างเข้าด้วยกัน คือ
DALY ขึ้นอยู่กับการยอมรับว่า ค่าวัดผลของโรคเรื้อรังที่เหมาะที่สุดก็คือเวลา ทั้งที่เสียไปเพราะตายก่อนวัยและเพราะใช้ชีวิตกับความพิการ
ค่า DALY 1 หน่วย จึงเท่ากับหนึ่งปีที่เสียไปของชีวิตที่มีสุขภาพดี |
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] | การสูญเสียปีสุขภาวะ
โรค/ความพิการมีผลลบต่อบุคคลเท่าไรเรียกว่า น้ำหนักความพิการ (disability weight, DW)
โดยไม่ต่างกันตามอายุ
มีตารางที่ระบุโรคและความพิการเป็นจำนวนพัน ๆ เริ่มตั้งแต่โรคอัลไซเมอร์ไปจนถึงการเสียนิ้ว แต่ละรายการระบุน้ำหนักความพิการเนื่องกับเหตุนั้น ๆ |
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ตัวอย่างน้ำหนักความพิการอยู่ทางด้านขวา
บางค่าเป็นค่าระยะสั้น โดยมีค่าระยะยาวที่ต่างกัน |
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] | การสูญเสียปีสุขภาวะ
น้ำหนักความพิการระหว่างปี 2004 กับ 2010 บางค่าลดลงมาอย่างมาก เช่น ตาบอด หูหนวก เป็นต้น
เพราะพิจารณาว่า เป็นค่าวัดสุขภาพ (health) ไม่ได้วัดความเป็นอยู่ที่ดี (well-being, welfare) และคนตาบอดหรือคนหูหนวก ไม่นับว่าป่วย
คือ
"ตามศัพท์ในเรื่องภาระโรคแห่งโลก () คำว่า ความพิการ ใช้ตามความหมายกว้าง ๆ หมายถึง สุขภาพที่ไม่ได้ดีสุด ไม่ว่าจะในด้านสำคัญใด ๆ"
ในระดับประชากร ภาระโรคดังที่วัดด้วย DALY คำนวณโดยบวกค่า YLL เข้ากับค่า YLD
ส่วนค่า YLL เป็นค่าการคาดหมายคงชีพที่คิดตามอายุเมื่อเสียชีวิต
จำนวนปีที่เสียไปเพราะพิการ (YLD) กำหนดด้วยจำนวนปีที่พิการคูณด้วยน้ำหนักเนื่องกับความพิการหรือเป็นโรคด้วยสูตร
ในสูตรนี้ I = จำนวนกรณีในกลุ่มประชากร, DW = น้ำหนักความพิการของภาวะนั้น ๆ และ L = จำนวนปีเฉลี่ยก่อนโรคจะหายหรือเสียชีวิต
ยังมีการคำนวณ YLD ด้วยค่าความชุกโรค แทนจำนวนกรณี ส่วนจำนวนปีที่เสียไปเพราะเสียชีวิตก่อนวัย (YLL) ใช้สูตร
โดย N = จำนวนผู้เสียชีวิตเนื่องกับเหตุนั้น ๆ และ L = การคาดหมายคงชีพมาตรฐานคิดตามอายุเมื่อเสียชีวิต
ให้สังเกตว่า ค่าการคาดหมายคงชีพที่อายุต่าง ๆ ไม่เท่ากัน
ยกตัวอย่างเช่น ในยุคหิน ค่าการคาดหมายคงชีพเมื่อเกิดอยู่ที่ 33 ปี
แต่เมื่อถึงอายุ 15 ปี จะมีชีวิตอยู่ได้อีก 39 ปี (รวมทั้งหมด 54 ปี) |
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การคาดหมายคงชีพมาตรฐานใช้สถิติของประเทศญี่ปุ่นเพื่อวัดการเสียชีวิตก่อนวัย เพราะคนญี่ปุ่นมีชีวิตยืนที่สุดโดยเฉลี่ย |
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] | การสูญเสียปีสุขภาวะ
ความแตกต่างที่สำคัญอย่างหนึ่งในงานศึกษาที่ใช้ DALY ก็คือการใช้น้ำหนักโดยอายุ (age-weighting) ที่ให้ค่าแต่ละปีของชีวิตโดยขึ้นอยู่กับอายุ
แต่องค์การอนามัยโลกก็ได้เลิกใช้น้ำหนักโดยอายุและการลดเวลา (time discounting) ในการคำนวณ DALY ตั้งแต่ปี 2010 |
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] | การสูญเสียปีสุขภาวะ
มีวิธีการสองอย่างที่คำนวณให้เวลาแตกต่างกัน คือ น้ำหนักโดยอายุ และการลดเวลา
แนวคิดของน้ำหนักโดยอายุมาจากทฤษฎีทุนด้านมนุษย์ (human capital)
โดยสามัญก็คือ ปีในวัยฉกรรจ์ (young adult, อายุระหว่าง 18-32 ปี) ให้ค่ามากกว่าปีที่เป็นเด็กเล็กมากหรือผู้ชรามาก เพราะวัยฉกรรจ์ให้ผลงาน/ผลิตภาพในระดับสูงสุด
แต่วิธีนี้ก็ถูกติเตียนมากเพราะให้ค่าคนวัยฉกรรจ์เหนือกว่าเด็กเล็ก ๆ และผู้ชรา
คือเป็นทั้งการติเตียนและการให้เหตุผลว่า นี่สะท้อนประโยชน์ต่อสังคมเนื่องกับผลงานที่ได้และทุนที่ได้คืนจากการเลี้ยงเด็กจนโต
การใช้น้ำหนักโดยอายุจึงหมายความว่า ผู้ที่พิการเมื่ออายุ 30 ปีเป็นเวลา 10 ปี จะวัดว่าเสีย DALY (คือเกิดภาระโรค) มากกว่าผู้ที่พิการเพราะโรคหรือการบาดเจ็บเช่นเดียวกันเมื่ออายุ 70 ปี |
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] | การสูญเสียปีสุขภาวะ
ฟังก์ชันน้ำหนักโดยอายุเช่นนี้ใช้เพื่อคำนวณ DALY ที่เสียไปเนื่องกับความพิการเท่านั้น
เพราะปีที่เสียไปเพราะเสียชีวิตก่อนวัยจะกำหนดโดยอายุที่เสียชีวิตและความคาดหมายคงชีพที่อายุนั้น ๆ |
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] | การสูญเสียปีสุขภาวะ
งานศึกษา Global Burden of Disease Study (GBD) ปี 2001-2002 นับ DALY เท่ากันสำหรับทุก ๆ วัย แต่งาน GBD 1990 และ GBD 2004 ได้ใช้สูตร
formula_1
โดยที่ formula_2 เป็นอายุในปีนั้น ๆ และ formula_3 เป็นค่าที่ให้กับให้กับมันเทียบกับค่าเฉลี่ยที่ 1
ในงานศึกษาเหล่านี้ ปีในอนาคตยังลดค่า (discounted) ที่อัตราปีละ 3% เพราะสุขภาพที่เสียไป
การลดค่าตามเวลา (time discounting) เช่นนี้ ต่างหากกับฟังก์ชันน้ำหนักอายุ เพราะระบุความสำคัญที่ให้กับเวลาดังที่ใช้ในแบบจำลองทางเศรษฐกิจ |
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] | การสูญเสียปีสุขภาวะ
ผลของปฏิกิริยาระหว่างการคาดหมายคงชีพ ปีที่เสียไป การลดค่า กับน้ำหนักทางสังคม ค่อนข้างจะซับซ้อน โดยขึ้นอยู่กับความรุนแรงและระยะการมีโรค
ยกตัวอย่างเช่น พารามิเตอร์ที่ใช้ในงาน GBD 1990 ทั่วไปให้น้ำหนักแก่การเสียชีวิตในปีทุกปีก่อนอายุ 39 มากกว่าปีหลังจากนั้น โดยการตายของทารกเกิดใหม่มีน้ำหนักที่ 33 DALY และการตายของคนมีอายุระหว่าง 5-20 ปีเท่ากับประมาณ 36 DALY |
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] | การสูญเสียปีสุขภาวะ
หลังจากได้ปรึกษากันหลายครั้ง ในปี 2010 องค์การอนามัยโลกในที่สุดก็ยกเลิกการใช้น้ำหนักอายุและการลดค่าตามเวลา
และยังแทนการใช้ค่าความชุกโรคด้วยค่าการเกิดโรค (incidence) เพราะเป็นค่าที่งานต่าง ๆ สำรวจ |
994701#14 | [
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แต่มีประโยชน์แนะแนวการแบ่งทรัพยากรในระบบสาธารณสุขเพราะให้ค่าตัวเศษเช่นเดียวกัน ช่วยให้แสดงประโยชน์เป็น DALY/งบประมาณ |
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] | การสูญเสียปีสุขภาวะ
ยกตัวอย่างเช่น ในประเทศแกมเบีย โปรแกรมการฉีดวัคซีนป้องกันปอดบวมคือ pneumococcal conjugate vaccine มีค่าใช้จ่าย 670 ดอลลาร์สหรัฐ (ประมาณ 21,250 บาท) ต่อทุก ๆ DALY ที่ช่วยไม่ให้เสียไป
ซึ่งสามารถใช้เทียบกับการรักษาโรคอื่น ๆ เพื่อกำหนดว่า การให้งบประมาณเพื่อป้องกันหรือรักษาโรคอื่นจะมีประสิทธิภาพมากกว่าต่อสุขภาพทั่วไปของชุมชนหรือไม่ |
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โรคจิตเภทมีน้ำหนัก 0.53 และกระดูกต้นขาหัก 0.37 ตามรายการล่าสุดขององค์การอนามัยโลก |
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ในประเทศออสเตรเลีย มะเร็ง (25.1/1,000) โรคหัวใจร่วมหลอดเลือด (23.8/1,000) ปัญหาทางจิตใจ (mental 17.6/1,000) ปัญหาทางประสาท (neurological 15.7/1,000) ปัญหาทางเดินหายใจเรื้อรัง (9.4/1,000) และโรคเบาหวาน (7.2/1,000) เป็นเหตุหลักของปีที่เสียไปเนื่องจากโรคหรือการเสียชีวิตก่อนวัย |
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ในประเทศซิมบับเวปี 2013 โรคระบาดที่มีผลสูงสุดต่อปีที่เสียไปเนื่องจากโรคหรือการเสียชีวิตก่อนวัยก็คือ ไข้รากสาดน้อย แอนแทรกซ์ มาลาเรีย ท้องเสียธรรมดา และโรคบิด |
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] | การสูญเสียปีสุขภาวะ
ในบรรดาประเทศที่มีประชากรหนาแน่นที่สุด 25 ประเทศ DALY เพราะความผิดปกติที่เกิดหลังความเครียดที่สะเทือนใจ () มีค่าสูงสุดในเอเชียแปซิฟิกและสหรัฐ |
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] | การสูญเสียปีสุขภาวะ
DALY เนื่องจากความพิการเพราะเสียงดังในพนักงานอเมริกันทั่วทุกอุตสาหกรรมคำนวณว่าเป็น 2.53 ปีต่อผู้ได้รับเสียงดัง 1,000 คนทุก ๆ ปี
พนักงานขุดเหมืองและก่อสร้างเสีย 3.45 ปีและ 3.09 ปีต่อ 1,000 คนตามลำดับ
โดยทั่วไป แม้ตัวอย่างสถิติเพียง 66% จะอยู่ในอุตสาหกรรมการผลิต แต่ก็เสีย DALY 70% ของพนักงานในอุตสาหกรรมทั้งหมด |
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] | การสูญเสียปีสุขภาวะ
ในปี 1990 มหาวิทยาลัยฮาร์วาร์ดได้พัฒนา DALY ขึ้นเพื่อธนาคารโลก ต่อมาในปี 1996 องค์การอนามัยโลกจึงได้เริ่มใช้วิธีนี้ในรายงานการลงทุนในการวิจัยและพัฒนาทางสุขภาพ (Investing in Health Research & Development)
ปัจจุบันได้กลายเป็นวิธีการที่สำคัญซึ่งใช้ในสิ่งตีพิมพ์ขององค์การอนามัยโลก เช่น ภาระโรคของโลก (Global Burden of Disease)
และก็ใช้ในรายงานปี 1993 ของธนาคารโลกด้วย |
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] | การสูญเสียปีสุขภาวะ
นักวิชาการบางท่านได้วิจารณ์ DALY ว่าเท่ากับเป็นค่าวัดผลิตภาพทางเศรษฐกิจของบุคคลที่เกี่ยวข้อง
แม้ DALY จะมีฟังก์ชันที่ให้น้ำหนักขึ้นกับอายุตามผลิตภาพทางเศรษฐกิจของบุคคล แต่ก็ใช้ค่าคุณภาพชีวิตเนื่องกับสุขภาพเพื่อกำหนดน้ำหนักของความพิการ ซึ่งเริ่มตั้งแต่ 0 (ไม่พิการ) จนถึง 1 (พิการ 100%) สำหรับโรคทุกโรค
เป็นน้ำหนักที่ไม่ได้เป็นไปตามสมรรถภาพการทำงาน แต่เป็นผลของความพิการที่มีต่อชีวิตของบุคคลนั้นโดยทั่วไป
นี่เป็นเหตุที่ปัญหาทางจิตใจเป็นโรคระดับต้น ๆ อย่างหนึ่งที่งานศึกษาภาระโรคของโลกวัด โดยโรคซึมเศร้ามีค่าถึง 51.84 ล้านปี (DALY)
ปัญหาของเด็กใกล้คลอด (perinatal) ซึ่งมีผลต่อทารกที่มีน้ำหนักอายุต่ำมาก ก็มีค่า DALY เป็นอันดับต้น ๆ เท่ากับ 90.48 ล้านปี
และโรคหัดก็อยู่ที่อันดับ 15 และมีค่า 23.11 ล้านปี |
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นักวิชาการบางท่านก็ตั้งข้อสงสัยว่า งานสำรวจภาระโรค (เช่น EQ-5D) จะสามารถเก็บผลทางปัญหาจิตใจได้อย่างสมบูรณ์หรือไม่ เพราะเหตุปรากฏการณ์ต่าง ๆ รวมทั้ง ceiling effect (ซึ่งตัวแปรอิสระไม่มีผลต่อตัวแปรตามอีกต่อไป) |
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] | การสูญเสียปีสุขภาวะ
นักวิชาการอีกท่านหนึ่งได้อ้างว่า แบบจำลองดังที่ใช้กับ DALY มีข้อสมมุติโดยทฤษฎีหลายอย่าง (คือ utility independent, risk neutral, and constant proportional tradeoff behaviour)
ที่ทำให้ความหมายและประโยชน์ของค่าวัดน่าสงสัย |
994701#25 | [
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] | การสูญเสียปีสุขภาวะ
สุขภาพที่สมบูรณ์พร้อม ยากหรือไม่สามารถกำหนดได้
และก็มีนักวิชาการบางท่านที่อ้างว่า สุขภาพไม่ดีบางอย่างแย่ยิ่งกว่าตาย ดังนั้น ควรมีค่าลบ (และจริง ๆ ก็มีนักเศรษฐศาสตร์บางท่านที่ใช้ค่าลบเพื่อคำนวณ)
การกำหนดระดับสุขภาพขึ้นอยู่กับค่าวัดที่บางท่านอ้างว่า ให้ความสำคัญแก่ความเจ็บปวดทางกายและความพิการยิ่งกว่าสุขภาพทางใจ |
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การจัดลำดับการให้การรักษาอาศัยค่าใช้จ่ายต่อ DALY (หรือค่าคล้ายกันเช่นอื่น ๆ) สร้างความขัดแย้งเพราะเป็นวิธีการคำนวณอาศัยผลประโยชน์ (ทางสังคม/เศรษฐกิจ) เพื่อกำหนดว่าใครจะได้การรักษาและใครจะไม่ได้
แต่ผู้สนับสนุนก็อ้างว่า เพราะทรัพยากรในระบบสาธารณสุขมีจำกัด วิธีนี้ทำให้สามารถแบ่งทรัพยากรให้เกือบดีที่สุดสำหรับสังคม รวมทั้งสำหรับคนไข้โดยมากด้วย |
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] | การสูญเสียปีสุขภาวะ
เหตุผลคัดค้านอีกอย่างก็คือเป็นวิธีที่ไม่เท่าเทียมกัน เพราะผู้มีอายุน้อยกว่า มีสุขภาพดีกว่า อาจได้ความสำคัญมากกว่าผู้มีอายุมากกว่า ป่วยกว่า
คือ คุณค่าการรักษาผู้มีอายุและคนอื่น ๆ ผู้มีค่าคาดหมายคงชีพน้อยกว่า อาจประเมินต่ำเกินในการวิเคราะห์เยี่ยงนี้
อนึ่ง หลายคนอ้างว่า ถ้าตัวแปรอื่น ๆ เท่ากันทุกอย่าง คนไข้ที่ป่วยหนักกว่าควรสำคัญกว่าผู้ที่ป่วยน้อยกว่า ถ้าประโยชน์สัมบูรณ์ที่ได้สำหรับทั้งสองเท่ากัน |
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] | การสูญเสียปีสุขภาวะ
นักวิชาการได้แนะนำให้ทำงานวิจัยเรื่องความสมเหตุสมผลของการวิเคราะห์เช่น DALY (คือ QALY) เริ่มตั้งแต่ปี 1989
ในปี 2010 ด้วยงบประมาณจากคณะกรรมาธิการยุโรป ECHOUTCOME (European Consortium in Healthcare Outcomes and Cost-Benefit Research) ได้เริ่มงานศึกษาขนาดใหญ่เกี่ยวกับ QALY ที่ใช้เพื่อประเมินเทคโนโลยีทางสุขภาพ (health technology assessment)
นักวิชาการผู้นำของงานศึกษาได้กล่าวว่า นี่ "เป็นงานศึกษาขนาดใหญ่ที่สุดอุทิศโดยเฉพาะเพื่อตรวจข้อสมมุติของ QALY"
ในงานประชุมสุดท้ายของนักวิจัยปี 2013 ECHOUTCOME ได้ตีพิมพ์ผลงานเบื้องต้นซึ่งสำรวจนักวิชาการ 1,361 คนในประเทศเบลเยียม ฝรั่งเศส อิตาลี และสหราชอาณาจักร
งานสำรวจได้ถามคำถาม 14 ข้อเกี่ยวกับความชอบใจในสุขภาพระดับต่าง ๆ และระยะที่เกิดเหตุการณ์ทางสุขภาพเช่นนั้น ๆ (เช่น การเดินกระย่องกระแย่งเป็นเวลา 15 ปี เทียบกับการต้องใช้เก้าอี้ล้อหมุนเป็นเวลา 5 ปี)
แล้วสรุปว่า "ความชอบใจของผู้ที่ตอบไม่เข้ากับข้อสมมุติทางทฤษฎีของ QALY" ข้อสมมุติรวมทั้ง
ECHOUTCOME ยังตีพิมพ์รายงาน "แนวทางยุโรปเพื่อประเมินประสิทธิภาพค่าใช้จ่ายของเทคโนโลยีทางสุขภาพ (European Guidelines for Cost-Effectiveness Assessments of Health Technologies)" ซึ่งแนะนำไม่ให้ใช้ QALY เพื่อตัดสินใจในเรื่องการรักษาและดำรงสุขภาพ
โดยแนะนำให้วิเคราะห์ประสิทธิภาพค่าใช้จ่ายโดยเล็งที่ "ค่าใช้จ่ายต่อผลการรักษาที่เป็นประเด็นแต่ละอย่าง" |
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ต่อมาผู้แทนขององค์กรต่าง ๆ คือ National Institute for Health and Care Excellence (NICE), Healthcare Improvement Scotland (HIS) และ Organisation for Economic Co-operation and Development (OECD) ได้ยกประเด็นต่าง ๆ เหล่านี้ขึ้นเพื่อคัดค้าน |
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] | เนื้อแดง
ในเรื่องการทำอาหารของชาวตะวันตก เนื้อแดง () ปกติจะแดงเมื่อยังสด และมีสีเข้มขึ้นเมื่อสุก เทียบกับกับ "เนื้อขาว" ที่มีสีออกซีด ๆ ทั้งสดทั้งสุก
เนื้อจากสัตว์เลี้ยงลูกด้วยนมหรือสัตว์ปีกเท่านั้น (ไม่รวมปลา) จะจัดเป็นเนื้อแดงเนื้อขาว
ในโภชนศาสตร์ เนื้อแดงหมายถึงเนื้อใดก็ได้ที่มีโปรตีนไมโยโกลบินมากกว่า "เนื้อขาว" ที่นิยามว่า เป็นเนื้อสีไม่เข้มจากไก่ (ไม่รวมน่องหรือขา) หรือจากปลา
เนื้อบางอย่าง เช่น เนื้อหมู จัดเป็นเนื้อแดงตามโภชนศาสตร์ แต่จัดเป็นเนื้อขาวตามการทำอาหาร |
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] | เนื้อแดง
ตามกระทรวงเกษตรสหรัฐ () เนื้อที่ได้มาจากสัตว์เลี้ยงลูกด้วยนมทั้งหมดไม่ว่าจะเป็นส่วนไหนหรืออายุเท่าไร เป็นเนื้อแดงเพราะมีไมโยโกลบินมากกว่าปลาหรือเนื้อขาว
จากไก่ (แต่อาจไม่มากกว่าเนื้อเข้ม) |
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] | เนื้อแดง
ตามนิยามของการทำอาหาร เนื้อจากสัตว์เลี้ยงลูกด้วยนมที่โตแล้ว หรือเนื้อป่า รวมทั้งเนื้อวัว เนื้อม้า เนื้อแกะ เนื้อกวาง เนื้อหมูป่า เนื้อกระต่ายเป็นต้น เป็นเนื้อแดง แต่เนื้อจากสัตว์ที่ยังไม่โต (รวมทั้งลูกกระต่าย ลูกวัว และลูกแกะ) เป็นเนื้อขาว
เนื้อสัตว์ปีกโดยมากเป็นเนื้อขาว แต่เป็ดและห่านเป็นเนื้อแดง
เนื้อส่วนต่าง ๆ จากหมูโดยมากเป็นเนื้อแดง แต่ส่วนอื่น ๆ จัดเป็นเนื้อขาว
เนื้อป่าบางครั้งจัดเป็นหมวดต่างหาก ( = dark meats)
นักเขียนอื่น ๆ จัดเนื้อบางอย่าง (เช่น แกะ หมู) ในหมู่อื่น ๆ |
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เนื้อหมูบางส่วนจัดเป็นเนื้อขาวตามหลักการทำอาหาร แต่ในโภชนาการ นี้จัดเป็นเนื้อแดง
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] | เนื้อแดง
เนื้อแดงมีแร่ธาตุและวิตามินต่าง ๆ รวมทั้งธาตุเหล็ก, creatine, สังกะสีและฟอสฟอรัส, วิตามินบี (รวมทั้งไนอาซิน วิตามินบี12 ไทอามีน และไรโบเฟลวิน )
เป็นแหล่งหนึ่งของ alpha lipoic acid |
994710#5 | [
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เนื้อแดงมีวิตามินดีเล็กน้อย
โดยตับจะมีจำนวนมากที่สุดในบรรดาส่วนต่าง ๆ |
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] | เนื้อแดง
ในปี 2011 กระทรวงเกษตรสหรัฐเริ่มโครงการอาหาร MyPlate ซึ่งไม่ได้จำแนกเนื้อเป็นชนิดต่าง ๆ แต่ก็แนะนำให้ทานปลาอย่างน้อย 227 กรัมต่อสัปดาห์
ในปีเดียวกันคณะสาธารณสุขศาสตร์ของมหาวิทยาลัยฮาร์วาร์ดก็ได้เริ่มโครงการ Healthy Eating Plate ส่วนหนึ่งก็เพราะมองว่า คำแนะนำของกระทรวงเกษตรไม่ดีพอ
โครงการแนะนำให้ผู้บริโภคเลี่ยงเนื้อแปรรูปและจำกัดการทานเนื้อเพียงแค่ 2 ครั้งต่ออาทิตย์เพราะสัมพันธ์กับโรคหัวใจ โรคเบาหวาน และมะเร็งลำไส้ใหญ่
โดนแนะนำให้ทานปลา ไก่ พืชถั่วหรือเมล็ดถั่วแทน |
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] | เนื้อแดง
ความเห็นพ้องว่าการบริโภคเนื้อแดงมีผลเพิ่มความเสี่ยงโรคหัวใจร่วมหลอดเลือดได้เปลี่ยนไปเมื่อเร็ว ๆ นี้
งานศึกษาที่แยกแยะผลของเนื้อแปรรูปและเนื้อสดไม่พบความสัมพันธ์ระหว่างเนื้อแดงที่ไม่ได้แปรรูปกับโรคหัวใจ
งานวิเคราะห์อภิมานขนาดใหญ่ของมหาวิทยาลัยฮาร์วาร์ดปี 2010 ซึ่งรวมข้อมูลของคน 1 ล้านคนที่ทานเนื้อพบว่า เนื้อแปรรูปเท่านั้นมีผลลบต่อโรคหลอดเลือดเลี้ยงหัวใจ ()
งานศึกษาจึงเสนอว่า "ความแตกต่างของเกลือและสารกันเสีย ไม่ใช่ไขมัน อาจอธิบายความเสี่ยงโรคหัวใจและโรคเบาหวานที่สูงกว่าดังที่เห็นกับเนื้อแปรรูป แต่ไม่เห็นกับเนื้อแดงที่ไม่ได้แปรรูป"
กลไกที่เสนอว่าทำไมการบริโภคเนื้อแดงจึงเป็นปัจจัยเสี่ยงต่อโรคหัวใจร่วมหลอดเลือดรวมทั้งผลของมันต่อคอเลสเตอรอลในเลือด,
เนื้อแดงมีกรด arachidonic acid,
มีเหล็กแบบ heme,
มี homocysteine
และมีไขมันอิ่มตัวสูง |
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งานศึกษาหลายงานได้พบความสัมพันธ์ระหว่างเนื้อแดงที่ไม่ได้แปรรูปกับการเกิดโรคหลอดเลือดเลี้ยงหัวใจ () และโรคหลอดเลือดสมองบางประเภทโดยได้ควบคุมปัจจัยเสี่ยงที่เป็นตัวแปรกวนหลายอย่างแล้ว
งานศึกษาในหญิง 84,000 คนเป็นเวลา 26 ปี พบว่า ผู้ที่ทานเนื้อแดงไม่ได้แปรรูปมากที่สุด เสี่ยงโรค CHD สูงขึ้น 13%
เช่นเดียวกัน งานศีกษาของมหาวิทยาลัยฮาร์วาร์ดปี 2012 พบว่า การบริโภคเนื้อแดงที่ไม่ได้แปรรูปปริมาณที่หนึ่งต่อวัน (ประมาณ 42 กรัม/วัน) เพิ่มความเสี่ยงตาย 13%
ส่วนเนื้อแดงที่แปรรูปปริมาณเท่ากันเพิ่มความเสี่ยงตาย 20%
แม้อัตราทั้งสองจะรวมทั้งโรคมะเร็งและโรคหัวใจร่วมหลอดเลือด () แต่งานศึกษาก็บ่งว่า ในบรรดาผู้เสียชีวิต 23,926 ราย ที่ได้ตรวจสอบเมื่อกำลังทำงานศึกษา
5,910 รายเสียชีวิตเนื่องกับ CVD
การเสียชีวิตสัมพันธ์กับเนื้อแปรรูปและกับเนื้อไม่ได้แปรรูปโดยไม่ต่างกันอย่างสำคัญ |
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] | เนื้อแดง
ความต่างกันระหว่างงานวิเคราะห์อภิมานต่าง ๆ จะต้องหาข้อยุติ เพราะแม้งานหนึ่งจะชี้ว่า เนื้อแดงที่ไม่ได้แปรรูปไม่มีผลต่อความเสี่ยงโรค แต่งานศึกษาตามแผนขนาดใหญ่ที่ทำเฉพาะเรื่องต่าง ๆ ก็ยังพบสหสัมพันธ์
การบริโภคเนื้อแดงที่ไม่ได้แปรรูปมีหลักฐานเบื้องต้นว่าสัมพันธ์กับความเสี่ยงโรคเบาหวานชนิด 2 ที่สูงขึ้น แต่ความสัมพันธ์ค่อนข้างอ่อนและชัดเจนน้อยกว่าความสัมพันธ์ระหว่างเนื้อแดงที่แปรรูปกับโรคเบาหวาน |
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] | เนื้อแดง
งานอื่น ๆ ได้เสนอว่า ความสัมพันธ์อาจเป็นกับไขมันอิ่มตัว ไขมันทรานส์ และคอเลสเตอรอลในอาหาร ไม่ใช่กับเนื้อแดงโดยตรง
งานศึกษาหนึ่งประเมินว่า "การแทนที่เนื้อแดงหนึ่งที่ต่อวันด้วยเมล็ดถั่ว ผลิตภัณฑ์นมไขมันต่ำ และธัญพืชไม่ขัดสี สัมพันธ์กับความเสี่ยงโรคเบาหวานชนิด 2 ที่ต่ำกว่า 16-35%" |
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