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系統識別號 U0007-1407201016431500
論文名稱(中文) 飲食中鈣質介入體重控制計畫對於體重過重及肥胖者減重成效之評估
論文名稱(英文) Effect of Daily Calcium Intervention on the Effectiveness of Weight loss in the Overweight or Obese Humans
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 98
學期 2
出版年 99
研究生(中文) 林若君
學號 G556096002
學位類別 碩士
語文別 中文
口試日期 2010-06-03
論文頁數 108頁
口試委員 委員-黃惠宇
委員-胡雪萍
指導教授-簡怡雯
關鍵字(中) 肥胖
低熱量飲食
體重控制
減重
鈣質
副甲狀腺素
關鍵字(英) obesity
energy restricted diet
weight loss
calcium
parathyroid hormone (PTH)
學科別分類
中文摘要 本研究目的主要是探討對於體重過重或肥胖者,給予高鈣低熱量飲食介入體重控制計畫,對於減重成效與體組成之影響,藉以了解在體重控制中提供足夠的鈣質攝取是否能改善體重過重或肥胖者體內脂肪量。本實驗受試者為平日鈣攝取量少於500毫克/天,且健康的體重過重或肥胖者 (BMI:25~30 公斤/(公尺)2) 共42位,隨機且雙盲分成高鈣組 (每日攝取兩份高鈣代餐) 以及控制組,人數各為21人,分別有16位女性及5位男性。兩組提供8週的低熱量飲食 (熱量:1200大卡/天,醣類:55%,脂肪:25%,蛋白質:20%),並於實驗第0週與第8週進行3日飲食紀錄、體組成以及血液生化值的分析。由飲食分析的結果顯示,在鈣質攝取量的部分,高鈣組實驗後平均鈣質攝取量為964.5 ± 75.5毫克,明顯大於控制組的353.7 ± 96.6毫克 (p<0.05);減重8週後,兩組在體重、BMI、體脂肪、體脂肪百分比、腰圍、腰臀比、血中總膽固醇、三酸甘油酯、LDL-C濃度、TC/HDL-C的比值均較減重前顯著的下降。此外,高鈣組的體重 (-6.9 ± 3.3 公斤, p<0.05)、BMI (-2.7 ± 1.1公斤/(公尺)2, p<0.01)、體脂肪 (-5.7 ± 2.7 公斤, p<0.05)、體脂肪百分比 (-5.7 ± 2.7 公斤, p<0.05) 以及TC/HDL-C的比值 (-0.4 ± 0.6, p<0.05) 皆比控制組顯著的降低。在血清副甲狀腺素的部分,高鈣組在實驗第8週明顯低於第0週 (p<0.05),而血清副甲狀腺素的濃度與鈣質的攝取呈現負相關。因此,在限制熱量攝取的減重條件下,給予體重過重或肥胖者足夠的含鈣飲食,可增加體重控制的效益。
英文摘要 The purpose of this study was to assess the impacts of dietary calcium intervention on effectiveness of weight loss program in obese. All subjects had an initial BMI (body fat index) >24 kg/m2 and low calcium diet (<500 mg/d). Forty two healthy overweight or obese were randomly and equally divided into two groups: Hi-Ca group (female: 16, male: 5) and control group (female: 16, male: 5). In Hi-Ca group, we provided two bottles of Hi-Ca drinks per day and low energy diet (energy: 1200 kcal, carbohydrate: 55%, fat: 25%, protein: 20%) for 8 weeks. In control group, we only provided low energy diet for 8 weeks. We measured 3-day-food record, anthropometric and blood biochemical data respectively at week 0 and week 8. After 8 weeks, results showed that the calcium intake was 964.5 ± 75.5 mg in Hi-Ca group is where 353.7 ± 96.6 mg in control group (p<0.05). Besides, the loss of body weight (-6.9 ± 3.3 kg, p<0.05), BMI (-2.7 ± 1.1 kg/m2, p<0.01), body fat mass (-5.7 ± 2.7 kg, p<0.05), body fat percentage (-4.4 ± 1.9 %, p<0.002) and TC/HDL-C (-0.4 ± 0.6, p<0.05) in Hi-Ca group were significantly different from those of control group in 8 weeks. In the of lipid profile, serum cholesterol, triglyceride and LDL-C concentration were significantly decreased compared with those in week 0. In the serum PTH (parathyroid hormone) level, Hi-Ca group was significantly lowered compared with the baseline (-5.3 ± 10.4 pg/mL, p<0.05) in week 0, which showed that the concentration of PTH and calcium intake were negative correlation and indicated that using high calcium diet together with low energy diet on weight loss program had more significant decreasing in body weight, BMI, body fat mass, and body fat percentage. Therefore, under the circumstance of energy restricted diet, it would increase the effectiveness on weight loss that giving high calcium diet to those overweight and obese humans.
論文目次 摘 要…………………………………………………………………I
英文摘要………………………………………………………………...II
致 謝………………………………………………………………..III
目 錄………………………………………………………………..IV
表 目 錄……………………………………………………...…..……VII
圖 目 錄……………………………………………………..…….…VIII
附錄目錄…………………………………………………….………….IX
第一章 緒論………………………………………………………..…....1
第一節 研究動機………………………………………………...…1
第二節 研究目的…………………………………………………...3
第二章 文獻回顧…………………………………………………………4
第一節 肥胖定義與盛行率………………………………………...4
第二節 肥胖對健康的危害………………………………………...7
第三節 肥胖的成因……………………………………….………10
第四節 國人鈣質攝取現況……………………………………….12
第五節 鈣質的生理作用………………………….………………14
第六節 飲食中的鈣質型式與影響因子…………….……………16
第七節 鈣質與骨骼的相關性…………………………….………18
第八節 鈣質與肥胖的相關性……………………………….……20
第九節 鈣質調控體重的機制.. ……………………….………….23
第三章 實驗設計與方法……………………………..…………….….27
第一節 研究執行流程圖與實驗設計………………..…...…27
第二節 研究對象……………………………………………….…29
第三節 飲食介入……………………………………………….…30
第四節 研究項目………………………………………………….31
第五節 統計方法………………………………………………….40
第四章 結果…………………………………………………………....41
第一節 受試者基本資料……………………………………….…41
第二節 受試者減重前後營養素的攝取狀況………………....…43
第三節 減重期間體位測量值之變化……………………...…..…45
第四節 減重期間對血脂質濃度的影響……………………..….50
第五節 減重期間對副甲狀腺素濃度的影響…………………...53
第六節 鈣質變化量、甲狀腺素、體位變異數相關性………….…54
第七節 減重期間對肝功能與腎功能指數之影響……………..55
第五章 討論…………………………………………………………56
第一節 高鈣低熱量飲食對受測者減重成效之探討………….…56
第二節 高鈣低熱量飲食對於受測者血液生化值之探討….....61
第三節 血清副甲狀腺素濃度與減重效果的關係…...………..…64
第六章 結論…………………………………………………..………..67
第七章 參考文獻………………………………………………………85
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系統識別號 U0007-1501200811142000
論文名稱(中文) 疾病狀態及身體活動度對第1型糖尿病兒童心率變異度之影響
論文名稱(英文) Impact of Disease Status and Physical Acitivity on Heart Rate Variability in Children with Type 1 Diabetes
校院名稱 臺北醫學大學
系所名稱(中) 醫學科學研究所
系所名稱(英) Graduate Institute of Medical Sciences
學年度 96
學期 1
出版年 97
研究生(中文) 陳淑如
學號 D102090013
學位類別 博士
語文別 中文
口試日期 2007-12-28
論文頁數 128頁
口試委員 指導教授-鄭綺
共同指導教授-邱泓文
委員-李燕晉
委員-陳品玲
委員-張瑩如
關鍵字(中) 第1型糖尿病
肥胖
心率變異度
自主神經
身體活動度
關鍵字(英) Type 1 diabetes
Obese children
Heart rate variability
Autonomic neuropathy
Physical activity
學科別分類
中文摘要 自主神經病變與糖尿病心血管疾病的發生率及死亡率有著密切的關係,而肥胖是第2型糖尿病的高危險群,心率變異度(heart rate variability, HRV)的下降反映出自主神經的不平衡,並且是許多疾病死亡率的重要預測因子。往昔研究著重在比較第1型糖尿病與健康個案心率變異度的差異,並將這種差異歸因於高血糖的結果,對於其它影響因子的研究較少。本研究目的為:一、探討血糖控制及罹病年數對第1型糖尿病兒童心率變異度之影響。二、探討身體活動度對第1型糖尿病及健康兒童心率變異度之影響。三、探討身體活動度對肥胖及健康兒童心率變異度之影響。
本研究為一橫斷性研究,採立意取樣,研究對象包括診斷第1型糖尿病的兒童、肥胖兒童及同年齡、性別的健康兒童,共收取93位為第1型糖尿病兒童,88位肥胖兒童以及107位健康兒童。研究工具以心電圖測量個案在休息狀態及活動狀態下的心率變異度,並以「身體活動量表-兒童版」調查個案每週平均身體活動量。
研究結果顯示,第1型糖尿病兒童的LnLF、LnHF及LnTP顯著低於健康兒童,相較於罹病年數,糖化血色素對LnLF、LnHF及LnTP具有較高的解釋力。第1型糖尿病兒童,若同時出現血糖控制不良加上罹病年數長,則其心率變異度會顯著的降低。肥胖兒童之LnHF及LnTP顯著低於健康兒童,LnLF雖略高於健康兒童,但無顯著差異。而肥胖兒童除LnLF顯著高於第1型糖尿病兒童外,LnHF, LnLF/LnHF及LnTP與第1型糖尿病兒童並無顯著差異。當由休息狀態轉變為活動狀態,無論第1型糖尿病、肥胖或健康兒童均呈現心率變異度顯著的下降,且活動狀態下心率變異度的表現和休息狀態是不一樣的。在身體活動度部分,輕度身體活動之第1型糖尿病兒童,其LnLF、LnHF及LnTP均顯著低於中、重度身體活動之第1型糖尿病兒童及健康兒童。而輕度身體活動之肥胖兒童,其LnHF及LnTP顯著低於健康兒童,但中、重度身體活動之肥胖兒童,LnHF及LnTP傾向與健康兒童無差異。
本研究依上述結果做出以下結論:一、良好的血糖控制,可以預防或延緩第1型糖尿病兒童心率變異度的下降。二、第1型糖尿病及肥胖兒童心率變異度均顯著低於健康兒童,且主要以副交感神經功能的下降為主。三、中度以上身體活動度之第1型糖尿病及肥胖兒童,其心率變異度顯著高於輕度身體活動度之第1型糖尿病及肥胖兒童。
英文摘要 Autonomic neuropathy is one of the major complications of diabetes, and is associated with morbidity and mortality of diabetes. Obesity is a high risk factor of type 2 diabetes. Heart rate variability (HRV) has been used to assess the dysfunction of autonomic nervous system. Reduced HRV reflects autonomic imbalance and has been shown to be an independent predictor of mortality in various patient population. Most of the studies focused on the differences of HRV between type 1 diabetic and healthy children, and attributed the autonomic neuropathy of diabetes to the effects of hyperglycemia. However, the influences of other factors on the autonomic nervous function in diabetic children are little known. The purpose of the research is to explore the impact of disease status on HRV in type 1 diabetes, and to explore the influence of physical activity on HRV in type 1 diabetes and healthy children. The influences of physical activity on HRV in obese and healthy children were also studied.
This is a cross-sectional study using purposive sampling which includes type 1 diabetic children, obese children, and healthy control children. A total of 93 type 1 diabetic children, 88 obese children, and 107 healthy children were recruited. Electrocardiography was used to measure HRV both in resting state and active state. Physical activity questionnaire for children was adopted to explore their average physical activity.
The results showed that: type 1 diabetic children had significant lower LnLF, LnHF, and LnTP than those of healthy children. Glycosylated hemoglobin and disease duration are two factors that affecting HRV in type 1 diabetes. Only children with poor glycemic control and extended disease duration will manifest autonomic neuropathy. Obese children had significant lower LnHF and LnTP, but similar LnLF, LnLF/HF than those of healthy children. When proceeding from resting state to active state, there was consistent decrease of LnLF, LnHF, and LnTP for all the study groups. However, the response of HRV during exercise differed from the responses of HRV at rest. Diabetic children with low physical activity have a HRV significantly lower than healthy control. However, the HRV among patients with moderate activity, high activity, and the healthy control were not different. The increase of physical activity was associated with an improvement of autonomic nervous function in obese children.
We concluded that hypoglycemic control may help prevent the decrease of HRV in type 1 diabetes. Type 1 diabetes and obese children had significant lower HRV than those of healthy children. The increase of physical activity was associated with an improved HRV in type 1 diabetes and obese children, especially activity with moderate intensity.
論文目次 致 謝…………….…………………………………………………. 1
中文摘要……………………………………………………………….. 2
英文摘要……………………………………………………………….. 4
目 錄……………………………………………….......................... 6
圖表目次……………………………………………………………….. 9
附 錄……………………………………………………………….. 11

第一章 緒 論
第一節 研究動機與重要性………………………………………. 12
第二節 研究目的…………………………………………………. 17
第三節 研究假設…………………………………………………. 17
第四節 名詞界定………………………………………………..... 17

第二章 文獻查證
第一節 心率變異度的相關概念…………………………………. 19
第二節 糖尿病自主神經病變及其心率變異度…………………. 30
第三節 肥胖者自主神經病變及其心率變異度…………………. 39
第四節 身體活動度對心率變異度的影響………………………. 41

第三章 研究方法

第一節 研究設計…………………………………………………. 46
第二節 研究對象…………………………………………………. 46
頁數
第三節 研究場所…………………………………………………. 50
第四節 研究工具…………………………………………………. 51
第五節 研究倫理考量……………………………………………. 61
第六節 研究流程…………………………………………………. 61
第七節 資料分析方法….………………………………………… 64

第四章 研究結果
第一節 血糖控制及罹病年數對第1型糖尿病兒童心率變異度
之影響………………………………………………….… 65
第二節 身體活動度對第1型糖尿病及健康兒童心率變異度之
影響………………………………………………………. 73
第三節 身體活動度對肥胖及健康兒童心率變異度之影響……. 81

第五章 討 論

第一節 血糖控制及罹病年數對第1型糖尿病兒童心率變異度
之影響……………………………………………………. 92
第二節 身體活動度對第1型糖尿病及健康兒童心率變異度之
影響………………………………………………………. 94
第三節 身體活動度對肥胖及健康兒童心率變異度之影響….... 97

第六章 結論與建議


第一節 結論………………………………………………………. 101
第二節 建議………………………………………………………. 101
第三節 研究限制………….……………...………………………. 104

參考資料
頁數
中文文獻……….……………………..…………………………….. 106
英文文獻………….………..……………………………………….. 107
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系統識別號 U0007-1704200714541614
論文名稱(中文) 多囊性卵巢症候群影響因子之探討
論文名稱(英文) A study on risk factors of Polycystic Ovary Syndrome
校院名稱 臺北醫學大學
系所名稱(中) 公共衛生學研究所
系所名稱(英) Graduate Institute of Public Health
學年度 93
學期 2
出版年 94
研究生(中文) 林茹玉
學號 M508092009
學位類別 碩士
語文別 中文
口試日期
論文頁數 98頁
口試委員 指導教授-葉錦瑩
關鍵字(中) 多囊卵巢症候群
胰島素抗性
雄性肥胖
脂質障礙
高同半胱胺酸血症
關鍵字(英) Polycystic ovary syndrome
Insulin Resistance
Android obesity
Dyslipidemia
Hyperhomocysteinemia
學科別分類
中文摘要 本研究目的在探討多囊性卵巢症候群(Polycystic ovary syndrome; PCOS)患者之危險因子,如:雄性肥胖、胰島素抗性、同半胱胺酸及各類脂質濃度等。採病例對照研究法,從台安醫院生殖醫學中心選取病例組及對照組,收集其血液檢體並利用結構式問卷調查研究對象的生活習慣、月經週期史、過去病史及家族疾病史等人口學資料,另外也分析兩組間微量元素硒、鉻及(抗)氧化壓力的差異。研究結果顯示,多囊性卵巢症候群患者體內胰島素抗性指標較對照組高(空腹胰島素濃度中位值:9.0 vs. 4.22 μU/ml, p=0.0002;空腹血糖/胰島素比值之中位值:10.48 vs. 22.62, p=0.0003;Homeostasis model assessment, HOMA:2.09 VS. 0.98, p<0.0001;Quantitative sensitivity check index , QUICKI:0.34 vs. 0.39, p<0.0001),另外,同半胱胺酸濃度及脂質障礙情形皆較對照組高,並且達統計上顯著意義,(同半胱胺酸中位值: 8.34 vs. 6.94 μmol/l, p=0.02;三酸甘油脂中位數:82.0 vs. 62.5 mg/dl, p=0.004;膽固醇中位數:177.0 vs.155.0 mg/dl, p=0.0009);而微量元素鉻(Chromium)、硒(Selenium)、代表抗氧化壓力的Glutathione(GSH)及代表氧化壓力的脂質過氧化物質(Malondialdehyde;MDA),在本研究中並沒有特別的發現。在模式分析中發現年齡、總膽固醇/高密度脂蛋白比值(Total cholesterol/HDL ratio)、飯後血糖(PC sugar)、胰島素抗性指標HOMA是最能解釋罹患PCOS的變項,解釋力達43%。本研究結果發現PCOS病患同時具備較高的胰島素抗性、高同半胱胺酸血症及脂質障礙等特性,而這些特性同時也是心血管疾病的危險因子,因此,預防PCOS的發生或惡化應該與預防心血管疾病類似,即低油飲食、規律運動、控制體重等生活習慣的培養是很重要的,而PCOS患者未來是否容易發生心血管疾病並不清楚,真正的關係仍有待釐清。
英文摘要 In order to explore the risk factors, such as android obesity, insulin resistance, homocysteine, lipid profile of Polycystic Ovary Syndrome (PCOS) in women. A case-control study was performed. Two groups with and without PCOS women were included at the center for reproductive medicine and infertility in Taiwan Adventist Hospital. The demographic characteristics were collected by structural questionnaire that included the life habits, history of menstration, past history and family history etc. The blood samples were also collected for biochemical examination. Moreover, the concentration of blood trace element (selenium, chromium) in PCOS and non-PCOS women were also measured. Our results showed that insulin resistance (median of AC insulin: 9.0 vs. 4.22 μU/ml, p=0.0002; AC G/I ratio: 10.48 vs. 22.62, p=0.0003; HOMA: 2.09 VS. 0.98, p<0.0001; QUICKI: 0.34 vs. 0.39, p<0.0001), concentration of plasma homocysteine (median: 8.34 vs. 6.94 μmol/l, p=0.02) and dyslipidemia (median: triglyceride:82.0 vs. 62.5 mg/dl, p=0.004; cholesterol: 177.0 vs.155.0 mg/dl, p=0.0009) in the PCOS patients was significantly higher than in the non-PCOS patients. Waist circumference was high and concentrations of chromium, glutathione were low in PCOS women than non-PCOS women, but not significantly. Selenium and MDA were no finding. In multiple logistic regression analysis, Age, Total cholesterol/HDL ratio, pc sugar and HOMA (Homeostasis model assessment) had the best explanatory power for PCOS with coefficiency of determination 0.43. Because the risk factors of PCOS is identical to cardiovascular risk factors, therefore, low oil diet, exercise regularly, control the body weight that maybe the most important lifestyles for prevention. Several risk factor clusters together in PCOS women and its contribution to the development of cardiovascular disease need more evidence to confirm in the future.
論文目次 圖目錄…………………………………………………………………………………V 表目錄…………………………………………………………………………………V 第一章、 前言……………………………………………………………………… 1 第一節 研究背景………………………………………………………………… 1 第二節 研究目的………………………………………………………………… 3 第三節 研究架構………………………………………………………………… 4 第二章、 文獻探討………………………………………………………………… 5 第一節 多囊性卵巢症候群的定義及診斷方式……………………….…………5 第二節 多囊性卵巢症候群的可能危險因子………………………………….…6 一、 雄性肥胖………………………………………………………………….6 二、 胰島素抗性……………………………………………………………….6 三、 高同半胱胺血症………………………………………………………….7 四、 脂質障礙……………………………………………………...…………9 五、 C反應蛋白……………………………………………………………… 10 六、 氧化壓力及抗氧化程度……………………………………………… 10 七、 微量元素(鉻、硒)………………………………………………………11 第三節 多囊性卵巢症候群與心血管疾病的關係………………………………12 第四節 小結……………………………………………………………….…… 13 第三章、 材料與方法………………………………………………………………21 第一節 研究對象的選取………………………………………………………. 21 第二節 收集檢體及檢查流程…………………………………………………. 25 第三節 檢體處理流程…………………………………………………………. 26 第四節 血液中微量元素及抗氧化相關物質之分析…………………………..27 第五節 統計方法與分析………………………………………………………..40 第四章、 結果…………………………………………………………………… 41 第一節 研究對象基本人口學資料之分析……………………………….…… 41 第二節 研究對象雄性肥胖與胰島素抗性之分析………………………………45 第三節 研究對象同半胱胺酸、C反應蛋白、(抗)氧化與微量元素之分析… 52 第四節 研究對象之胰島素抗性與同半胱胺酸、抗氧化程度之分析…………54 第五節 研究對象各類脂質之分析………………………………………………56 第六節 各危險因子之間相關性分析……………………………………………59 第七節 以ROC Curve分析各檢驗值的適當切點………………………………65 第八節 羅吉斯迴歸模式分析多囊性卵巢症候群與危險因子之相關…………69 第五章、 討論………………………………………………………………………79 第一節 研究對象之基本資料及臨床資料分析…………………………………79 第二節 雄性肥胖、胰島素抗性與多囊性卵巢症候群的關係…………………79 第三節 胰島素抗性與同半胱胺酸的關係………………………………………81 第四節 心血管疾病危險因子同時也是多囊性卵巢症候群的特徵……………82 第六章、 結論………………………………………………………….………… 85 第七章、 研究限制…………………………………………………………………86 第八章、 建議………………………………………………………………………87 參考文獻…………………………………………………………………………… 88
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系統識別號 U0007-1704200714541845
論文名稱(中文) 胃隔間手術和血中生化指標相關性
論文名稱(英文) Comparison with Biochemical Markers after Swedish adjustable gastric band Operation
校院名稱 臺北醫學大學
系所名稱(中) 醫學檢驗生物技術學研究所
系所名稱(英) Graduate Institute of Biomedical Technology
學年度 93
學期 2
出版年 94
研究生(中文) 廖嘉勇
學號 G160091007
學位類別 碩士
語文別 中文
口試日期
論文頁數 109頁
口試委員 指導教授-李宏謨
關鍵字(中) 肥胖蛋白
病態性肥胖
關鍵字(英) SAGB
hs-CRP
leptin
學科別分類
中文摘要 生活水準的提昇,生活壓力加上缺乏運動,使得肥胖人口不斷增加,病態性的肥胖(BMI≧40 Kg/m2)增加人們生病和死亡的危險性也是造成許多疾病的危險因子。(如:心臟血管疾病和營養代謝失調)。當無法以物理性減肥方式達到目的(如:運動、飲食營養控制、藥物治療等),外科胃隔間手術經常被用來達到減肥的最終方法。此外,肥胖是脂肪細胞和控制食慾、維持身體能量平衡的蛋白(leptin)經由一連串複雜的訊號傳遞造成身體能量失調的結果。在本實驗中,我們收集16位接受胃隔間手術的肥胖者和10位對照組,比較手術前後肥胖者體內leptin和high sensitivity C-Reactive Protein (HS-CRP)的變化情形。手術前血中leptin濃度(67.22±8.58)和手術後(20.33±5.28)比較明顯高出許多,BMI下降的程度(-35.64%)和leptin以及HS-CRP濃度下降也有相關性。HS-CRP 濃度大幅下降的結果也說明胃隔間手術改善這些病人的健康情形。進一步我們也比較胃隔間手術前後肝功能項目、腎功能項目、脂質檢測、心臟相關酵素活性和血糖。發現肝功能、腎功能項目並沒有明顯的改變。但是胃隔間手術後明顯改善心臟相關酵素、UA和血糖的情況。我們也觀察到TG 大幅度下降50%。綜合以上的結論,leptin應該是脂肪組織的指示劑。胃隔間手術不僅可以降低血中leptin濃度也可以改善血中UA、血糖和TG濃度。
英文摘要 Morbid obesity (BMI≧40 Kg/m2)is associated with increased risk of morbidity and mortality from chronic health conditions including cardiovascular diseases and metabolic disorders. Swedish adjustable gastric band operation(SAGB)has been used to treat morbid obesity when conventional physical therapy including exercise, diet and medication fails to reduce the body weight of the patients. However, obesity is a consequence of positive energy balance which is controlled by a complex networks of signals originated from a number of tissues, including adipose tissue, leptin, a satiety hormone control appetite and energy balance of the body. In the present study, we examined serum leptin level and high sensitivity c-reactive protein (HS-CRP)before and one year after SAGB in sixteen morbid obese subjects and ten age-matched control. Average pre-operative serum leptin level was very high 67.22±8.58 as compare to 20.33±5.28 post-operatively, BMI decreased significantly (-35.64%)which was correlated with a decreased of serum leptin level, and dramatic decrease of HS-CRP. The improved postoperative HS-CRP suggested that SAGB improved that general health conditions. To explore further, we examined the liver function tests(LFT),renal function tests(RFT),lipid profiles, cardiac enzyme activities and fasting glucose level before and after SAGB, which the LFT and RFT were not significantly changed, the cardiac enzymes, serum uric acid(UA) level, as well as fasting glucose level were significantly improved after SAGB. Consistently, there was a 50% reduction of serum triglyceride(TG)level one year after surgery. Taken together, serum leptin level may be predictive of the mass of adipose tissue. Reduction of body weight by SAGB not only reduce the serum the leptin level but also normalized serum UA, fasting glucose and TG levels which were abnormal before SAGB-induced active weight loss. Keywords: Swedish adjustable gastric band operation, leptin, high sensitivity c-reactive protein, morbid obesity
論文目次 第一章 緒論 1 Leptin的特質 1 HS-CRP的特質 3 Leptin研究現況 4 Leptin和BBB飽和運輸模式關係 4 Leptin相關訊息傳遞在鼠科動物模式 5 Leptin和高血壓、心血管疾病關係 5 Leptin和早產兒成長關係 6 Leptin和女性懷孕生產關係 7 Leptin、Leptin resistance和脂肪組織、肥胖關係 8 Leptin和乳房癌症、前列腺癌症細胞成長關係 9 Leptin和免疫系統關係 9 研究目的 11 第二章 實驗材料與方法 12 檢體收集 12 實驗材料 12 藥品試劑 12 儀器設備 19 實驗方法 20 一、血中Leptin濃度檢測 20 二、Hitachi 7170全自動生化分析儀操作 21 三、各項生化指標的測定 22 四、統計分析 22 第三章 實驗結果 23 一、胃隔間手術對血清中Leptin濃度的影響 23 二、胃隔間手術對血清中HS-CRP濃度的影響 24 三、胃隔間手術對血清中Cardiac Enzyme濃度的影響 24 四、胃隔間手術對血清中Lipid Profile濃度的影響 25 五、胃隔間手術對血清中UA濃度的影響 27 六、胃隔間手術對血清中Glucose濃度的影響 27 七、胃隔間手術對血清中AMY/LIP濃度的影響 28 八、胃隔間手術對血清中Liver Function profile濃度的影響29 九、胃隔間手術對血清中Kidney Function profile的影響 30 十、胃隔間手術對血清中Ca/P濃度的影響 31 第四章 討論 33 第五章 參考文獻 37 附圖 一、Albumin檢測原理生化反應 54 二、ALP檢測原理生化反應 55 三、ALT檢測原理生化反應 56 四、AMY檢測原理生化反應 57 五、AST檢測原理生化反應 58 六、BUN檢測原理生化反應 59 七、Ca檢測原理生化反應 60 八、Creatinine檢測原理生化反應 61 九、CK檢測原理生化反應 62 十、Glucose檢測原理生化反應 63 十一、HDL-C檢測原理生化反應 64 十二、HS-CRP檢測原理生化反應 65 十三、LDH檢測原理生化反應 66 十四、LDL-C檢測原理生化反應 67 十五、Lipase檢測原理生化反應 68 十六、P檢測原理生化反應 69 十七、TB檢測原理生化反應 70 十八、TC檢測原理生化反應 71 十九、TG檢測原理生化反應 72 二十、TP檢測原理生化反應 73 二十一、UA檢測原理生化反應 74 實驗結果圖表 表目錄 TABLE 1. Pre- and Postoperative 75 Characteristics of patients TABLE 2. 使用試劑原理廠牌一覽表 76 圖目錄 Fig. 1.A. Leptin濃度和手術後時間關係 77 Fig. 1.B. 血清中Leptin濃度手術前後變化情形 78 Fig. 2.A. HS-CRP濃度和手術後時間關係 79 Fig. 2.B. 血清中HS-CRP濃度手術前後變化情形 80 Fig. 3.A. CK/CKMB濃度和手術後時間關係 81 Fig. 3.B. 血清中CK濃度手術前後變化情形 82 Fig. 3.C. 血清中CKMB濃度手術前後變化情形 83 Fig. 3.D. LDH濃度和手術後時間關係 84 Fig. 3.E. 血清中LDH濃度手術前後變化情形 85 Fig. 4.A. Lipid Profile濃度和手術後時間關係 86 Fig. 4.B. 血清中TC濃度手術前後變化情形 87 Fig. 4.C. 血清中HDL-C濃度手術前後變化情形 88 Fig. 4.D. 血清中LDL-C濃度手術前後變化情形 89 Fig. 4.E. TG濃度和手術後時間關係 90 Fig. 4.F. 血清中TG濃度手術前後變化情形 91 Fig. 5.A. UA濃度和手術後時間關係 92 Fig. 5.B. 血清中UA濃度手術前後變化情形 93 Fig. 6.A. Glucose濃度和手術後時間關係 94 Fig. 6.B. 血清中Glucose濃度手術前後變化情形 95 Fig. 7.A. AMY/LIP濃度和手術後時間關係 96 Fig. 7.B. 血清中AMY濃度手術前後變化情形 97 Fig. 7.C. 血清中LIP濃度手術前後變化情形 98 Fig. 8.A. Liver Function Profile濃度和手術後時間關係 99 Fig. 8.B. 血清中AST濃度手術前後變化情形 100 Fig. 8.C. 血清中ALT濃度手術前後變化情形 101 Fig. 8.D. 血清中ALP濃度手術前後變化情形 102 Fig. 8.E. 血清中TB濃度手術前後變化情形 103 Fig. 9.A. BUN/Creatinine濃度和手術後時間關係 104 Fig. 9.B. 血清中BUN濃度手術前後變化情形 105 Fig. 9.C. 血清中Creatinine濃度手術前後變化情形 106 Fig. 10.A. Ca/P濃度和手術後時間關係 107 Fig. 10.B. 血清中Ca濃度手術前後變化情形 108 Fig. 10.C. 血清中P濃度手術前後變化情形 109
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系統識別號 U0007-1704200714542075
論文名稱(中文) 比較台灣地區肥胖病人與正常個體在Ghrelin基因的多型性與新陳代謝
論文名稱(英文) Comparison of ghrelin gene polymorphisms and its related metabolism between obese and non-obese subjects in local area
校院名稱 臺北醫學大學
系所名稱(中) 醫學檢驗生物技術學研究所
系所名稱(英) Graduate Institute of Biomedical Technology
學年度 93
學期 2
出版年 94
研究生(中文) 張福安
學號 G160092009
學位類別 碩士
語文別 中文
口試日期
論文頁數 48頁
口試委員 指導教授-劉正民
關鍵字(中) 肥胖症、ghrelin、基因多型性
關鍵字(英) Obesity、ghrelin、gene polymorphisms
學科別分類
中文摘要 Ghrelin 是由人類胃部的細胞所分泌的激素,短期控制在攝取食量的系統中,扮演了一個重要的角色,而過度攝取食物是導致肥胖的主要原因之一。先前國外有研究指出Ghrelin轉錄區在第51個及第72個氨基酸有基因的多型性差異,為了解台灣地區在肥胖症與正常個體在Ghrelin基因多型性,利用Restriction Fragment Length Polymorphisms (RFLPs)方法研究分析92人台灣地區肥胖症結果有15人發現Arg51Gln突變,相較於台灣地區正常個體99人無出現該點變異(p<0.001)。另外在Leu72Met基因位置,肥胖症與正常個體也有差異 (p<0.05),其結果顯示台灣地區肥胖與正常人口Ghrelin基因可能存在基因多型性差異。比較有突變與無突變肥胖人口在生理及生化檢查並無差異性,其結論推測Ghrelin單一肥胖基因變異,並不能改變肥胖者生理及生化值的變化。
英文摘要 Ghrelin, an hormone released from epithelial cells in the stomach, plays an important factor for food intake control during a short term period, while over food intake is one of the major reasons toward obese. It has been identified by foreign researchers that the ghrelin transcript regions of amino acid the 51 and the 72 are two different loci in genetic polymorphism. This report is focused on the ghrelin genetic polymorphism of the obesity and normal persons in Taiwan by Restriction Fragment Length Polymorphisms (RFLPs). It was is observed 15 out of 92 obese Taiwanese, have Arg51Gln mutation while 99 normal Taiwanese have no such mutation (p<0.001). Moreover, it is different between the obesity and normal persons in the gene coding position of Leu72Met (p<0.05). Based on these results,, we may conclude the ghrelin genetic polymorphism is different between the obesity and the normal Taiwanese. However, there is no difference in comparison for the obesity with ghrelin gene mutations and without mutations on some related physiological and biochemical parameters.
論文目次 Abstract ii 中文摘要 iii 目次 iv 表目錄 vi 圖目錄 vii 第一章、緒論 1 一、研究項目 1 二、Ghrelin簡介 3 第二章、研究材料 5 一、實驗材料 5 二、常用儀器 8 第三章、實驗方法 10 一、生物資訊 10 二、設計primer及restriction enzyme 10 三、DNA萃取純化 10 四、Polymerase Chain Reaction(PCR) 11 五、PCR-RFLP(Polymerase Chain Reaction - Restriction Fragment Length Polymorphism) 11 六、直立式電泳分析 12 七、PCR-RFLP判讀 12 八、血清濃度分析 12 第四章、實驗結果 16 PCR-RFLP結果 16 第五章、討論 19 附表與圖 22 Reference 44
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系統識別號 U0007-1704200714553819
論文名稱(中文) 成年人體脂肪測量方法的比較及體位與體脂肪相關性的探討
論文名稱(英文) Comparison with the methods for measuring body fat and interrelationships between anthropometry and body fat in adults
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 93
學期 2
出版年 94
研究生(中文) 楊蕙
學號 G556091002
學位類別 碩士
語文別 中文
口試日期
論文頁數 73頁
口試委員 指導教授-楊淑惠
關鍵字(中) 成人
肥胖
生物電阻分析
身體組成
體重控制
關鍵字(英) adult
obese
bioelectrical impedance analysis
body composition
weight control
學科別分類
中文摘要 本研究主要目的是要探討一般成年人與肥胖者,以分段多頻率生物電阻分析法所得之體脂率為標準值,比較足到足生物電阻分析法、手到手生物電阻分析法及紅外線測量法其所得之體脂率的相關性及準確性;並探討肥胖者體脂肪及身體組成與一般體位者的差異性。本研究分為二部分,研究一以一般成年人為對象,男性25人,女性93人,結果顯示:四種測量法均具有相關性,但以足到足及手到手生物電阻分析法所得之體脂率無統計性的差異,而紅外線測量法所得之值明顯的偏低(P < 0.05);體位測量的腰圍、臀圍、腰臀比、身體質量指數均與體脂率成正相關性,其中男性以腰圍(r=0.72, P < 0.0001)女性以BMI(r=0.79, P < 0.0001)呈最顯著正相關性。研究二以肥胖者BMI > 27 kg/m2為對象,男性6人,女性21人,結果顯示:以足到足及手到手生物電阻分析法所得之體脂率並無統計性的差異,紅外線測量法明顯的偏低(P < 0.05),其中肥胖男性以手到手電阻法 (r=0.93, P < 0.05),肥胖女性以足到足生物電阻法所得之值更接近標準值(r=0.80, P < 0.0001);體位測量方面肥胖男性只有臀圍與體脂率有正相關(r=0.85, P < 0.05),肥胖女性以腰圍、臀圍、BMI與體脂率有正相關性,以BMI(r=0.78, P < 0.001)呈最顯著正相關性。探討腰臀比值則所有肥胖男女兩性的腰臀比與體脂率並無相關性,而且不能夠代表減重的成果。
英文摘要 The purpose of this study is to compare the methods among Segmental Bioelectrical Impedance Analysis (SBIA), Foot-to-Foot Bioelectrical Impedance Analysis (FFA), Hand-to-Hand Bioelectrical Impedance Analysis (HHA), and Near Infra-red Interactance (NIRI) for measuring the accuracy of body fat and finding the correlations of body composition for normal adults and obese adults. The variations of body fat and body composition for obese and normal adults are also investigated. This study is divided as two phases. In phase 1, 25 men and 93 women are studied. The results show that all four methods are correlated. However, no significant statistic differences presented in measurement of body fat percentile using both FFA and HHA and lower measurement (P < 0.05) observed for NIRI. Body fat percentileile is correlated with body waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and body mass index (BMI). The significant correlated values are presented for men with WC (r=0.72, P < 0.0001) and women with BMI (r=0.79, P < 0.0001). In phase 2, the obese adults, 6 men and 21 women with BMI over 27 kg/m2 are investigated. The results demonstrate that no statistic differences presented in measurement of body fat percentile using both FFA and HHA, however, the lower measurement (P < 0.05) presented for NIRI. It also shows that the standard values are achieved using HHA for obese men (r=0.93, P < 0.05) and using FFA for obese women (r=0.80, P < 0.0001). Body fat percentile is only correlated with HC for obese men (r=0.85, P < 0.05), while it is correlated with WC, HC and BMI for obese women, the significant correlated values with BMI (r=0.78, P < 0.001). It also shows that body fat percentile is not correlated with WHR for both obese men and obese women. However, it can not show the index of weight control result.
論文目次 中文摘要 I 英文摘要 III 誌 謝 IV 目 錄 V 表目次 VIII 圖目次 IX 第一章 緒 論 1 第一節 研究動機 1 第二節 研究目的 3 第二章 文獻回顧 4 第一節 名詞縮寫 4 第二節 身體的組成 5 第三節 身體組成測量的方法 6 第四節 生物電阻分析法 9 第五節 生物電阻分析法的相關研究 11 第六節 肥胖與疾病 12 第七節 體位測量與身體脂肪 13 第三章 材料與方法 17 第一節 研究架構 17 第二節 研究工具 17 第三節 研究對象與研究步驟 21 第四章 研究結果 24 第一節 研究一受試者資料分析 24 第二節 研究一身體脂肪測量結果分析 25 第三節 研究一身體脂肪與體位測量值的比較分析 26 第四節 研究二受試者資料分析 27 第五節 研究二肥胖者體脂肪測量結果分析 27 第六節 研究二肥胖者體脂肪與體位測量值的分析 29 第七節 研究二肥胖組減重前、後體脂肪及體位的變化 29 第五章 討 論 32 第一節 研究一一般成年人體脂肪測量法其準確性的探討 32 第二節 研究一一般成年人身體脂肪與體位測量值相關性的探討 34 第三節 研究二肥胖者體脂肪測量法其準確性的探討 35 第四節 研究二肥胖者體位與體脂肪相關性的探討 37 第五節 研究二肥胖組減重前、後體位與體脂肪相關性的探討 38 第六章 結 論 40 參考文獻 41 表目次 表 一 受試者的基本資料1, 2 49 表 二 受試者的體位測量值1, 2, 3 50 表 三 受試者身體脂肪測量值1, 2, 3 51 表 四 受試者身體脂肪測量之相關係數1, 2 52 表 五 受試者體位測量與身體脂肪測量之相關係數1, 2 53 表 六 肥胖組基本資料1, 2 54 表 七 肥胖者身體脂肪測量值1, 2, 3 55 表 八 肥胖者身體脂肪測量之相關係數1, 2 56 表 九 肥胖者體位測量值與身體脂肪之相關係數1, 2 57 表 十 肥胖組減重前、後身體脂肪的變化1, 2, 3 58 表 十一 肥胖組減重前、後體位測量值的變化1, 2, 3 59 圖目次 圖 一 身體的五層次模型 60 圖 二 空氣排除體積描記器 60 圖 三 雙能量X射線吸收法 61 圖 四 測量身體組成方法的長處與限制 61 圖 五 BIA測量方法 62 圖 六 SBIA八個電極位置圖 63 圖 七 五個電阻位置圖 63 圖 八 研究架構圖 64 圖 九 分段電阻分析法(SBIA) 65 圖 十 足到足生物電阻分析儀(FFA) 65 圖 十一 手到手生物電阻分析儀(HHA) 66 圖 十二 近紅外線體脂肪測定儀(NIRI) 66 圖 十三 三頭肌皮層厚度(TSF) 67 圖 十四 研究一的研究流程 68 圖 十五 研究二 研究流程 69 圖 十六 肥胖男性SBIA與FFA體脂率的相關性 70 圖 十七 肥胖男性SBIA與HHA體脂率的相關性 71 圖 十八 肥胖女性SBIA與FFA體脂率的相關性 72 圖 十九 肥胖女性SBIA與HHA體脂率的相關性 73
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系統識別號 U0007-1704200714571380
論文名稱(中文) 影響過重及肥胖成人減重行為之相關因素研究
論文名稱(英文) Associated Factors of the Weight Control Behaviors for Overweighed and Obese Adults
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 92
學期 2
出版年 93
研究生(中文) 張子智
學號 M406090014
學位類別 碩士
語文別 中文
口試日期
論文頁數 141頁
口試委員 指導教授-陳品玲
關鍵字(中) 減重行為
減重信念
自我效能
社會支持
過重及肥胖成人
關鍵字(英) weight control behavior
belief of weight control
self-efficacy
social support
overweighed and obese adult
學科別分類
中文摘要 臺灣有四分之一以上的成人過重,故近年來政府及民間對減肥投入相當多的心力,但過重與肥胖成人的盛行率仍是有增無減。所以本研究目的想探討過重及肥胖成人執行減重行為之現況,及個人背景因素、減重信念、自我效能、社會支持與減重行為之間的相關性。本研究採橫斷式調查性研究法,以方便取樣台北市文山區及信義區符合條件之200位個案為研究樣本,採結構式問卷收集資料,重要結果如下: 一、研究對象有56﹪從未採取任何減重行為,近一年採取健康減重的情形 為40.5﹪,採取另類減重的情形為27﹪,且每人平均用2~3種健康方 式減重,及0~1種另類方式減重,而同時採用健康與另類減重的人佔 23.5﹪。 二、女性執行另類以及同時採取二種減重行為的情形比男性還高。BMI每 增加1分採取健康減重的機率降低0.775倍。而年齡、婚姻狀況、教育 程度,則與減重行為在統計上無明顯差異。 三、研究對象於過重對健康的影響、減重利益、減重障礙的認知上,介於 不同意至同意。 四、研究對象的自我效能把握度為五成。在節制飲食自我效能表現有六成 把握,運動自我效能有三成把握。 五、研究對象的家人、朋友社會支持度為很少至偶爾。醫護人員社會支持 情形介於從未至很少。 六、過重對生理健康的影響、減重利益、減重障礙與健康減重行為有 關。 過重對心理社會健康的影響、減重利益與另類及同時採取二種 減重行為有關。 七、節制飲食自我效能、運動自我效能與另類減重行為呈負相關,與健康 減重行為無關,而節制飲食自我效能與同時採取二種減重行為呈負相 關。 八、家人、朋友、醫護人員社會支持與健康減重行為呈正相關。朋友、醫 護人員社會支持與另類及同時採取二種減重行為呈正相關。 本研究結果顯示過重對心理健康影響越大、節制飲食自我效能表現越差、朋友社會支持越好及女性,較會採取另類減重行為。建議未來在社區宣導或推行減重計畫時,宜注意有以上特質的民眾,協助解決減重相關問題與障礙,予適時指導並強化其採取健康減重行為。
英文摘要 There are over 25﹪adults are overweight in Taiwan. In recent years, the Government and the folk take much effort on weight controlling. However, the populations of overweight and obese adults are still increasing. The purposes of this study were, therefore, to explore the behaviors of overweight and obese adults weight-control and associated factors. A cross-sectional study was conducted using convenience sampling with a structured questionnaire. Two hundred subjects were participated in the Wenshan district and Hsinyi district, Taipei city. The results were summarized as followed: 1. The results indicated that 56 percent of subjects never conduced a weight control behavior. In the recent year, 40.5 percent conducted healthy methods, 27 percent conducted alternative methods. They use a mean number of 2~3 healthy methods and 0~1 alternative methods. Twenty four percent of subjects used both healthy and alternative methods. 2. The ratio of female conducting alternative and both method were higher than male. The propobility of using healthy method is 0.775 times less with BMI score increasing 1 point. Age, marriage and educations were no statistically significant associated with weight reduce behaviors. 3. The perceived of subjects toward the affect of over weight to health, benefits of weight reduce and barriers of weight were between agreement and disagreement. 4. The self-efficacy of subjects was 50 percent on themselves, and 60 percent on dietary and 30 percent on exercise behavior. 5. Social supports were between rare to occasional from subjects’ family members, friends and were between never and rare from health professionals. 6. Healthy weight reduce behaviors were associated with the effects of over weight to physical health, benefits of weight reduce, and barriers of weight reduce. Alternation and conducting both health and alternative behaviors were associated with the effects of over weight to psychological and social health, and benefits of weight reduce. 7. Self-efficacy on dietary and on exercise are positively associated with alternative weight reduced behaviors and were not associated with healthy reduce behaviors. Self-efficacy on dietary was negatively associated with conducting both healthy and alternative weight control behaviors. 8. Social supports from family members, friends and health professionals were positively associated with health weight reduce behaviors. Social supports from friends and health professionals were negatively associated with alternative weight reduced behaviors and conducting both weight reduce behaviors. The results were shown that those who were (i) more effects of over weight to psychological health, (ii) worth Self-efficacy on dietary, (iii) more social support from friends and (iv) females had more chance to conduct alternative methods. In the future, it is better to take note to those who have these characteristics when propagating or carrying out weight control programs in the communities, and to encourage them to use healthy weight control methods.
論文目次 第一章 緒論 第一節 研究背景與動機-------------------------------------1 第二節 研究目的-------------------------------------------7 第二章 文獻查證 第一節 過重及肥胖的定義-----------------------------------8 第二節 過重及肥胖的成因----------------------------------10 第三節 過重及肥胖對健康的影響----------------------------13 第四節 減重行為之相關概念--------------------------------16 第五節 影響減重行為之相關因素研究------------------------24 第六節 概念架構------------------------------------------38 第七節 名詞解釋------------------------------------------40 第八節 研究問題------------------------------------------42 第九節 研究假設------------------------------------------43 第三章 研究方法 第一節 研究設計------------------------------------------44 第二節 研究對象------------------------------------------45 第三節 研究工具------------------------------------------46 第四節 研究步驟------------------------------------------50 第五節 資料處理與分析------------------------------------54 第四章 分析與結果 第一節 研究對象特質之描述性統計--------------------------57 第二節 研究對象個人背景因素、減重信念、自我效能、社會支 持與減重行為之關係--------------------------------69 第五章 討論 第一節 研究對象的減重行為--------------------------------80 第二節 研究對象的個人背景因素、減重信念、自我效能、社會 支持----------------------------------------------82 第三節 研究對象減重行為之相關因素------------------------86 第六章 結論與建議 第一節 結論----------------------------------------------93 第二節 應用建議------------------------------------------95 第三節 限制----------------------------------------------98 參考資料 中文部份--------------------------------------------100 英文部份--------------------------------------------105
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系統識別號 U0007-1704200715033214
論文名稱(中文) 建構與評估支援減重行為療法之網際網路平台
論文名稱(英文) Construction and Evaluation of the Internet Behavioral Modification on Weight Loss Platform
校院名稱 臺北醫學大學
系所名稱(中) 醫學資訊研究所
系所名稱(英) Graduate Institute of Medical Informatics
學年度 94
學期 2
出版年 95
研究生(中文) 李建志
學號 M110093006
學位類別 碩士
語文別 中文
口試日期
論文頁數 100頁
口試委員 指導教授-邱泓文
關鍵字(中) 肥胖
行為療法
虛擬學習社群
遠距醫療
關鍵字(英) Weight loss program
Behavioral therapy
Virtual community
學科別分類
中文摘要 近年台灣民眾肥胖的盛行率有逐年增加的趨勢。由於電腦及寬頻網路的普及化,國外已有許多減重網站,提供肥胖的民眾利用線上專家諮商、電子郵件、飲食控制、行為療法及小組討論的方式進行減重治療。 本研究著重於如何利用資訊網路科技協助減重計畫中的飲食控制,以二十四小時回憶法為飲食記錄方法,透過網際網路的特性及電腦的應用,以簡化在登錄飲食記錄的不便,並可以隨時查詢營養成份及熱量、自動計算攝取熱量及運動消耗熱量。減重平台亦使用圖形化報表將飲食記錄、熱量攝取及運動耗能等訊息清楚地提供給民眾,並配合運動、行為療法之方法、虛擬學習社群及應用遠距醫療以及遠距學習計畫的設計與實施,希望能夠證明施行網路減重計畫的成效,並且協助一般民眾或肢體殘障人士達到控制體重的目的,進而維持健康的身心,提升生活品質及回復自信心。
英文摘要 The overweight prevailing rate of Taiwan people has the tendency to increase recently. Because of the popularization of the computer and internet network, many websites provides expert’s consults、Email、dietary principles、exercise guildelines、behavioral therpy and group discussion for weight loss. The aim of the study is focused on how to use internet technologies to facilitate the diet-controlled of the weight-loss program. Participants use 24 hours recall to record the food plans through the weight loss platform. They can make inquiry the following information; nutritional values and calories of foods、calories consumed of the exercises. We also utilize reports to show the massages to participants through the graphics interface and some concepts of nutritional knowledge to assist with patients to lose body weight and cost-effective for reducing weight and body mass index (BMI).
論文目次 標題 i 審定書 ii 上網授權書 iii 誌謝 iv 圖目錄 vi 表目錄 viii 中文摘要 ix 英文摘要 x 第一章 緒論 1 1.1 研究動機 1 1.2 研究目的 3 第二章 文獻探討 5 2.1 肥胖定義及治療 5 2.1.1 肥胖的定義 5 2.1.2 肥胖的成因 7 2.1.3 肥胖的治療 9 2.2 遠距醫療 15 2.3 遠距學習 16 2.4 行為療法 20 2.5 商業網路減重網站 22 2.5.1 健康資訊網站的特徵及目的 22 2.5.2.1 eDiets.com 26 2.5.2.2 Weight Watchers 28 第三章 系統分析與設計 32 3.1 研究設備及軟體 32 3.2 研究流程 33 3.3 系統架構 35 3.4 研究方法 40 3.5 系統評估及問卷 42 第四章 研究結果 44 4.1系統開發界面 44 4.1.1首頁 44 4.1.2學員聯絡簿 45 4.1.3飲食記錄 46 4.1.4食品資料庫建檔 49 4.1.5營養衛? 52 4.1.6體重記錄 55 4.1.7體重變化趨勢圖 56 4.1.8運動記錄及運動耗能圖 57 4.1.9電子佈告欄 58 4.1.10學員登入次數統計 60 4.2 系統評估分析 60 第五章 結論與討論 69 5.1結論 69 5.2討論 69 5.3研究限制 72 5.4未來展望 72 參考文獻 74 中文文獻 74 英文文獻 75 電子資料 77 附錄 80 附錄一 學員評估調查表 80 附錄二 子系統滿意度調查表 82 附錄三 專家效度調查表 84 附錄四 麥當勞各項食品成份表 87
參考文獻 Chang CJ., Wu CH., Chang CS., Yao WJ., Wu JS. & Lu FH. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. Int J obes 2003;27:253-9. Friedman JM. Obesity in the new millennium. Nature. 2000;404:632-4. Heshka S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX. Weight Loss With Self-help Compared With a Structrued Commercial Program - A Randomized Trial. JAMA 2003; 289:1792-8. Kopelman PG. Obesity as medical program. Nature. 2000;404:635-42. Kushner R. Commercial Program and Product Review. Obesity Management. 2005;1:27-8. Lamminen H, Niiranen S, Niemi K, Mattila H, Kalli S. Health-related services on the internet. Med.Inform. 2002;27:13-20. Liou TH, Pi-Sunyer FX, Laferrere B. Physical Disability and Obesity. Nutrition Reviews. 2005;63:321-331. Tsai AG, & Wadden TA. Systematic Review: An Evaluation of Major Commercial Weight Loss Programs in the United States. Ann Intern Med. 2005;142:56-66. Tate DF, Wing RR, Winett RA. Using Internet Technology to Deliver a Behavioral Weight Loss Program. JAMA, 2001, 285:1172-7. Truby H., Baic S., deLooy A.,Fox KR., Livingstone MBE., Logan CM.,Macdonald IA., & et al. Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials”. BMJ, 2006,332:1309-14. Whyte JJ. Marting RN. How to guide patients away from fad diets and toward healthy eating. Patient Care. 2005 May. William R Hersh, Mark Helfand, James Wallace, Dale Kraemer, Patricia Patterson, Susan Shapiro and Merwyn Greenlick. Clinical outcomes resulting from telemedicine interventions: a systematic review. BMC Medical Informatics and Decision Making 2001;1:5. William R. Gersh, Katherine Junium & Mark Mailhot. Implementation and Evaluation of a Medical Informatics Distance Education Program. J Am Med Inform Assoc. 2001;8:570-4. Winett RA, Tate DF, Anderson ES, Wojcik JR, Winett SG. Long-term Weight Gain Prevention:A Theoretically Based Internet Approach. Preventive Medicine. 2005; 41:629-641. Wing RR, Sallis JF JR, Goldstein MG, Smith-West D, Acton KJ, Jeffery RW, Birch LL, Surwit SS, Jackicic JM. Behavioral Science Research in Diabetes. Diabetes Care. 2001;24:117-23. Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A Randomized Controlled Trail of a Commercial Internet Weight Loss Program. Obes Res. 2004;12:1011-8. Zora Djuric, Nora M. DiLaura, Isabella Jenkins, Linda Dara, Catherine k. L. Jen, Darlene Mood, Ellen Bradley & William M, Hryniuk. Combining Weight-Loss Counseling With the Weight Watchers Plan for Obese Breast Cancer Survivors. Obes Res. 2002;10:657-65.

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系統識別號 U0007-1704200715050232
論文名稱(中文) 體重控制介入方案對復健期肥胖精神病患減重之成效探討
論文名稱(英文) The Effective of Weight Control Program on Decreasing Body Weight for Obese Psychotic Recovery Patients
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 李宜育
學號 G455092019
學位類別 碩士
語文別 中文
口試日期
論文頁數 116頁
口試委員 指導教授-劉淑娟
關鍵字(中) 復健期肥胖精神病患
體重控制方案
減重
關鍵字(英) obese Psychotic Recovery Patients
Weight Control Program
Decreasing Body Weight
學科別分類
中文摘要 本研究旨在探討復健期肥胖精神病患,經過八週的體重控制方案,予以運動訓練、飲食教育和行為改變策略介入後對身體質量指數、體脂肪比、腰臀圍比、飲食認知、飲食行為的影響。採前測-後測類實驗設計,以立意取樣方式,將台北市某教學醫院復健病房符合收案條件之肥胖精神病患52名,採分層隨機依診斷、使用精神科藥物、性別,分派至實驗組及對照組,各為26名。實驗組予以施行運動訓練、飲食教育和行為改變策略介入,對照組予以一般照顧。 所得資料以描述統計、相依樣本t、獨立樣本t考驗等統計方法加以處理分析,顯著水準為α=.05。實驗前作同質性考驗,實驗組及對照組個案之基本資料及疾病屬性在統計上並無顯著差異。 研究結果發現實驗組的身體質量指數、體脂肪比、腰圍、臀圍、飲食認知、飲食行為與對照組比較皆達顯著差異(p<.05);顯示為期八週的體重控制方案介入有助於復健期肥胖精神病患改善身體組成及對飲食認知、飲食行為的改變有正向的提昇。
英文摘要 The purpose of this study was to investigate the effects of 8-week weight control program, taking exercise training, diet education and behavior modification intervention on the BMI, percentage of body fat, waist and hip circumference, dietary behavior, dietary cognition of obese Psychotic Recovery Patients. The design of the study was quasi-experimental using a purposing sampling in a district teaching hospital recovery ward, the patients who fit the criteria of this study were assigned to the study. According to the diagnosis, use antipsychotic medications, gender, the patients were stratified randomly sampling divided into experiment group or control group. Each group had 26 participants. Weight control program intervention in the experimental group included exercise training, diet education and behavior modification. However, no any interventions were taken for the control group. Collected data were analyzed by descriptive statistics, independent t-test, and paired t-test. The significant level was α=.05. No statistic significant differences were showed on demographics and disease characteristics between experimental group and control group. The result indicated that after 8-week Weight Control Program intervention, the amount of the experiment group showed significant difference between pre- and postexperiment (p<.05). The conclusion of this study showed that 8-week weight control program intervention improved the obese Psychotic Recovery Patients’BMI, percentage of body fat, waist and hip Circumference, dietary behavior, dietary cognition.
論文目次 目 錄 頁 數 致 謝....…………………………………………………….…. I 中文摘要………………………………………………………..…. III 英文摘要…………………………………………………………. IV 目 錄………………………………………………………… VII 圖表目次………………………………………………………… X 第一章 緒論 第一節 研究動機……………….…………………………… 1 第二節 研究重要性………………………………………….. 3 第三節 研究目的…………………………………………….. 4 第三節 名詞界定……………………………………………... 5 第二章 文獻查證 第一節 肥胖的相關探討…………………………………….. 6 第二節 復健期精神病患肥胖問題…………………………. 10 第三節 抗精神疾病藥物與肥胖……………………………. 11 第四節 肥胖的指標……………………………….………… 14 第五節 過重及肥胖對健康的影響…………………………. 16 第六節 體重控制的方法…………………………………… 17 第三章 研究方法 第一節 研究設計…………………………………………… 20 第二節 研究架構…………………………………………… 24 第三節 研究假設…………………………………………… 26 第四節 研究取樣…………………………………………… 27 第五節 研究工具…………………………………………… 28 第六節 研究步驟…………………………………………… 33 第七節 預試成果…………………………………………… 35 第八節 資料處理及統計分析……………………………… 36 第九節 倫理考量…………………………………………… 38 第四章 分析與結果 第一節 研究樣本之屬性與分佈..………………………….. 39第二節 體重控制介入對復健期肥胖精神病患飲食認知及 飲食行為之成效…………………………………… 42 第三節 體重控制介入對復健期肥胖精神病患身體組成之成 效…………………………………….………………. 52 第四節 體重控制介入對復健期肥胖精神病患服務滿意度之 成效……………………………….…………………. 58 第五章 討論 第一節 體重控制的介入對復健期肥胖精神病患飲食認知及 飲食行為有成效…………………………………… 60 第二節 體重控制的介入對復健期肥胖精神病患身體組成有 成效………………………………………………… 61 第三節 體重控制的介入對復健期肥胖精神病患服務滿意度有 成效………………………………………………… 63 第六章 結論與建議 第一節 結論………………………………………………… 64 第二節 建議………………………………………………… 65 第三節 研究限制及未來研究方向之建議………………… 67 參考資料 中文部份……………………………………………………… 68 英文部分……………………………………………………… 72 附錄 附錄一 基本資料…………………………………………. 78 附錄二 專家內容效度問卷函……………………………… 80 附錄三 專家內容效度問卷說明…………………………… 81 附錄四 「飲食認知」--CVI….………………………… 83 附錄五 「飲食認知」內在一致性信度測試……………… 84 附錄六 「飲食行為」--CVI……………………………. 85 附錄七 「飲食行為」內在一致性信度測試……………... 87 附錄八 簡短??症??表………………………………… 88 附錄九 簡短??症??表 量表使用授權書….....….…….. 93 附錄十 『體重控制方案』個案滿意度調查表--CVI.…… 94 附錄十一『體重控制方案』個案滿意度調查表 內在一致性 信度測試………………………………………… 95 附錄十二同意收案公文函…………………………………… 96 附錄十三人體試驗委員會同意函…………………………… 97 附錄十四受訪者同意書.……………………………………... 98 附錄十五團體處置之設計與執行.…………………………… 101 圖表目次 頁數 圖一 體重控制介入方案對復健期肥胖精神病患之減重成效架 構圖………………………………………………………… 25 圖二 研究流程………………………………………………….. 34 圖三 復健期肥胖精神病患實驗組飲食認知差距…………….. 49 圖四 復健期肥胖精神病患實驗組前後飲食行為差距……….. 51 圖五 復健期肥胖精神病患身體組成成效之比較分析……….. 62 表一 研究設計………………………………………………… 21 表二 體重控制介入方案一覽表……………………………… 22 表三 身體組成再測信度考驗結果…………………..………… 31 表四 資料統計與分析表…………………………………………… 37 表五 復健期肥胖精神病患基本資料之描述………………… 40 表六 復健期肥胖精神病患飲食認知及飲食行為之前測結果 43 表七 復健期肥胖精神病患飲食認知及飲食行為前後差異表…. 45 表八 復健期肥胖精神病患飲食認知及飲食行為方面差距表 47 表九 復健期肥胖精神病患身體組成方面之前測結果……… 53 表十 復健期肥胖精神病患身體組成方面前後差異表……… 55 表十一 復健期肥胖精神病患身體組成組間差距表…………… 57 表十二 復健期肥胖精神病患個案服務滿意度調查表………… 59
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系統識別號 U0007-1807200815200700
論文名稱(中文) 不同體型與健康檢查指標相關性之研究-隱藏性肥胖者之風險指標
論文名稱(英文) The relationship between body composition and indicators of physical examination: A study on the health risk indicators of concealed obesity.
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 96
學期 2
出版年 97
研究生(中文) 詹恩慈
學號 G556092002
學位類別 碩士
語文別 中文
口試日期 2008-06-30
論文頁數 80頁
口試委員 委員-王銘富
委員-葉松鈴
指導教授-陳俊榮
關鍵字(中) 身體質量指數
體脂肪率
隱藏型肥胖
關鍵字(英) BMI
body fat
concealed obesity
學科別分類
中文摘要 身體質量指數(body mass index, BMI)是最常被使用作為評斷肥胖程度的指標,但BMI會受到性別、個人、年齡及種族的影響,無法完全表示體內脂肪堆積的情形。臨床上常有一些年輕的受檢者,其BMI正常,體脂肪率過高,但因外型標準且無重大健康問題,而忽略健康管理的重要性。將受檢者體型依體組成分為五大類,分別為正常(Normal)、隱藏性肥胖(Concealed Obesity)、肥胖(Obesity)、BMI偏低體脂肪未超過(Low BMI & Low Body Fat)與BMI過高體脂肪未超過(High BMI & Low Body Fat)。探討被歸類為隱藏性肥胖體型者,其重要的健康檢查指標(血壓、腰臀比、空腹血糖、脂肪肝、肝功能指數、尿酸、血脂等七項指標)之異常發生率與平均值是否高於正常體型者,是否可作為代謝性疾病的警訊,提早給予健康對策,預防未來生活習慣病或代謝性疾病的發生。本研究是利用2006年度8萬名受檢人次之體檢資料進行分析。收集所有接受全身健康檢查者的問卷及體檢結果資料。使用SPSS 軟體進行資料分析,包括:百分比、平均值、標準差、交叉分析等。以卡方檢定(Chi-square test)與一方分類變異數分析(ANOVA test)分析各項健康指標與不同體組成之間的相關性。男性隱藏性肥胖體型,在腰臀比、脂肪肝、肝功能檢查、尿酸與血脂肪之異常發生率明顯高於正常體型者(p < 0.001),而在女性隱藏性肥胖、肥胖與BMI過高體脂率正常之體型,七項指標之異常率皆明顯高於正常體型者(p < 0.001)。在隱藏性肥胖體型中,其尿酸、三酸甘油酯、膽固醇與CHOL/HDL-C之平均值明顯高於正常體型者(p < 0.001)。若再區分性別,男性在腰臀比、尿酸、三酸甘油酯、膽固醇、CHOL/HDL-C之平均值顯著地高於正常體型(p < 0.001) , HDL-C平均值顯著地低於正常體型(p < 0.05);女性則在腰臀比、尿酸、三酸甘油酯、CHOL/HDL-C之平均值顯著地高於正常體型(p < 0.001)。對於隱藏性肥胖者,其未來發生心血管疾病、代謝症候群、慢性病的機率可能高於正常體型者。
英文摘要 Body mass index (BMI) is the most frequently used standard for determinate obesity. But, BMI would be affected by gender, personal, age and nationality. Also, it cannot fully indicate the distribution of body fat. Some of the younger examinees, they may disregard the importance of the health management due to their appearance look like normal and without any serious illness. However, their BMI falls in the normal range but with high percentage of body fat. Body composition of the examinees will be divided into 5 body shapes: separately, normal, concealed obesity, obesity, Low BMI & Low percentage of body fat, and High BMI & Low percentage of body fat. The issue is focusing to discuss the concealed obesity. It will compare the health indexes including blood pressure, hip/waist ratio, fasting blood sugar, fatty liver, liver functions, urine acid and blood lipid tests, with the healthy examinees, to study if it can be reflected the chance of having metabolic syndrome. If there are relationships between the health indexes and the chance of having metabolic syndrome, suggestions can be provided as soon as possible to prevent the life-style diseases and metabolic syndromes. This research is based on the data of the health check-up in year 2006 that it includes 80 thousands examinees with their questionnaires and check-up results. The data is analyzed by SPSS including percentage, means, standard derivation, and alternating analysis. The research also analyzed the relation between health indexes and body shapes by Chi-square test and ANOVA test.Males with concealed obesity usually had abnormal WHR, fatty liver, abnormal liver function, elevated urine acid level, and abnormal blood lipid tests, compared with normal population (p < 0.001). For females with concealed obesity, with obese and High BMI & Low percentage of body fat population, those 7 health indexes are usually above normal population (p < 0.001). Regarding to the concealed obesity, their triglyceride, total cholesterol and CHOL/HDL-C level are also above normal population (p < 0.001). If separated by gender, males had WHR, urine acid, triglyceride, cholesterol and CHOL/HDL-C are usually above normal population, and HDL-C is lower than normal population (p < 0.001). For females, WHR, urine acid, triglyceride, CHOL/HDL-C are usually above normal population (p < 0.001).The findings indicated that cardiovascular diseases, metabolic symptoms and chronic disease may a positively associated with concealed obesity.
論文目次 摘要 I
ABSTRACT II
致謝 III
目錄 IV
表目錄 VI
圖目錄 VII
第一章 緒論 1
第二章 文獻回顧 5
第一節 名詞定義 5
第二節 體重與健康的相關性 8
第三節 體重正常與代謝性疾病的相關性 12
第四節 體脂肪率與健康的相關性 15
第三章 研究架構、方法與步驟 17
第一節 研究架構 17
第二節 研究假設 19
第三節 研究對象 20
第四節 測量項目及分析方法 20
第五節 統計分析 23
第四章、結果 25
第一節 基本資料 25
第二節 健檢結果資料分析 27
第三節 各體型分類之性別年齡分佈 28
第四節 各體型分類與健康檢查指標之交叉分析 29
第五節 體型分類與健康檢查指標之統計分析 30
第五章 討論 39
第一節 肥胖與隱藏型肥胖的盛行率 39
第二節 各體型與健康檢查指標異常率之探究 41
第三節 肥胖與隱藏性肥胖者之飲食控制 44
第四節 肥胖與隱藏性肥胖者運動處方與生活習慣之建議 48
第六章 結論 52
第七章 參考文獻 53

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系統識別號 U0007-1907201012544500
論文名稱(中文) 不同比例之不飽和脂肪酸組成對脂質代謝和體脂肪蓄積之影響
論文名稱(英文) Effects of Varying Unsaturated Fatty Acid Composition on the Lipid Metabolism and Body Fat Accumulation
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 98
學期 2
出版年 99
研究生(中文) 廖芳瑄
學號 D507092003
學位類別 博士
語文別 中文
口試日期 2010-07-01
論文頁數 199頁
口試委員 指導教授-謝明哲
共同指導教授-簡怡雯
委員-鄭心嫻
委員-江孟燦
委員-劉麗雲
委員-黃惠煐
委員-左克強
關鍵字(中) 單元不飽和脂肪酸
多元不飽和脂肪酸/飽和脂肪酸比值
飲食誘導肥胖
PPARs
脂蛋白脂解酶
荷爾蒙敏感性脂解酶
關鍵字(英) monounsaturated fatty acid
polyunsaturated to saturated fatty acid ratio
diet-induced obese
peroxisome proliferator-activated receptors
lipoprotein lipase
hormone-sensitive lipase
學科別分類
中文摘要 本研究旨在探討膳食油脂中的單元不飽和脂肪酸(MUFA)和多元不飽和脂肪酸(PUFA)對體脂蓄積之影響。首先,本論文實驗設計以2x2因子討論油脂中的MUFA比例和PUFA / SFA(P/S)比值,共計四種實驗調和油,其中固定高MUFA比例為60%且其P/S比值為5或3,另外兩種則固定MUFA比例為30%且其P/S比值為5或3,以大豆油作為對照組;倉鼠隨機分為五組以餵食12週不同之15% (w/w)調和油。結果發現,各組攝食量均無差異,而餵食P/S比值為5、MUFA比例60%調和油之倉鼠,有較輕的體重和白色脂肪組織重量,並降低血漿胰島素濃度、血漿游離脂肪酸濃度以及肝臟脂質合成酵素活性,且明顯提高肝臟脂肪酸氧化酵素:acyl-CoA oxidase(ACO)和carnitine palmitoyltransferase-I(CPT-I)活性,抑制體脂肪蓄積。再由飲食誘導肥胖倉鼠實驗模式,餵食8週4% (w/w)低油飲食發現,與肥胖對照組比較,P/S比值為5、MUFA比例60%調和油組有明顯減少白色脂肪組織重和血漿瘦體素濃度,降低白色脂肪組織PPARγ和脂蛋白脂解酶mRNA 表現,並增加肝臟脂質氧化酵素ACO和CPT-I活性;且P/S比值為5、MUFA比例60%調和油比橄欖油較能調節白色脂肪組織荷爾蒙敏感性脂解酶(hormone-sensitive lipase)的活化,顯示肥胖倉鼠的肝臟和白色脂肪組織都明顯促進脂肪消耗以減少體脂肪蓄積;相反地,肥胖倉鼠餵食橄欖油(高MUFA比例、極低P/S比值)則會明顯促進肝臟脂肪酸合成作用。另外,利用3T3-L1成熟脂肪細胞模式發現, P/S比值對影響體脂肪蓄積之重要性會明顯大於MUFA/PUFA比值,顯示油脂中的SFA、MUFA、PUFA需存在適當的比例(SFA:MUFA:PUFA為1:10:5)始能對促進脂質代謝和抑制體脂肪蓄積發揮較妥適的生理促進效果。本論文證實,脂肪酸組成為P/S比值等於5、MUFA比例60%之油脂可有效減少脂質合成作用和促進脂質氧化,以減少體脂肪蓄積。未來,可以提供國人在體重控制或是維持理想體重時,有更多的資訊選擇適當的油脂來源。
英文摘要 The aim of this study was to assess the relationship between high monounsaturated fatty acid (MUFA) with different levels of polyunsaturated-to-saturated fatty acid (P/S) ratios and body fat accumulation. We designed a 2 x 2 factorial study, with 2 levels of MUFAs (60% and 30%) and 2 levels of the polyunsaturated-to-saturated fatty acid (P/S) ratio (5 and 3) to prepare four kinds of experimental oils consisting of 60% MUFAs with a high or low P/S ratio, or 30% MUFAs with a high or low P/S ratio. Forty male golden Syrian hamsters were randomly divided into five groups and fed the diets contained 15% (w/w) fat for 12 weeks. Hamsters fed soybean oil were as control group. No difference was observed in the mean daily food intake. Hamsters fed the high MUFA% with high P/S ratio diet had lower not only plasma insulin and free fatty acid concentrations but also hepatic acetyl-CoA carboxylase activities, and elevated hepatic acyl-CoA oxidase and carnitine palmitoyltransferase-I activities among the groups. The high MUFA% with high P/S ratio oil diet appeared to be beneficial in preventing white adipose tissue accumulation. In diet-induced obese (DIO) models, DIO hamsters fed the high MUFA% with high P/S ratio oil diet had significant reductions in white adipose tissue deposition and plasma leptin levels, suppression in adipose peroxisome proliferator-activated receptors (PPAR) γ and lipoprotein lipase (LPL) mRNA expressions and increases in hepatic lipolytic enzyme activities compared with those in the obese-control group. The high MUFA% with high P/S ratio oil group upregulated phosphorylation of hormone-sensitive lipase (HSL) relative to total HSL protein levels compared with the olive oil group. However, the olive oil consisting of the high MUFA% with very low P/S ratio group significantly elevated hepatic FAS activities (de novo lipogenesis) compared with the high MUFA% with high P/S ratio oil group. Moreover, we found effects of body fat accumulation of P/S ratio were more important than those of MUFA/PUFA ratio in 3T3-L1 adipocyte, suggesting that SFA, MUFA and PUFA are needed to consist of the optimal dietary fat composition. In conclusion, 60% MUFA with P/S ratio=5 oil appeared to be beneficial in preventing white adipose tissue accumulation.
論文目次 第一章 緒論…………………………………………………………….. 1
第二章 文獻回顧………………………………………………………... 5
第一節 各種膳食油脂對體脂肪蓄積之影響…………………….... 5
第二節 油脂PUFA/SFA比值對體脂與血脂之影響………………. 11
第三節 脂肪酸類型對影響脂肪蓄積之代謝………………………. 14
第四節 脂肪酸類型對荷爾蒙分泌之影響…………………………. 17
第五節 脂肪酸類型對減重之成效…………………………………. 20
第六節 脂肪酸類型對脂質代謝相關轉錄因子之影響……………. 22
第三章 不同脂肪酸比例對倉鼠體脂肪蓄積之影響…………………… 25
第一節 前言………………………………………………………….. 25
第二節 實驗設計流程圖…………………………………………….. 26
第三節 材料與方法………………………………………………….. 27
第四節 結果………………………………………………………….. 46
第五節 討論…………………………………………………….……. 59
第六節 結論………………………………………………………….. 74
第四章 不同脂肪酸比例對飲食誘導肥胖老鼠之脂肪蓄積影響…….... 75
第一節 前言………………………………………………………….. 75
第二節 實驗設計流程圖…………………………………………….. 77
第三節 材料與方法………………………………………………….. 78
第四節 結果………………………………………………………….. 92
第五節 討論…………………………………………………….…... 116
第六節 結論………………………………………………………… 131
第五章 混合脂肪酸對3T3-L1脂肪細胞株之影響...…………………...132
第一節 前言………………………………………………………… 132
第二節 實驗設計流程圖…………………………………………….133
第三節 材料與方法………………………………………………….134
第四節 結果………………………………………………………….141
第五節 討論…………………………………………………….……152
第六節 結論………………………………………………………….160
第六章 總討論…….……………………………………………………..161
第七章 總結論.…………………………………………………………..168
參考文獻………………………………………………………………….. 169
參考文獻 參考文獻

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系統識別號 U0007-2107200814090900
論文名稱(中文) 過重、肥胖與正常體位學齡期兒童課後靜態活動之比較
論文名稱(英文) The comparison of sedentary activity after school between the overweight, obese and normal weight school-age children
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 96
學期 2
出版年 97
研究生(中文) 黃秀玫
學號 M406094014
學位類別 碩士
語文別 中文
口試日期 2008-07-02
論文頁數 126頁
口試委員 指導教授-張碧真
委員-簡莉盈
委員-李碧霞
關鍵字(中) 學齡期兒童
過重
肥胖
靜態活動
關鍵字(英) School-Aged Children
Overweight
Obesity
Sedentary activity
學科別分類
中文摘要 過重與肥胖的兒童及青少年在世界各地有增加的趨勢,這個健康問題與遺傳、環境、社會以及文化因素相關,近年來由於兒童活動型態改變,身體活動量減少而靜態活動逐漸增加,兒童逐漸參與不同的靜態活動,開始有研究探討靜態活動與體重過重、肥胖之間的關係,不過並未有一致的研究結果,因此必需再有研究探討他們之間的關係。所以,本研究的目的在探討學齡期兒童課後靜態活動型態,以及過重、肥胖與正常體位兒童課後靜態活動時間的差異。
本研究採個案對照研究設計,以立意取樣選取196位國小四年級過重、肥胖兒童與其父母親為研究對象,之後再以班級、性別和年齡配對選取正常體位學童為對照組。研究中學童連續填寫三天身體活動量表,以獲得兒童從事課後活動的型態,並比較過重、肥胖與正常體位兒童課後靜態活動時間的差異。
研究結果如下: 總計有428位學童參與研究,男生有238位、女生190位,平均年齡為9.8歲。(1)學齡期兒童平均每天從事靜態活動總時間約273.1分鐘,平日課後花費在寫作業、上安親班與看電視時間較多;在假日以看電視與寫作業的時間較多。(2)全面型與中央型過重、肥胖兒童平日看電視時間顯著高於正常體位兒童(p <.01),中央型肥胖兒童平日課後閱讀時間少於正常體位兒童(22.2min vs. 14.6min, p <.001)。兒童自填問卷非學業型靜態活動中,看電視時間(p <.05)與接觸總傳媒時間(p <.01)大於2小時與中央型肥胖有顯著相關性。由父母親填寫問卷中看電視(p <.01)與接觸總傳媒時間(p <.001)大於2小時與全面型以及中央型肥胖有顯著相關性。。
本研究結果希望可以作為教育與學校單位之參考,未來可以利用介入性的措施以減少兒童課後靜態活動的時間,增進兒童身體活動程度,以及預防兒童過重與肥胖的問題。
英文摘要 Overweight, obese children and adolescents are increasing worldwide. This health problem has been considered in relation to genetic, environmental and social-cultural factors. Due to changes of activity patterns in recent years, children’s physical activity decrease and sedentary activity increase. Besides that children engage in different sedentary activities from before. Hence, research need to investigate the relationships between sedentary behavior and overweight (include obese); however research results have been inconsistent findings, for that further research. The aims of this study are understand children’s sedentary activity patterns and compare their sedentary activities after school between the overweight (include obese) and normal weight school-age children.
The design of this study is case control Purposive sampling was used to select 196 fourth-grade overweight (include obese) children with their parents, and 196 class, age, and gender- matched control. Three-day physical activity record was used three consecutive days to obtain sedentary activities and in order to compare sedentary activities between the overweight and normal weight school-age children.
The results of this study were as below: The sample consists of 238 boys and 190 girls that have a mean age of 9.8 year. (1) Children spent time on sedentary activity 273.2min. Children spent more time on homework, cram school and TV viewing on weekday. However, children spent more time on TV viewing and doing homework on weekend. (2) Total and central overweight(include obese) children spent more time on television viewing significant more than normal weigh children (p <.01) and central obesity children spent more time on reading significant less than normal weight children (14.6min/day vs. 22.2min/day, p <.01) on weekday. Time spent on TV viewing(p <.05) and total media time (p <.01)more than 2 hours are related to central obesity for self-report nonacademic sedentary activity, and which are related to total and central obesity for parent-report.
The results of the research can be used for the improvement of education and school units. Suggestions are made to develop interventions to reduce the time in sedentary activities, and increase physical activity levels in order to prevent children’s overweight and obese.
論文目次 致謝....................... Ⅰ
中文摘要................... II
英文摘要.................. IV
目錄...................... VI
圖表目次.................. VIII
第一章  緒論...................... 1
第一節 研究動機與重要性........ 1
第二節  研究目的.............. 5
第三節 研究問題............... 5
第四節 名詞界定............... 6
第二章 文獻查證................... 8
第一節 兒童肥胖............... 8
第二節 靜態活動................18
第三章 研究方法.................... 32
第一節 研究設計................ 32
第二節 研究對象............... 32
第三節 研究工具............... 34
第四節 研究過程............... 37
第五節 研究倫理考量.............41
第六節 資料統計分析方法........ 41
第四章 分析與結果................ 43
第一節 研究對象的基本屬性...... 43
第二節 研究對象課後靜態活動.... 48
第五章 討論及建議 ..................66
第一節 學齡期兒童課後靜態活動................... 66
第二節 過重學童與正常體位學童靜態活動之比較...... 72
第三節 學童體位評估與靜態活動評估工具之討論.......80
第四節 研究限制........ 89
第五節 建議................. 89
參考文獻............................ 93
中文部分.............................93
英文部分............................ 95
附錄................................ 115
附錄一 家庭基本資料............. 115
附錄二 身體活動紀錄單.......... 118
附錄三 研究邀請函.............. 120
附錄四 研究同意書............. 121
附錄五 兒童研究同意書.......... 122
附錄六 家庭地位與社會地位評定....123
附錄七 人體試驗同意書.......... 125


圖表目次
表 一 兩組研究對象基本屬性 (N = 428)......... 44
表 二 兩組學童家庭基本狀況 (N = 428)....... 45
表 三 以不同評估工具區分健康體位 (N = 428)... 47
表 四 以t-test檢定self-report學童課後靜態活動 (N = 428)... .....49
表 五 以t-test檢定parent-report學童課後靜態活動 (N = 428) ......50
表 六 t-test檢定self-report全面型肥胖(過重)與正常體位兒童課後靜態活動.... 53
表 七 t-test檢定parent-report全面型肥胖(過重)與正常體位兒童靜態活動量.... 54
表 八 self-report接觸傳媒時間與全面性肥胖(過重)之卡方檢定及連結分析...... 57
表 九 parent-report接觸傳媒時間與全面性肥胖(過重)之卡方檢定及連結分析...... 58
表 十 以t-test檢定Self-report中央型過重、肥胖與正常體位兒童課後靜態活動.... 60
表 十一 以t-test檢定parent-report中央型肥胖兒童與正常體位兒童靜態活動量.... 61
表 十二 self-report接觸傳媒時間與中央型肥胖之卡方檢定及連結分析... 64
表 十三 parent-report接觸傳媒時間與中央型肥胖之卡方檢定及連結分析............ 65
表 十四 Self-report與parent-report平日靜態活動分類相關性(N = 428)................. 86
表 十五 Self-report與parent-report假日靜態活動分類相關性(N = 428) ....................87
表 十六 Self-report與parent-report靜態活動分類相關性(N = 428) ......................88

圖 一 收案流程圖................ 40

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系統識別號 U0007-2207200812591300
論文名稱(中文) 芝麻素對於肥胖大鼠體脂肪蓄積與脂質代謝的影響
論文名稱(英文) Effects of sesamin on fat accumulation and lipid metabolism in Sprague-Dawley rats
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 96
學期 2
出版年 97
研究生(中文) 郭倍秀
學號 M507095004
學位類別 碩士
語文別 中文
口試日期 2008-06-20
論文頁數 121頁
口試委員 委員-楊素卿
委員-黃惠宇
指導教授-簡怡雯
關鍵字(中) 肥胖
芝麻素
體脂蓄積
脂質代謝
胰島素敏感性
關鍵字(英) obesity
sesamin
fat accumulation
lipid metabolism
insulin sensitivity
學科別分類
中文摘要 芝麻中含量最多的木質酚類--芝麻素,以可促進體內脂肪酸氧化和減少脂肪酸生成而受到注目。本實驗中,採用雄性Sprague-dawley大鼠,經一週適應期後分為正常體重組(N)與肥胖組(F)各30隻,N組給予AIN93G飲食,F組給予45%熱量來自油脂的高脂飲食,四週後依體重將N組與F組各分為三組並添加不同劑量的芝麻素當作實驗飲食:N0與F0組不添加芝麻素、N1與F1添加0.1%芝麻素、N5與F5組添加0.5%芝麻素於飲食中。每週測量其體重變化及攝食狀況,給予四週實驗飲食後予以犧牲。結果指出N5組中,其血漿中三酸甘油酯(TG)、總膽固醇(TC)與低密度膽固醇(LDL-C)濃度都顯著下降,其肝臟中fatty acid synthase(FAS)活性顯著下降、carnitine palmitoyltransferase(CPT)與acetyl CoA oxidase(ACO)活性具有增加的趨勢,並可減少相對副腎脂肪和相對總脂肪的重量,但對體重增加情況沒有改變。在F5組結果指出,血漿中TG、LDL-C、游離脂肪酸濃度顯著下降、高密度膽固醇濃度顯著增加,其肝臟中FAS、Acyl CoA carboxylase活性顯著減少、CPT、ACO活性顯著增加,並可增加胰島素敏感性並可減少副睪和相對副睪脂肪、副腎和相對副腎脂肪及總脂肪和相對總脂肪的堆積情況,並可達到減輕體重的目的。
英文摘要 Sesamin, a major lignan in sesame seeds and oil, has been known to increase β-oxidation and reduce lipogenesis. In this study, 30 sprague-dawley rats were fed with pure AIN-93G diet (standard diet) and 30 rats were fed with high fat diet (modified from AIN-93G containing 45% calories from soybean oil). After 4 weeks to induce obesity, rats were assigned to 6 groups: N0 (standard diet without sesamin), N1 (standard diet with 0.1% sesamin), N5 (standard diet with 0.5% sesamin), F0 (high fat diet without sesamin), F1 (high fat diet with 0.1% sesamin), F5 (high fat diet with 0.5% sesamin). The rats were weighted weekly and sacrificed after 4 weeks of experiment. Results found that there were significantly reducing in body weight, epididymal adipose tissue and adipocyte size in group F5. Supplement with sesamin led to significantly increase serum HDL-C and decrease plasma triglyceride, LDL-C, non-esterified fatty acid. Insulin sensitivity had also been improving in F5 group. Besides, there were significantly reducing in liver triglyceride and total cholesterol concentration. The enzyme activities of fatty acid synthase and acetyl CoA carboxylase were significantly decreasing in group F5 and acyl CoA oxidase, carnitine palmitoyltransferase were significantly increasing in group F1 and F5. Therefore, we concluded that sesamin can improve lipid metabolism and prevent the accumulation of white adipose tissue.
論文目次 中文摘要 I
英文摘要 III
致謝 V
目錄 VII
表目次 IX
圖目次 X
第一章、緒論 1
第二章、文獻回顧 3
第一節、肥胖 3
第二節、木質酚類(Lignan) 9
第三節、芝麻素 13
第四節、芝麻素與肥胖 21
第五節、研究動機 23
第三章、實驗設計與方法 24
第一節、實驗流程 24
第二節、實驗材料與分組 27
第三節、分析方法 31
第四節、統計分析 54
第四章、結果 55
第一節、芝麻素成分組成分析 55
第二節、動物體重、飲食和臟器重量分析 57
第三節、體脂肪堆積分析 62
第四節、血脂質濃度分析 64
第五節、肝臟脂質分析 79
第六節、肝臟中酵素活性測定 84
第七節、組織切片 92
第五章、討論 95
第一節、添加芝麻素飲食對於脂質代謝方面的影響 95
第二節、添加芝麻素飲食對於體重和脂肪囤積的影響 100
第三節、添加芝麻素飲食對於胰島素敏感性的影響 104
第四節、添加芝麻素飲食對於血漿中Leptin濃度的影響 106
第六章、結論 108
第七章、參考文獻 109

表目次
表3- 1:AIN-93G 實驗飲食組成 29
表4- 1 正常體重組中N0、N1、N5 組以及肥胖組中F0、F1、
F5 組其實驗飲食所提供每日蛋白質、脂質、醣類、熱量
及芝麻素含量 60
表4- 2 芝麻素對於增加體重量及肝臟、腎臟、副睪白色脂肪、
副腎白色脂肪和總脂肪重量的影響 60
表4- 3 芝麻素對血漿中TG、TC、NEFA、HDL-C、LDL-C、
insulin 和leptin 濃度的影響 69
表4- 4 犧牲時大鼠肝脂質濃度和肝臟酵素活性 86

圖目次
圖2- 1、木質酚類的化學結構式 11
圖2- 2 木質酚類的代謝 12
圖2- 3、芝麻樹 14
圖2- 4、芝麻 14
圖2- 5、芝麻中木質酚類的化學結構(Kamal-Eldin et al., 1995)
16
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行政院衛生署(2002) http://www.doh.gov.tw/cht2006/index_populace.aspx
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系統識別號 U0007-2207201015413700
論文名稱(中文) 步行運動搭配計步器對體重過重及肥胖中年人的每日步數、生理指標及生活品質之影響
論文名稱(英文) The Effects of Walking Exercise with Pedometer on Daily Steps, Physiological Parameters and Quality of Life Among Overweight and Obese Middle-Aged Adults
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 98
學期 2
出版年 99
研究生(中文) 陳美淇
學號 M406095019
學位類別 碩士
語文別 中文
口試日期 2010-07-07
論文頁數 124頁
口試委員 指導教授-李碧霞
委員-卓俊辰
委員-曾旭民
關鍵字(中) 步行運動
計步器
體重過重及肥胖中年人
生理指標
生活品質
關鍵字(英) walking exercise
pedometer
overweight and obese middle-aged adults
physiological parameters
quality of life
學科別分類
中文摘要 背景:上班族的中年人缺乏時間及動機運動,而且容易身材發福,成為代謝症候群的高危險群,因而提高罹患慢性病率及死亡率的風險。
目的:探討步行運動搭配計步器對體重過重及肥胖中年人的每日步數、生理指標及生活品質之影響。
方法:採前實驗性研究設計法,針對臺北市大安區某職場51位40-64歲的體重過重及肥胖員工,以每日步行運動搭配計步器進行為期12週的介入,以身體組成、血壓、空腹血糖及血脂等數值,以及體重對生活品質衝擊量表-簡明版為評值成效之指標,受試者分別於第1週及第12週接受前後測。研究資料以SPSS 15.0版統計軟體進行分析,統計方法有:描述性統計、成對樣本t檢定、卡方檢定及獨立樣本t檢定等。
結果:(1)每日平均步數由9,548步增加到11,937步。(2)體重、身體質量指數、腰圍、臀圍、平均舒張壓、總膽固醇及三酸甘油酯皆有顯著改善。(3)體重對生活品質衝擊量表-簡明版的身體功能、自尊等兩個次量表,以及總分有顯著改善。(4)達成每日一萬步者與未達成每日一萬步者在性別、身體質量指數、臀圍及體重對生活品質衝擊量表-簡明版得分上有顯著差異。
結論:步行運動搭配計步器可增加體重過重及肥胖中年人每日平均步數及改善身體組成、血壓及血脂等數值,且能提升生活品質。
英文摘要 Background: Middle-aged office workers lack the time and the motivation to exercise, and moreover, it’s easy to gain weight in stature, becomes the high dangerous group of metabolism syndrome, and enhances the risk of chronic disease rate and the mortality.
Purpose: The aim of this study was to investigate effects of walking exercise with a pedometer on daily steps, physiological parameters and quality of life among overweight and obese middle-aged adults.
Methods: Using pre-experimental design approachs, the data were collected by 51 40-64 year-old employers with overweight and obese who work in a certain unit of the Daan district in Taipei city, and adopted daily walking exercise with a pedometer to intervene for 12 weeks. Indexes of the evaluation result was according to body composition, blood pressure, fasting blood sugar, blood lipid profile and the impact of weight on quality of life-lite(IWQOL-Lite). Participants were measured respectively at the beginning and the end of the study. The collect data were analyzed by SPSS statistics software of version 15.0 with the following statistical methods: descriptive statistics, paired-t test, Chi-square test, and independent t-test.
Results: (1) The average daily step is from 9,548 steps increases to 11,937 steps. (2) There are significant improvements in body weight, BMI, waist circumference, hip circumference, average diastolic blood pressure, total cholesterol and triglycerides. (3) There were significant improvements in physical function, self-esteem and total score of the IWQOL-Lite. (4) The total score that among≧10,000 steps and<10,000 steps is with significant differences in gender, BMI, hip circumference, and IWQOL-Lite scales.
Conclusion: Walking exercise with a pedometer increases the average daily steps among overweight and obese middle-aged adults, and improves body composition, blood pressure, blood lipid profile, and to promote the quality of life .
論文目次 目 錄
頁數
致 謝 ………………………………………………………..Ⅰ
中文摘要 …………………………………………………..…....Ⅱ
英文摘要 …………………………………………………..……Ⅳ
目 錄 …………………………………………………..……Ⅵ
圖表目次 …………………………………………………..……Ⅹ
第一章 緒論
第一節 研究動機與重要性……………………………………… 1
第二節 研究目的 ..…………………………………………….....7
第三節 研究問題 ………………………………………………...8
第四節 研究假設 ..……………………………………………… 8
第五節 名詞界定 ………………………………………………...9
第二章 文獻查證
第一節 體重過重及肥胖的相關問題……………………………11
第二節 步行運動的相關研究……………………………………19
第三節 步行運動搭配計步器對每日步數、生理指標及生活品
質的影響…………………………………………………31

第三章 研究方法
第一節 研究設計…………………………………………………36
第二節 研究架構…………………………………………………37
第三節 研究對象與地點…………………………………………38
第四節 研究工具與測量…………………………………………40
第五節 資料收集流程……………………………………………47
第六節 倫理考量…………………………………………………49
第七節 資料處理與分析…………………………………………50
第四章 研究結果
第一節 研究對象的人口學特性、每日步數、生理指標及生活品
質的分佈情形……………………………………………52
第二節 步行運動搭配計步器對每日步數、生理指標及生活品質
的影響……………………………………………………65
第三節 達成每日一萬步者與未達成者在人口學特性、生理指標
及生活品質上的差異……………………………………71
第五章 討論
第一節 研究對象的每日步數、生理指標及生活品質的分佈情…………………………………………………………79
第二節 步行運動搭配計步器對每日步數、生理指標及生活品質
的影響……………………………………………………84
第三節 達成每日一萬步者與未達成者在人口學特性、生理指標
及生活品質上的差異……………………………………87
第六章 結論與建議
第一節 結論……………………………………………..………..91
第二節 研究限制………………………………………..………..93
第三節 建議……………………………………………..………..94
參考文獻
中文部份 …………………………………………………………96
英文部分 ………………………………………………………..102
附錄
附錄一 體重對生活品質衝擊量表-簡明版(IWQOL-Lite)
…………………………………………………………108
附錄二 運動記錄小冊子..............................................................110
附錄三 基本資料 ………………………………………………116
附錄四 體重對生活品質衝擊量表-簡明版(IWQOL-Lite)授權書
…………………………………………………………..117
附錄五 研究同意書……………………………………………..119
附錄六 每日步數追蹤表………………………………………..120
附錄七 人體試驗委員會通過證明函…………………………..121
附錄八 研究對象第2-12週與第1週每日平均步數增減之比較
表……………………………………………………… .117

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英文文獻
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系統識別號 U0007-2507200821512400
論文名稱(中文) 肥胖病人非酒精性脂肪肝疾病與發炎因子: 探討Tumor Necrosis Factor-alpha, Leptin和 Adiponectin的角色
論文名稱(英文) Inflammatory Cytokines in Nonalcoholic Fatty Liver Disease in Obese Patients: Role of Tumor Necrosis Factor-alpha, Leptin and Adiponectin
校院名稱 臺北醫學大學
系所名稱(中) 臨床醫學研究所
系所名稱(英) Graduate Institute of Clinical Medicine
學年度 96
學期 2
出版年 97
研究生(中文) 劉蓓麗
學號 M102095031
學位類別 碩士
語文別 英文
口試日期 2008-07-15
論文頁數 96頁
口試委員 指導教授-陳志榮
共同指導教授-李威傑
委員-潘文涵
委員-黃銘德
委員-劉燦宏
關鍵字(中) 非酒精性發炎性脂肪肝
細胞激素
脂肪細胞激素
肝臟組織切片
肥胖
關鍵字(英) nonalcoholic steatohepatitis
cytokines
adiponectin
liver histopathology
obesity
學科別分類
中文摘要 肥胖是心血管疾病,腦中風,糖尿病及癌症的重要危險因子;高血壓、高血脂症、高膽固醇症、糖尿病及脂肪肝被認為是新陳代謝症候群(metabolic syndrome)。很多研究顯示,肥胖是一種慢性、低度發炎疾病(low grade inflammation),發炎因子在各種新陳代謝症候群中扮演重要的角色。非酒精性脂肪肝疾病(nonalcoholic fatty liver disease, NAFLD)是一群因脂肪囤積而引起廣泛性肝臟細胞破壞引起疾病的統稱,它的病程包括單純性脂肪肝(liver steatosis)、脂肪性肝臟發炎(steatohepatitis)、肝臟纖維化(liver fibrosis)及肝硬化(liver cirrhosis)。確切的診斷及嚴重度之評斷需藉助病理切片檢查。
非酒精性脂肪肝疾病的致病機轉仍未完全明瞭,目前最被人接受的是“兩次撞擊”的假說,“第一次撞擊(first hit)”是脂肪囤積在肝臟細胞,與胰島素抗性(insulin resistance)有密切關係。大部份的病人可能只有單純脂肪肝卻沒有伴隨發炎反應,這種疾病的病程是比較良性的。但是若合併發炎反應,即進入“第二次撞擊(second hit)”,它所引發的發炎反應就變得很複雜,牽涉到很多不正常細胞激素產生(abnormal cytokine production)及氧化壓力反應(oxidative stress)的作用,其中最著名的細胞激素是adiponectin,tumor necrosis factor -?? ( TNF-??)和leptin。TNF-?悇O一種前發炎因子(proinflammatory cytokine)。Leptin 則與肝臟纖維化有關。Adiponectin是目前被研究較多的cytokine,它具有明顯抗發炎性(anti-inflammatory effect)及胰島素敏感化(insulin sensitivity)的作用,與NAFLD的發生有密切的關連。
非酒精性脂肪肝疾病的致病機轉與發炎因子應有明顯的關係,本研究以BMI?d35以上的台灣肥胖病人肝臟組織,分析Leptin,TNF-?恁AAdiponectin及Adiponectin Receptor II(adipoRII)的表現與相互間的關係,藉此探討非酒精性脂肪肝疾病的致病機轉。同時以病理組織學的變化,佐以臨床資料與血液生化檢查結果(年齡、性別,腰臀比、血糖、血脂、肝功能指數),研究Leptin,TNF-?恁AAdiponectin及Adiponectin Receptor II與肝臟受損程度,肝臟纖維化與臨床資料的相關性。
本研究包含四十位肥胖病人,共12位男性,28位女性,平均年齡為29.43 ± 9.19歲,平均BMI 為 44.79 ± 5.37 kg/m2。四十位肥胖病人中有30 位(75 %)診斷為非酒精性脂肪性肝發炎(nonalcoholic steatohepatitis,NASH)。我們將病人分成三組作研究:第一組為非酒精性脂肪性肝發炎(nonalcoholic steatohepatitis,NASH)合併0-1期肝臟纖維化,共11 位病人。第二組為非酒精性脂肪性肝發炎合併2-4期肝臟纖維化,共19 位病人。第三組包括10 位病人,因只有單純脂肪肝卻沒有伴隨發炎反應,被歸類為對照組。臨床抽血資料顯示, aspartate transaminase (AST) (p =0.000)、 alanine transaminase (ALT) (p =0.000)、 γ-glutamyl transferase (GGT)(p =0.045) 和hemoglobin A1c (HbA1c)(p =0.001) 在三組病人中具有統計學上的差異。
在病理切片組織學方面,總共36(90%)位病人發現單純脂肪囤積在肝臟細胞。肝臟細胞汽球化退化(ballooning degeneration)存在於所有的肝臟發炎(steatohepatitis)病人。三十九(97.5%)位病人表現肝小葉發炎(lobular inflammation),有11 位 (27.5%)表現輕度、 13 位(32.5%)表現中度和15位(37.5%)表現嚴重程度肝小葉發炎。四十位肥胖病人中,沒有任何一位進展到肝硬化。本研究無法偵測到肝臟leptin的mRNA表現。另一方面,不管是TNF-α/GAPDH cDNA,adiponectin/GAPDH cDNA或是adipoRII /GAPDH cDNA的肝臟mRNA表現,也沒有達到統計學上的差異。
臨床病理相關性方面,我們發現單純脂肪囤積在肝臟細胞與血糖、AST、 ALT、GGT、三酸甘油脂和HbA1c有關;卻和高密度脂蛋白(high density lipoprotein)成負相關。肝臟細胞汽球化退化(ballooning degeneration) 與血糖、AST、 ALT和HbA1c也有相關性。另一方面,肝小葉發炎(lobular inflammation)和 AST、ALT 和HbA1c有關。至於肝臟纖維化則和AST、 ALT 和 C-peptide有關。Adiponectin/GAPDH cDNA和尿酸成負相關性; TNF-α/GAPDH cDNA ratio 則與單純脂肪囤積在肝臟細胞有關。免疫組織染色方面,leptin的免疫染色表現與C-peptide、 門脈區發炎(portal inflammation)有相關性。AdipoRII與收縮壓成負相關性; 與Mallory body、 glycogenated nuclei成正相關性。TNF-α的免疫染色表現和AST、血紅素、肝小葉發炎、門脈區發炎和NAS activity有關。而adiponectin的免疫染色表現則沒有達到統計學上的相關性。
胰島素抗性(insulin resistance)和人體對胰島素敏感度降低是非酒精性脂肪肝疾病重要特徵。在本研究中,我們無法釐清TNF-α、 leptin、 adiponectin、adipoRII和單純脂肪囤積在肝臟細胞、 肝臟發炎和肝臟纖維化的關係,未來需要更大、更深入的研究來探討非酒精性脂肪肝疾病與肝臟纖維化的致病機轉。我們的研究也透露出胰島素抗性(insulin resistance),不管是肝臟或是週邊的胰島素抗性,似乎比不正常細胞激素產生(abnormal cytokine production)與發炎因子扮演更重要的角色。
英文摘要 Obesity is a chronic inflammatory condition and obesity has been claimed one of risk factors for cardiovascular disease, stroke, diabetes mellitus and cancers. The metabolic syndrome includes hypertension, hyperlipidemia, diabetes mellitus and fatty liver disease. Nonalcoholic fatty liver disease (NAFLD) is considered a hepatic manifestation of systemic metabolic syndrome. NAFLD is a wide spectrum of liver damage, ranging from simple steatosis, to nonalcoholic steatohepatitis (NASH) and cirrhosis on the basis of longstanding fatty change of the liver. While NASH implies a risk of progressive liver disease, simple steatosis is regarded as a benign condition.
The “two hit hypothesis” has become an important theoretical framework for understanding the pathogenesis of NAFLD. The “first hit” is liver fat accumulation in hepatocytes, linked with insulin resistance. In the majority of patients with excess liver fat or scarce hepatic inflammation, this condition will be termed simple steatosis. However, a “second hit” may trigger the necroinflammatory response characterizing NASH through abnormal cytokine production and oxidative stress. The mediated abnormal cytokine production including adiponectin, leptin and tumor necrosis factor -?恁]TNF-?恁^. TNF-?? is a proinflammatory cytokine, whereas leptin has fibrogenetic effect. In contrast, adiponectin play antidiabetic and anti-inflammatory role that acts as a fascinating mediator linking adipose tissue, insulin resistance, and inflammation. Adiponectin may have protective effect on the development of NAFLD, potentially antagonizing the effect of TNF-??.
Although the participation of inflammatory mediators and cytokines in the pathogenesis of NAFLD is widely recognized, their relative important in Taiwanese obese patients is not fulfilled. In this study, we analyzed the clinicopathology of morbidly obese patients (BMI?d35) from liver biopsied specimens. To further elucidate the role of inflammation in NAFLD, we evaluated mRNA and protein expression of leptin, TNF-??, and anti-inflammatory factor adiponectin and adiponectin receptor II (adopoRII) in liver tissues of NAFLD patients.
Our study enrolled 40 obese patients, including 12 men and 28 women with mean age 29.43 ± 9.19 years, and the mean BMI was 44.79 ± 5.37 kg/m2. Histologic evidence of NASH (NAS ≧5) was present in 30 patients (75%). Of these 30 patients, 11 patients were grouped as NASH with stage 0-1 mild liver fibrosis and 19 patients were grouped as NASH with stage 2-4 advanced liver fibrosis. The other 10 patients had normal liver histology or simple steatosis only without necroinflammation (NAS<3) and they were considered as control group. The serum levels of alanine transaminase (ALT) (p =0.000), aspartate transaminase (AST) (p =0.000), γ-glutamyl transferase (GGT) (p =0.045) and hemoglobin A1c (HbA1c) (p =0.001) have statistically difference in these three groups. Only AST was independently different after multivariate logistic regression analysis.
Hepatic steatosis was present in 36 patients (90%). Ballooning degeneration of hepatocytes was occurred in all NASH group. Lobular inflammation found in 39 patients (97.5%). Of these 39 patients, 11 (27.5%), 13 (32.5%) and 15 (37.5%) presented with mild, moderate and severe lobular inflammation. Regarding the stage of fibrosis, only one patient presented without fibrosis. No obvious stage 4 fibrosis (or liver cirrhosis) was noted in any of the cases. The mRNA of leptin was undetectable in the liver tissue of any cases in our study. TNF-α/GAPDH cDNA ratio was highest in patients without NASH, while the adiponectin/GAPDH cDNA ratio tended to be higher in NASH with advanced liver fibrosis. In contrast, the adipoRII/GAPDH cDNA ratio was lower in NASH with advanced liver fibrosis. All the mRNA levels of the studied genes have not reached significantly different. Immunohistochemistry, adiponectin and adipoRII staining were less pronounced in liver sinusoids in NASH group compared with non-NASH group. In contrast, leptin staining was more pronounced in liver tissues of NASH group with advanced liver fibrosis. However, no significant difference between three groups was noted.
The clinicopathological correlation demonstrated that the degree of hepatic steatosis was best correlated with fasting sugar, AST, ALT, GGT, triglyceride and HbA1c. Inverse relationship was noted between hepatic steatosis and high density lipoprotein. Independent predictors of ballooning degeneration were serum fasting sugar, AST, ALT and HbA1c. The best predictors of lobular inflammation were AST, ALT and HbA1c. The predictors for liver fibrosis were AST, ALT and C-peptide. In addition, the predictor for adiponectin/GAPDH cDNA ratio was inversely correlated to uric acid level; and the predictor for TNF-α/GAPDH cDNA ratio was related to liver steatosis. Immunohistochemistry study showed that the best predictors of leptin expression were correlated with C-peptide and portal inflammation. AdipoRII immunohistochemical stain was inversely related with systolic blood pressure; and positively associated Mallory body and glycogenated nuclei. Finally, the predictors for TNF-α immunohistochemical expression were AST, hemoglobin, lobular inflammation, portal inflammation and NAS activity. No significantly predictor of adiponectin immunohistochemical expression was noted.
Insulin resistance and reduced whole-body insulin sensitivity are major characteristics of NAFLD. In our study, we could not completely address the complex association between TNF-α, leptin and adiponectin/adipoRII, insulin, liver steatosis, necroinflammation, and liver fibrosis. Therefore, the possibility that all these adipocytokines could influence necroinflammation and fibrosis, finally to the functional severity in NASH, is not completely understood. Larger studies are needed to fully establish the pathogenesis and mechanisms of fat accumulation in the liver and the progression to fibrosis. Finally, the relationship between hepatic and peripheral insulin resistance and the development of hepatic steatosis should be clarified in future research.
論文目次 目錄
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第一章中文摘要 (Abstract in Chinese)
……………………………………………………………………………3
第二章英文摘要 (Abstract in English)
……………………………………………………………………………6
第三章緒論 (Introduction)
……………………………………………………………………………10
3.1 Nonalcoholic fatty liver disease (NAFLD) and Nonalcoholic steatohepatitis (NASH)
……………………………………………………………………………10
3.2 The Pathogenesis of Nonalcoholic steatohepatitis (NASH)
……………………………………………………………………………13
3.3 Adipose tissue acts as endocrine organ
……………………………………………………………………………15
3.4 Cytokines: metabolic syndrome and obesity
……………………………………………………………………………17
3.5 Liver: local manifestation of systemic insulin resistance
……………………………………………………………………………19
3.6 Cellular injury in liver
……………………………………………………………………………22
3.7 Central role of TNF-α
……………………………………………………………………………24
3.8 leptin
……………………………………………………………………………28
3.9 Adiponectin and its receptors
……………………………………………………………………………31
3.10 Role of TNF-α, leptin, adiponectin and its receptors
……………………………………………………………………………36
3.11Aims of our study
……………………………………………………………………………39
第四章研究方法與材料 (Materials and Methods)
……………………………………………………………………………40
4.1 Study Design, Patient Selection and Laparoscopic surgery
……………………………………………………………………………40
4.2 Laboratory Measurements
……………………………………………………………………………41
4.3 Pathological Assessment
……………………………………………………………………………41
4.4 Definition of NASH
……………………………………………………………………………42
4.5 RNA Isolation
……………………………………………………………………………43
4.6 Fluorescence based real time polymerase chain reaction analysis
……………………………………………………………………………43
4.7Immunohistochemistry
……………………………………………………………………………45
4.8 Statistical Analysis
……………………………………………………………………………46
第五章實驗結果 (Results)
……………………………………………………………………………47
5.1 Clinical characteristics
……………………………………………………………………………47
5.2 Pathological findings
……………………………………………………………………………48
5.3 Detection of mRNA of Leptin, Adiponectin, AdipoRII and TNF-α in liver of NASH patients
……………………………………………………………………………49
5.4 Immunohistochemical study of expression of Leptin, Adiponectin, AdipoRII and TNF-α in liver tissues of NASH patients
……………………………………………………………………………50
5.5 Association between Clinical, Laboratory Data and Histological Features
……………………………………………………………………………50
5.6 Association between Cytokines mRNA expression, Clinical, Laboratory Data and Histological Features
……………………………………………………………………………51
5.7 Association between Immunohistochemical study, Clinical, Laboratory Data and Histological Features
……………………………………………………………………………51
第六章討論 (Discussion)
……………………………………………………………………………53
第七章結論與展望 (Conclusion and Perspective)
……………………………………………………………………………69
第八章參考文獻 (References)
……………………………………………………………………………70
第九章圖表 (Tables and Figures)
……………………………………………………………………………81

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系統識別號 U0007-2507201023540000
論文名稱(中文) 十字花科蔬菜衍生物indole-3-carbinol對高脂飲食誘導肥胖相關疾病調節及其機制之探討
論文名稱(英文) Effects of indole-3-carbinol on high fat diet-induced obesity related disorders and its mechanisms
校院名稱 臺北醫學大學
系所名稱(中) 藥學系(博士班)
系所名稱(英) Pharmacy (PhD)
學年度 98
學期 2
出版年 99
研究生(中文) 張筱珮
學號 D301092010
學位類別 博士
語文別 英文
口試日期 2010-07-13
論文頁數 215頁
口試委員 指導教授-陳玉華
委員-許惠恆
委員-馮濟敏
委員-馮琮涵
委員-黃士懿
關鍵字(中) 十字花科蔬菜衍生物
肥胖
發炎反應
關鍵字(英) cruciferous vegetable
obesity
inflammation
學科別分類
中文摘要 本研究欲探討十字花科蔬菜衍生物indole-3-carbinol (I3C)對於高脂飲食所誘導肥胖及其相關機制之影響,分為三部分進行。第一部分主要目的為觀察I3C對於高脂飲食誘導肥胖之臨床表徵及脂肪生成相關因子的影響;第二部分則探討I3C對於高脂飲食小鼠之血脂質、脂肪肝及肝臟中脂質相關代謝因子的影響;最後利用小鼠初代脂肪細胞與巨噬細胞RAW 264.7共同培養,模擬體內肥胖細胞發炎狀態,給予I3C是否可改善伴隨肥胖引起相關發炎介質之變化。C57BL/6小鼠隨機分為控制組 (B)、高脂飲食組 (HF)與高脂飲食並給與腹腔注射5 mg I3C/kg (HFI)三組,於給予12週後,結果顯示HF組體重、副睪脂肪皆高於其他兩組。相較於HF組,HFI組降低血清中血糖、三酸甘油酯、瘦體素和胰島素的濃度,增加葡萄糖耐受能力與adiponectin的濃度,以及減少脂肪組織中F4/80的表現。另外,給予I3C可降低脂肪組織中ACC mRNA和增加PPARγ蛋白質的含量。第二部分實驗結果顯示,HF組血清及肝臟中三酸甘油酯濃度顯著增加,而血清及糞便中膽固醇的濃度沒有顯著改變。HFI組在肝臟中的膽固醇含量顯著較控制組上升。HFI組肝臟中三酸甘油酯含量亦較HF組低,且I3C可以顯著降低由高脂飲食所誘導脂質相關代謝基因SREBP-1、ACC及HMGR mRNA與增加PPAR-α mRNA的表現。在脂肪細胞與巨噬細胞共同培養下,給予I3C可抑制iNOS mRNA的表現量,降低NO、MCP-1與IL-6之濃度,以及增加PPARγ mRNA的表現,並可抑制脂肪細胞之分化。綜合以上結果,本研究發現,I3C藉由改善血清中血糖、血脂和脂肪激素的含量,降低脂肪量、調控脂肪組織和肝臟中脂質代謝相關因子以及抑制肥胖細胞之發炎狀態,因而具有抑制肥胖的作用,此結果可支持十字花科蔬菜衍生物I3C於預防或治療肥胖相關疾病之應用。
英文摘要 The objective of this study was to investigate the effects of indole-3-carbinol (I3C), a compound derivated from cruciferous vegetables, on diet-induced obesity and its associated pathological conditions. The first study was to examine the effects of I3C on obesity and its related factors in high fat diet-induced obese (DIO) mice. Secondly, the effects of I3C on high-fat diet induced hepatic steatosis and on lipid metabolism associated genes were studied. Finally, the model of co-culture of adipocytes and macrophages was conducted to evaluate the anti-obesity activity mechanisms of I3C. For the first two studies, C57BL/6 mice were randomly divided into three groups, and received basal diet, high fat diet (HF), as well as high fat diet + 5 mg I3C/kg intraperitoneally (HFI) 3 times per week for 12 weeks. Results showed that body weight and epididymal adipose tissue weight were greater, and adipocytes were larger in the HF group than in the basal and HFI groups. Compared with the HF group, the HFI group had improved glucose tolerance, a higher serum adiponectin concentration, and lower serum glucose, triglyceride, insulin, and leptin concentrations, as well as less F4/80 expression in epididymal adipose tissue (p<0.001). Furthermore, I3C treatment decreased acetyl CoA carboxylase (ACC) mRNA expression (p<0.05) and increased peroxisome proliferators–activated receptor-γ (PPARγ) protein expression (p<0.05) in epididymal adipose tissue of DIO mice. In the second study, mice fed with high-fat diet had upregulation on serum lipid profiles and on hepatic TG accumulation. I3C reduced high fat diet-induced hepatic steatosis, glucose intolerance, lowered serum glucose, serum and hepatic triglyceride levels, and decreased expressions of sterol response element binding protein-1 (SREBP-1) and ACC mRNA, increased PPARα mRNA expressions in liver comparing to those of HF mice. However, no significant difference was observed in serum and fecal cholesterol levels between HFI and HF groups. As in macrophage and primary adipocyte co-culture study, I3C treatment decreased expression of inducible nitric oxide synthase (iNOS), lowered nitrite and interleukin-6 (IL-6) concentrations in medium, and enhanced mRNA expression of PPAR-γ. I3C also inhibited intracellular lipid accumulation in hypertrophic adipocytes, indicating an inhibition of adipocyte differentiation. In conclusion, I3C possesses anti-obesity activity as observed from decreased adiposity and infiltrated macrophages in epididymal adipose tissue of DIO mice. These reductions were associated with improved glucose tolerance and with modulated expression of adipokines and hepatic lipogenic-associated gene products. Besides, the possible mechanisms for anti-obesity effects of I3C may be involved in inhibition of macrophage-induced inflammatory changes and modulation expression of PPAR-γ and hepatic lipogenic genes.
論文目次 Acknowledgements I
Abstract III
中文摘要 V
Abbreviations VII
Contents VIII
Figure of contents XII
Table of contents XIV
Chapter 1 Introduction 1
1.1 Obesity 1
1.2 Obesity related disorders 3
1.2.1 Metabolic syndrome 3
1.2.2 Non-alcoholic fatty liver disease (NAFLD) 5
1.3 Obesity and adipogenesis 6
1.3.1 Accumulation of triglycerides (TG) and free fatty acid 6
1.3.2 Adipocyte and adipogenesis 7
1.3.3 Regulation of adipogenesis 10
1.3.4 The regulation factors of lipid metabolism 15
1.4 Obesity and inflammation 19
1.5 Adipokines 19
1.6 Adipokines and inflammation in obesity 23
1.7 Regulation of inflammatory signaling 26
1.8 Cruciferous vegetable derivatives 29
1.9 Cruciferous vegetable derivatives in disease prevention 32
Chaptre 2 Scheme of the study 34
2.1 Outline of the experimental design 35
Chapter 3 Diet-induced obesity (DIO) mice model 38
3.1 Introduction 38
3.2 Materials and methods 40
3.2.1 Animals and diet 40
3.2.2 Measurement size, mass, and immunohistochemistry of the adipocytes 42
3.2.3 Measurement of serum glucose, triglyceride contents 42
3.2.4 Reverse transcriptase-polymerase chain reaction analysis and real-time PCR 43
3.2.5 Measurement of serum level of insulin, leptin, adiponectin, IL-6 45
MCP-1 and resistin 45
3.2.6 Immunoblotting analysis 46
3.2.7 Statistical analysis 46
3.3 Results 47
3.3.1. Body and organ weights 47
3.3.2. Biochemical measurements 47
3.3.3. Histopathology and macrophage accumulation of adipose tissue 48
3.3.4. Expression of lipid metabolism-associated factors 48
3.3.5. Adipokines 49
3.4 Discussion 69
Chapter 4 High-fat diet-induced fatty liver 75
4.1 Introduction 75
4.2 Materials and methods 77
4.2.1 Animals and diet 77
4.2.2 Measurements triglyceride and cholesterol content 79
4.2.3 Histopathology of the liver 79
4.2.4 Reverse transcriptase polymerase chain reaction analysis 79
4.2.5 Statistical analysis 82
4.3 Results 82
4.3.1 Effects of indole-3-carbinol on liver histopathology in HF-fed mice. 82
4.3.2 Effects of indole-3-carbinol on serum parameters, liver and feces lipid profiles.
83
4.3.3 Effects of indole-3-carbinol on lipid metabolism related genes in the liver. 83
4.4 Discussion 90
Chapter 5 Co-culture of macrophages and adipocytes 96
5.1 Introduction 96
5.2 Materials and methods 98
5.2.1 Reagents 98
5.2.2 Cell culture 98
5.2.2.1 Cell lines 98
5.2.2.2 Primary adipocyte culture 99
5.2.2.3 Adipocytes and macrophages co-culture model 100
5.2.3 Measurement of nitric oxide (NO) 100
5.2.4 Measurement of IL-6 and MCP-1 production 101
5.2.5 Reverse transcriptase polymerase chain reaction (RT-PCR) 101
5.2.6 Oil red O staining of 3T3-L1 adipocytes 102
5.2.7 Statistical analysis 103
5.3 Results 105
5.3.1 Effects of indole-3-carbinol on inflammatory mediators in co-culture cells 105
5.3.2 Effects of indole-3-carbinol on the expression of PPAR-γ mRNA 106
5.3.3 Effects of indole-3-carbinol on intracellular lipid accumulation. 107
5.4 Discussion 118
6. Conclusions 124
7. References 125
8. Published Articles and honors: (2003~2010) 144

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系統識別號 U0007-2801200815075200
論文名稱(中文) 國人體重過重及肥胖者休息代謝率之實測值與估計值 之比較研究
論文名稱(英文) Comparison of Measured versus Predicted Resting Metabolic Rate in Taiwanese Adults with Excess Weight
校院名稱 臺北醫學大學
系所名稱(中) 保健營養學研究所
系所名稱(英) Graduate Institute of Nutrition and Health
學年度 96
學期 1
出版年 97
研究生(中文) 夏慧欣
學號 G556094005
學位類別 碩士
語文別 中文
口試日期 2008-01-11
論文頁數 91頁
口試委員 指導教授-謝明哲
共同指導教授-黃國晉
委員-劉珍芳
委員-陳慶餘
關鍵字(中) 休息代謝率
間接計熱器
預測公式
台灣肥胖
關鍵字(英) Resting Metabolic Rate
Indirect Calorimetry
Prediction equation
Obese Taiwanese
學科別分類
中文摘要 休息代謝率的高低與肥胖的形成有極大相關,正確的測量數值,有助於熱量平衡的控制;本研究以在台灣的體重過重及肥胖者族群為基礎,比較以間接計熱器測定休息代謝率與六種常用預測公式估計值的差異。

本實驗從醫院減重門診篩選了250位,年齡範圍從20-86歲(平均40±14.5歲),BMI範圍為24.1-51.7公斤/(公尺)2 (平均32±5.6公斤/(公尺)2)之過重或肥胖成人,以間接計熱器(MetaMax 3B,德國Cortex公司製)測量其空腹4小時休息代謝率,所得之值與常用的六種預測公式估計值作比較。體重、身高、體組成、24小時飲食記錄、日常活動量都列入記錄。數據以SPSS 13.0版之配對t檢定、Pearson相關係數、Stepwise線性回歸作各組比較分析。

在校正年齡及性別後,以間接計熱器測量值與六種預測公式所得之估計值比較有顯著差異,但中等程度相關(P<0.001),分別為Harris-Benedict (R2=0.63),Owen (R2=0.61),Mifflin (R2=0.63),WHO (R2=0.63),Bernstein (R2=0.62),and Liu equation(R2=0.63)。另外,實際測量值明顯比預測值低,其中以Bernstein差異最小(176.2±339.8大卡/天)。適合台灣過重及肥胖族群的各種預測模式依BMI 24-27,27-35,>35三個不同組別中,在越高的組別,預測模式的準確度越差。

六種常用預測公式對台灣成人過重及肥胖者的預估似乎有過高的情形,影響台灣過重及肥胖者的休息代謝率的主要相關因子為體重、身高、除脂肪組織(Fat-free mass)、腹圍、年齡、性別等。在過重及肥胖族群中,休息代謝率的預測模式建議為 RMR = -577.02+ 5.15× 體重(公斤) + 426.98 × 身高(公尺) + 6.87 × 腹圍(公分)-2.72 × 年齡(歲) + 184.28 × 性別(男=1,女=0)

英文摘要 Objectives: To compare the values of resting metabolic rate (RMR) derived from six common prediction equations with the measured RMR using an indirect calorimetry in adults with excess weight.

Methods: A total of 250 overweight and obese adults, aged 20-86 (40+14.5) years and BMI 24.1-51.7 (32 + 5.6) kg/m2, were recruited from the obesity clinic in a medical center, and their RMR was measured using an indirect calorimetry (MetaMax 3B,Cortex Germany). These measured RMR values were compared with values from six prediction equations (Harris and Benedict, Owen, Mifflin, WHO, Bernstein, and Liu) using a statistical analysis.

Results: A significant but moderate correlation (P < 0.001) adjusted for age and gender was found between measured RMR and RMR derived from the Harris-Benedict (R2= 0.63), Owen (R2= 0.61), Mifflin (R2= 0.63), WHO (R2= 0.62), Bernstein (R2=0.62), and Liu’s equation (R2= 0.62). Furthermore, the measured RMR values were significantly lower than RMR values calculated using the six prediction equations. Among these, the Bernstein equation has the smallest difference (176.2 + 339.8 kcal/day). Several predictive models showed progressively poor prediction in the groups with BMI.

Conclusions: The present prediction equations seem to overestimate RMR of the overweight and obese Taiwanese adults. Factors having influence on variations in resting metabolic rate are weight、height、fat-free mass 、waist、 gender and age. The better suggested predictive model was : -577.02 + 5.15× weight(kg) + 426.98 × height(m) + 6.87 × waist(cm)-2.72 × age(years)+ 184.28 × gerder (male=1,female=0)
論文目次 第一章 引言 8
第二章 研究動機與目的 11
第三章 文獻回顧 13
第四章 研究方法及步驟 34
第五章 結果 45
第六章 討論 66
第七章 結論 72
第八章 參考文獻 73
附 錄 研究問卷 85
台大醫院倫理委員會同意書91
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系統識別號 U0007-2807201020043200
論文名稱(中文) 北市高中學生身體質量指數之改變對其生理及心理指標之影響
論文名稱(英文) Impacts of changes of body mass index on psychological and physical condition -- Investigation on overweight high school students in Taipei
校院名稱 臺北醫學大學
系所名稱(中) 公共衛生學研究所
系所名稱(英) Graduate Institute of Public Health
學年度 98
學期 2
出版年 99
研究生(中文) 廖盈婷
學號 M508097009
學位類別 碩士
語文別 中文
口試日期 2010-07-06
論文頁數 122頁
口試委員 委員-邱弘毅
委員-吳振龍
指導教授-陳怡樺
關鍵字(中) 青少年
肥胖
過重
憂鬱
自尊
血壓
減重
關鍵字(英) adolescent
obesity
overweight
depression
self-esteem
blood pressure
weight loss
學科別分類
中文摘要 世界衛生組織(WHO)指出,從1980年代開始,許多歐洲國家的肥胖盛行率已增加三倍之多,WHO也提出警告:肥胖是一種疾病,且全球肥胖人口急遽增加,已經成為一種新的流行病,台灣同樣也面臨肥胖的威脅,不論是成人、青少年及兒童均有極高的肥胖盛行率,讓我們不能忽視的是其背後帶來可能的心理及生理上的疾病。
特別需要關注的就是青少年時期,因為肥胖兒童變成肥胖成人的機率有二分之一,但肥胖青少年變成肥胖成人的機率卻佔了四分之三,且台灣十大死因中,與肥胖相關之疾病就佔了六項,顯見青少年肥胖問題若不及時控制極可能在未來成為國家嚴重的醫療負擔。
本研究研究目的(一)了解北市過重肥胖高中生之前測、後測與後後測的體重狀態、心理行為及生理之分布。(二) 探討台北市肥胖及過重高中生身體質量指數變化後,其心理指標(如憂鬱、自尊等)在後測及後後測之改變。(三) 探討台北市肥胖及過重高中生身體質量指數變化後,其生理指標(如血壓、血糖等)在後測之改變。在台灣,相關研究多數為橫斷式研究,本研究利用前、後測以及後後測來看過重或肥胖之高中生,其BMI下降後,是否進一步影響到其生理以及心理行為指標。
本研究以臺北市政府衛生局98年度研究計畫「台北市立高中學生體重控制介入成效及其相關生理心理指標改變與影響」資料進行分析。該計畫針對六所社區高中,依學校意願選擇過重與肥胖組學生共100名於2009年4月參與為期12週的整合型介入方案,本研究選取這100名過重與肥胖學生,進行前測與短期三個月後測之體檢資料(含體重、血壓及抽10c.c.的血液進行血脂、血糖測定)測量。另外,上述兩個時間點,同樣也進行結構式問卷(含生活型態、憂鬱、身體意象等)測量,並於中期八個月後後測增加一次結構式問卷測量,以比較三次之差異。
本研究短期以身體質量指數(BMI)下降2%作為切點,中期則以BMI下降3%為切點,短期分(1) 「ΔBMI21<-2%」組 ,(2) 0%>ΔBMI21≧-2%組 ,(3) 「ΔBMI21≧0%」組;中期則分(4) 「ΔBMI31<-3%」組,(5) 0%>ΔBMI31≧-3%組 ,(6) 「ΔBMI31≧0%」組,各三組,針對身體質量指數下降不同之幅度之各組別,探討其在生理與心理各項指標之改變情形。本研究利用配對T檢定進行各組內研究分析,探討各變項在三次測量時間之差異;另外,透過one way ANOVA探討各組間之差異。
在身體質量指數(Body Mass index,BMI)下降之後,本研究發現短期三個月,憂鬱、自尊與身體意象各組間並沒有顯著差異,但男高中生中減重效果較好的「ΔBMI21<-2%」組(53.31±11.989 mg/dL)相較於減重沒成效的「ΔBMI21≧0%」組(44.24±6.53 mg/dL),其高密度脂蛋白膽固醇顯著較高(P=0.024);而在中期八個月內,本研究發現,「ΔBMI31≧0%」組自尊顯著下降(P<0.05)、 女高中生「ΔBMI31<-3%」組之憂鬱顯著較「0%>ΔBMI31≧-3%」組低且也顯著較「ΔBMI31≧0%」組低(P=0.009)。
本研究發現對男高中生短期體重介入,可改善其部分生化值,中期透過減重介入可改善女高中生之憂鬱傾向,未來研究建議在觀察時間上可拉長,並酌加質性調查,更能看出當中對青少年影響之脈絡,有鑒於部份過重、肥胖青少年生化值已出現異常,本研究建議對於青少年肥胖問題必須持續關注。
英文摘要 The World Health Organization (WHO) indicated that the prevalence of obesity has tripled in many European countries since 1980s. As the world's obese population has increased drastically, the WHO warns that obesity is a disease and has become a new epidemic illness worldwide. In Taiwan, the threats of obesity expand across lifespan, including childhood, adolescence, and adulthood.
Childhood obesity frequently persists into adulthood, with up to 42-63% of obese children and 80% of obese adolescents being reported to become obese adults. This is of great concern, given that many adverse effects on health are already found in obese adolescents, including physical (e.g., hypertension, type 2 diabetes) and psychosocial (e.g., depression) problems. As obesity has contributed to substantial medical burden and to many of the top ten causes of death, there is an imperative need to address the problem on adolescent obesity.
The purpose of this study was (1) to explore the distributions of weight status and psychological and physical conditions among overweight and obese high school students in Taipei across three different time points (i.e., Wave I (baseline), Wave II (3 months later), and Wave III (8 months later)); (2) to explore the effects of weight loss on the consequent change of psychological conditions in Wave II and Wave III; (3) to explore the effects of weight loss on the consequent change of physical conditions in Wave II. To the best of our knowledge, most of the previous reserches on adolescent weight loss in Taiwan were cross-sectional. Our study was designed to collect information on three time points to investigate if weight loss could improve both psychological and physical conditions on adolescents.
A total of 100 overweight and obese students who participated in the research project of “the Effectiveness of an Integrated Weight Management Intervention and its Consequences on Related Physical and Mental Indices for Taipei Municipal High School Students” starting from April, 2009 (Wave I) were recruited in our study. These students were selected among six municipal senior high schools in Taipei.
Three assessments of structured questionnaires (e.g., lifestyle, depression, and body image) and two measures of physical and laboratory examinations (e.g., weight, blood pressure, and 10c.c. blood for blood lipid and blood sugar measurements) were implemented at different time points. In addition, the change of body mass index (ΔBMI), the independent variable, was calculated. For the comparison between Wave I and Wave II status, we used 2% as a cut-off point (i.e., categorized into three groups of ΔBMI21<-2%, 0%>ΔBMI21≧-2%, and ΔBMI21≧0%), while for the comparison between Wave I and Wave III status, we used 3% as a cut-off point (i.e., categorized into three groups of ΔBMI31<-3%, 0%>ΔBMI31≧-3%, and ΔBMI31≧0%). The pair-T test ,one-way ANOVA and χ2 were adopted for analysis.
For the comparison between Wave I and Wave II status, we found that (1) there was no significant difference on psychological conditions within and between groups; (2) there was significant improvement on high density lipoprotein cholesterol (HDL-C) among male students. Specifically, the group of “ΔBMI21<-2% (53.31±11.989 mg/dL)” is better than the group of ΔBMI21≧0% (44.24±6.53 mg/dL; P=0.024).
For the comparison between Wave I and Wave III status, we found that (1) the group of “ΔBMI31≧0%” displayed significantly lower self-esteem. (P<0.05); (2) among female students, students in the group of “ΔBMI31<-3%” reported significantly lower scores on depression, compared to those in the group of “0%>ΔBMI31≧-3%” and “ΔBMI31≧0%” (P=0.009).
In conclusion, for male students with weight loss in about 3 months, the HDL-C might be improved accordingly. On the other hand, for female students with weight loss in about 8 months, depressive scores might be improved. It might be helpful to conduct longer-term intervention and qualitative researches in the future to further address the effects of change of weight status on the consequent modification of physical and psychological conditions among adolescents. Because abnormal biochemical values were observed on some of these obese students, the design and administration of the prevention and intervention programs on adolescent obesity have remained a major public health issue to concern for.
論文目次 第一章 前言 1
第一節 研究背景 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 青少年肥胖盛行率 4
第二節 青少年身體質量指數與心理指標、健康行為的相關 8
第三節 青少年身體質量指數與生理指標的相關 16
第四節 青少年身體質量指數下降對心理指標與健康行為之相關 20
第五節 青少年身體質量指數下降對生理指標之相關 21
第六節 青少年肥胖在公衛議題之重要性 22
第三章 研究設計與方法 25
第一節 研究架構 25
第二節 研究問題與假設 26
第三節 研究樣本及收案步驟 27
第四節 研究工具 31
第五節 研究變項及操作型定義 35
第六節 資料處理與分析 39
第四章 研究結果 41
第一節 基本人口學變項 41
第二節 單變項分析 42
第三節 不同施測時間之比較 48
第四節 短期內三組ΔBMI之組內心理行為變項改變之分析 57
第五節 短期內三組ΔBMI之組內生理變項改變之分析 60
第六節 中期內三組ΔBMI之組內心理行為變項改變之分析 65
第七節 短期內三組ΔBMI在心理行為與生理變項改變之雙變項分析 67
第八節 中期三組ΔBMI在心理行為變項改變之雙變項分析 72
第九節 短、中期內三組ΔBMI之心生理指標依性別分析 75
第五章 討論與結論 77
第一節 北市過重、肥胖高中生現況 77
第二節 高中生減重與社會心理因素之相關性 80
第三節 高中生減重與健康相關行為之相關性 84
第四節 高中生減重與生理指標之相關性 89
第五節 研究限制 90
第六節 結語與建議 93
感謝(ACKNOWLEDGEMENT) 97
參考文獻(REFERENCE) 98
一、英文部分 98
二、中文部分 105
三、網站部分 1100
附錄(APPENDIX) 111
第一節 研究工具使用同意書 111
第二節 正式施測問卷 114
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林素玲(2001)。營養教育與運動介入對肥胖者之體位、血壓、血糖、血脂質、尿酸及血清鈣鎂鋅銅影響之研究。碩士論文,靜宜大學,台中市。

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三、網站部分
行政院衛生署:國人肥胖定義及處理原則。
http://www.doh.gov.tw/CHT2006/DM /SEARCH_RESULT.aspx
行政院衛生署(2008)。國人肥胖盛行率十七% 年耗216億醫療費。http://www.doh.gov.tw/cht2006/index_populace.aspx
行政院衛生署(2008)。國中學生飲食與營養狀況知識、態度與飲食行為問卷調查計畫結果報告。網址:ttp://food.doh.gov.tw/news_1.asp?idCategory=10&idx=2040
國民營養健康狀況變遷調查http://www.ibms.sinica.edu.tw/~pan/nahsit/nahsit.htm

 


若您有任何疑問,請與我們聯絡!
臺北醫學大學 圖書館 簡莉婷
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