進階搜尋


  查詢北醫館藏
系統識別號 U0007-2201201723121800
論文名稱(中文) 肥胖女性進行胃繞道與胃袖狀切除手術後 飲食攝取、身體組成與血液組成的變化
論文名稱(英文) Dietary Intake, Body Composition and Blood Parameter Changes in Obese Women with Roux-en-Y Gastric Bypass and Sleeve Gastrectomy
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 105
學期 1
出版年 106
研究生(中文) 林琪凰
研究生(英文) Chi-Huang Lin
學號 G556103011
學位類別 碩士
語文別 中文
口試日期 2017-01-03
論文頁數 101頁
口試委員 指導教授-葉松鈴
委員-劉珍芳
委員-楊淑惠
中文關鍵字 胃繞道  胃袖狀切除  飲食攝取  身體組成  血液生化值 
英文關鍵字 Roux-en-Y gastric bypass  sleeve gastrectomy  dietary intake  body composition  biochemical parameter 
學科別分類
中文摘要 本研究目的為探討肥胖女性進行胃繞道與胃袖狀切除手術後飲食攝取、身體組成與血液生化數值的變化。採病歷回溯法收集2012年1月1日~2014年12月31日於台北醫學大學附設醫院進行減重手術的病患
資料,篩選出7位RYGB與7位SG手術之病患,兩組在術前平均年齡、身體質量指數、飲食攝取與身體組成無顯著差異(p>0.05)。結果顯示,在手術後3-6個月期間,RYGB組體重流失率高於SG組(RYGB, 67.8% vs. SG, 44.1%, p<0.05) ; 每日熱量攝取量也顯著少於SG組(RYGB, 700 ± 241 kcal/day vs. SG, 1034 ± 256 kcal/day, p<0.05)。術後7-12個月兩組病患在熱量攝取、體重、腰圍、脂肪重顯著低於術前(p<0.05),營養素攝取量、身體組成與血液生化值兩組間無顯著差異(p>0.05)。在RYGB組中有6位第2型糖尿病患,術後7-12個月空腹血糖與HbA1C顯著低於術前(BS, 226.7 mg/dl to 135.5 mg/dl; HbA1C, 9.3% to 6.6%).。本篇研究顯示,RYGB 組因手術後食物攝取量與小腸吸收面積小於SG組,在術後短期內對體重、脂肪重減少具有顯著的效果 ; 但7-12月後RYGB組熱量攝取上升與SG組相近,因此兩組在身體組成與血液生化值無顯著差異。
英文摘要 This is a retrospective study to investigate the impacts of two different bariatric surgeries on dietary intake, body composition and biochemical parameters of obese women. Patients who were scheduled for Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) from January 1, 2012 to December 31, 2014 were enrolled in this study at Taipei Medical University Hospital. Seven patients performed RYGB operation and seven age- and body mass index (BMI)-matched patients underwent SG operation were recruited. There were no significant differences in dietary intake and body composition at baseline between the two groups (p>0.05). The results indicated that excess body weight loss percentage (%EBWL) was higher (RYGB, 67.8% vs. SG, 44.1%, p<0.05) whereas the calorie intake was lower in
the RYGB group than the SG group (RYGB, 700 ± 241 kcal/day vs. SG, 1034 ± 256 kcal/day, p<0.05) at 3-6 months after surgery. Calorie intake and the body weight, waist circumference, fat mass were significantly reduced in both groups at postoperative 7-12 months. No significant
differences in nutrient intake, body composition and biochemical parameters were observed at this time point. Six out of the 7 patients underwent RYGB surgery had type 2 diabetes mellitus. The fasting blood glucose (BS) levels and HbA1c were significantly reduced 7-12 months after
surgery (BS, 226.7 mg/dl to 135.5 mg/dl; HbA1C, 9.3% to 6.6%). Because the food intake and intestinal absorption were lower in patients with RYGB operation than those of the SG patients, the reduction of weight and fat mass were much obvious at early phase after surgery. However, the calorie intake in the RYGB group rebound to the amount comparable to the SG group at 7-12 month and thus no differences in body composition and blood biochemical were
found between RYGB and SG groups at this time point.
論文目次 目錄

中文摘要Ⅰ
英文摘要Ⅱ
致謝Ⅲ
目錄Ⅳ
表目次Ⅵ
圖目次Ⅶ
附錄目次Ⅷ
全文縮寫中英文對照表Ⅸ
第一章 緒論1
第二章 文獻回顧2
第一節 減重手術的盛行率與肥胖併發症2
第二節 胃繞道與胃袖狀切除的手術方式與風險8
第三節 減重手術後的飲食攝取狀況11
第四節 減重手術後肥胖改善成效的評估方法13
第三章 研究設計與方法19
第一節 研究期間與收案對象19
第二節 研究設計20
第三節 資料收集與分析項目21
第四節 統計分析方法26
第四章 結果27
第一節 個案術前基本資料27
第二節 每日熱量與三大營養素攝取的28
第三節 體重與身體組成變化30
第四節 飲食中膳食纖維、脂肪酸與膽固醇攝取量之變化32
第五節 飲食中礦物質攝取之變化34
第六節 飲食中維生素攝取量之變化37
第七節 血液生化數值與血壓的變化41
第八節 術後生理症狀與 BED 病患的變化45
第五章 討論46
第一節 RYGB 與 SG 病患熱量攝取之差異46
第二節 RYGB 與 SG 病患蛋白質、碳水化合物攝取之差異47
第三節 術後維生素與礦物質缺乏問題之探討49
第四節 RYGB 與 SG 術後對疾病與 BED 改善之探討52
第五節 手術併發症之差異54
第六節 研究限制與未來展望55
第六章 結論57
第七章 參考文獻
一、 英文參考文獻78
二、 中文參考文獻84
三、 參考圖片85

表目次

表 一 WHO 與台灣衛生福利部對 BMI 的分類3
表 二 肥胖相關生理併發症 4
表 三 台灣代謝及減重外科醫學會統計 2010-2015 年間進行減重手術總人數 6
表 四 血壓參考值 14
表 五 NCEP ATPⅢ建議血液三酸甘油酯數值 17
表 六 ADA 對糖尿病的空腹血糖與 HbA1c 標準值 18
表 七 RYGB 與 SG 個案術前基本資料 58
表 八 RYGB 與 SG 個案熱量與三大營養素攝取的變化 59
表 九 術前與術後熱量與三大營養素攝取的變化60
表 十 RYGB 與 SG 個案身體組成的改變 61
表 十一 術前與術後身體組成的變化62
表 十二 RYGB 與 SG 個案膳食纖維、脂肪酸與膽固醇攝取量之變化63
表 十三 RYGB 與 SG 個案每日礦物質攝取量之變化64
表 十四 RYGB 與 SG 個案每日維生素攝取量之變化 65
表 十五 RYGB 與 SG 個案血液與血壓的變化66
表 十六 術前與術後血液與血壓的變化 67

圖目次

圖 一 台灣代謝及減重外科醫學會統計 2010-2015 年間進行 RYGB 與 SG 減重手術 人數 6
圖 二 台灣代謝及減重外科醫學會統計 2010-2015 年間進行減重手術男性與女性之 個案數 7
圖 三 台灣代謝及減重外科醫學會統計 2010 年-2015 年間 18-55 歲進行減重手術人 數與總人數 7
圖 四 台灣代謝及減重外科醫學會統計 2010 年-2015 年間進行 RYGB、SG 年齡與 平均手術年齡之差異 8
圖 五 胃繞道手術 10
圖 六 胃袖狀切除手術10
圖 七 治療成人血中膽固醇以降低動脈粥樣硬化風險16
圖 八 研究設計流程圖 20
圖 九 衛生福利部國民健康署腰圍量法 22
圖 十 RYGB 與 SG 病患術前飲食與生活習慣 69
圖 十一 RYGB 與 SG 病患術後熱量攝取的變化 70
圖 十二 RYGB 與 SG 術後 3-6 與 7-12 個月後體重減少的變化 71
圖 十三 RYGB 與 SG 術後 3-6 與 7-12 個月後 EBWL%的變化72
圖 十四 RYGB 與 SG 組 T2DM 病患術後 7-12 個月後 HbA1c 的變化 73
圖 十五 RYGB 與 SG 個案術後營養補充品攝取74
圖 十六 術 3-6 個月生理症狀 75
圖 十七 術後 7-12 個月生理症狀 76
圖 十八 BED 病患術後熱量取變化77
圖 十九 BED 病患術後體重的變化 78

附錄目次

附錄一、臨床試驗委員會通過同意書86
附錄二、國人膳食營養素參考攝取量修訂第七版87
附錄三、BED (Binge Eating Disorder) 問卷88
參考文獻 第七章 參考文獻
一、 英文參考文獻

Arnlov, J., Ingelsson, E., Sundstrom, J., & Lind, L. (2010). Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middleaged men. Circulation 121(2):230-236.

Ben-Porat, T., Elazary, R., Yuval, J. B., Wieder, A., Khalaileh, A., & Weiss, R. (2015). Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively? Surg Obes Relat Dis 11(5):1029-1036.

Benaiges, D., Flores-Le-Roux, J. A., Pedro-Botet, J., Ramon, J. M., Parri, A., Villatoro, M., et al. Goday, A. (2012). Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en-Y gastric bypass) on lipid profile. Obes Surg 22(8): 1268-1275.

Brolin, R. E., Bradley, L. J., Wilson, A. C., & Cody, R. P. (2000). Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity. J Gastrointest Surg 4(5):464-469.

Brolin, R. E., Gorman, J. H., Gorman, R. C., Petschenik, A. J., Bradley, L. J., Kenler, H. A., & Cody, R. P. (1998). Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg 2(5):436-442.

Choban, P. S., & Flancbaum, L. (2002). The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg 12(4):540-545.

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. (1998). Obes Res 6 Suppl 2:51s-209s.

Coen, P. M., Tanner, C. J., Helbling, N. L., Dubis, G. S., Hames, K. C., Xie, H., et al. Goodpaster, B. H. (2015). Cl. J Clin Invest 125(1):248-257.

Coupaye, M., Riviere, P., Breuil, M. C., Castel, B., Bogard, C., Dupre, T., et al. (2014). Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg 24(2):276-283.

Damms-Machado, A., Friedrich, A., Kramer, K. M., Stingel, K., Meile, T., Kuper, M. A., et al. Bischoff, S. C. (2012). Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg 22(6):881-889.

de Barros, F., Setubal, S., Martinho, J. M., & Monteiro, A. B. (2015). Early Endocrine and Metabolic Changes After Bariatric Surgery in Grade III Morbidly Obese Patients: A Randomized Clinical Trial Comparing Sleeve Gastrectomy and Gastric Bypass. Metab Syndr Relat Disord 13:264-271.

Decker, G. A., Swain, J. M., Crowell, M. D., & Scolapio, J. S. (2007). Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol 102(11): 2571-2580.

Dogan, K., Aarts, E. O., Koehestanie, P., Betzel, B., Ploeger, N., de Boer, H., et al. Berends, F. J. (2014). Optimization of vitamin suppletion after Roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine (Baltimore) 93(25):e169.

Donadelli, S. P., Junqueira-Franco, M. V., de Mattos Donadelli, C. A., Salgado, W., Jr., Ceneviva, R., Marchini, J. S., et al. (2012). Daily vitamin supplementation and hypovitaminosis after obesity surgery. Nutrition 28(4):391-396.

Franco-Villoria, M., Wright, C. M., McColl, J. H., Sherriff, A., & Pearce, M. S. (2016). Assessment of adult body composition using bioelectrical impedance: comparison of researcher calculated to machine outputted values. BMJ Open 6(1):e008922.

Fu, T. T., Lin, Y. M., & Huang, C. L. (2011). Willingness to pay for obesity prevention. Econ Hum Biol 9(3):316-324.

Gehrer, S., Kern, B., Peters, T., Christoffel-Courtin, C., & Peterli, R. (2010). Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg 20(4):447-453.

Giusti, V., Theytaz, F., Di Vetta, V., Clarisse, M., Suter, M., & Tappy, L. (2016). Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. Am J Clin Nutr 103(1):18-24.

Gomez-Ambrosi, J., Pastor, C., Salvador, J., Silva, C., Rotellar, F., Gil, M. J., et al. (2007). Influence of waist circumference on the metabolic risk associated with impaired fasting glucose: effect of weight loss after gastric bypass. Obes Surg 17(5):585591.

Goode, L. R., Brolin, R. E., Chowdhury, H. A., & Shapses, S. A. (2004). Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res 12(1):40-47.

Gras-Miralles, B., Haya, J. R., Moros, J. M., Goday Arno, A., Torra Alsina, S., Ilzarbe Sanchez, L., et al. (2014). Caloric intake capacity as measured by a standard nutrient drink test helps to predict weight loss after bariatric surgery. Obes Surg 24(12):2138-2144. Grupski, A. E., Hood, M. M., Hall, B. J., Azarbad, L., Fitzpatrick, S. L., & Corsica, J. A. (2013). Examining the Binge Eating Scale in screening for binge eating disorder in bariatric surgery candidates. Obes Surg 23(1):1-6.

Guan, X., Sun, G., Zheng, L., Hu, W., Li, W., & Sun, Y. (2015). Associations between metabolic risk factors and body mass index, waist circumference, waist-to-height ratio and waist-to-hip ratio in a Chinese rural population. J Diabetes Investig .

Handzlik-Orlik, G., Holecki, M., Orlik, B., Wylezol, M., & Dulawa, J. (2015). Nutrition management of the post-bariatric surgery patient. Nutr Clin Pract 30(3):383-392. Hanks, L. J., Tanner, R. M., Muntner, P., Kramer, H., McClellan, W. M., Warnock, D. G., et al. (2013). Metabolic subtypes and risk of mortality in normal weight, overweight, and obese individuals with CKD. Clin J Am Soc Nephrol 8(12): 2064-2071.

Hu, T., Mills, K. T., Yao, L., Demanelis, K., Eloustaz, M., Yancy, W. S., Jr., et al. (2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol 176 Suppl 7:44-54.

Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., et al. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 129:S102-138.

Kahan, S., & Zvenyach, T. (2016). Obesity as a Disease: Current Policies and Implications for the Future. Curr Obes Rep 5(2):291-297. Kramer, C. K., Zinman, B., & Retnakaran, R. (2013). Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med 159(11):758-769. Kwon, Y., Kim, H. J., Lo Menzo, E., Park, S., Szomstein, S., & Rosenthal, R. J. (2014). Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis 10(4):589-597.

Lassailly, G., Caiazzo, R., Buob, D., Pigeyre, M., Verkindt, H., Labreuche, J., et al. (2015). Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients. Gastroenterology 149(2):379-388.

Lee, S. H., Tak, Y. J., Yi, Y. H., Lee, S. Y., Cho, Y. H., Lee, J. G., et al. (2016). Correlations between obesity indices and cardiometabolic risk factors in obese subgroups in women with severe obesity: A multicenter, cross-sectional study. Obes Res Clin Pract. (pubmed ahead of print)

Li, Z., Yang, X., Yang, J., Yang, Z., Wang, S., Sun, F., & Zhan, S. (2016). The Cohort Study on Prediction of Incidence of All-Cause Mortality by Metabolic Syndrome. PLoS One 11(5):e0154990. Mahdy, T., Atia, S., Farid, M., & Adulatif, A. (2008). Effect of Roux-en Y gastric bypass on bone metabolism in patients with morbid obesity: Mansoura experiences. Obes Surg 18(12):1526-1531. Major, P., Matlok, M., Pedziwiatr, M., Migaczewski, M., Zub-Pokrowiecka, A., Radkowiak, D., et al. (2015). Changes in levels of selected incretins and appetitecontrolling hormones following surgical treatment for morbid obesity. Wideochir Inne Tech Maloinwazyjne 10(3):458-465.

Martinez-Larrad, M. T., Corbaton-Anchuelo, A., Fernandez-Perez, C., Lazcano-Redondo, Y., Escobar-Jimenez, F., & Serrano-Rios, M. (2016). Metabolic syndrome, glucose tolerance categories and the cardiovascular risk in Spanish population. Diabetes Res Clin Pract 114:23-31.

Mason, J. R., & Turner, G. (1975). Transmission and recombination of extranuclear genes during sexual crosses in Aspergillus nidulans. Mol Gen Genet 143(1):93-99.

McLean, R. C., Morrison, D. S., Shearer, R., Boyle, S., & Logue, J. (2016). Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment. Clin Obes 6(2):133-142.

Menegati, G. C., de Oliveira, L. C., Santos, A. L., Cohen, L., Mattos, F., Mendonca, L. M., et al. (2016). Nutritional Status, Body Composition, and Bone Health in Women After Bariatric Surgery at a University Hospital in Rio de Janeiro. Obes Surg 26(7):15171524.

Mikamori, M., Miyamoto, A., Asaoka, T., Maeda, S., Hama, N., Yamamoto, K., et al. (2016). Postoperative Changes in Body Composition After Pancreaticoduodenectomy Using Multifrequency Bioelectrical Impedance Analysis. J Gastrointest Surg 20(3):611-618.

Moize, V., Andreu, A., Rodriguez, L., Flores, L., Ibarzabal, A., Lacy, A., et al. (2013). Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr 32(4):550-555.

Nammi, S., Koka, S., Chinnala, K. M., & Boini, K. M. (2004). Obesity: an overview on its current perspectives and treatment options. Nutr J 3:3.

Nestvold, T. K., Nielsen, E. W., & Lappegard, K. T. (2013). Bariatric surgery reduces risk factors for development of type 2 diabetes mellitus in morbidly obese, nondiabetic patients. Metab Syndr Relat Disord 11(6):441-446.

Nguyen, N. T., Goldman, C., Rosenquist, C. J., Arango, A., Cole, C. J., Lee, S. J., & Wolfe, B. M. (2001). Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234(3):279-289.

Ooi, G. J., Burton, P. R., Doyle, L., Wentworth, J. M., Bhathal, P. S., Sikaris, K., et al. (2016). Effects of Bariatric Surgery on Liver Function Tests in Patients with Nonalcoholic Fatty Liver Disease. Obes Surg.

Osland, E., Yunus, R. M., Khan, S., Alodat, T., Memon, B., & Memon, M. A. (2016). Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review. Obes Surg.

Pekkarinen, T., Mustonen, H., Sane, T., Jaser, N., Juuti, A., & Leivonen, M. (2016). LongTerm Effect of Gastric Bypass and Sleeve Gastrectomy on Severe Obesity: Do Preoperative Weight Loss and Binge Eating Behavior Predict the Outcome of Bariatric Surgery? Obes Surg 26(9):2161-2167.

Peterli, R., Borbely, Y., Kern, B., Gass, M., Peters, T., Thurnheer, M., et al. (2013). Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg 258(5):690-694.

Peterli, R., Steinert, R. E., Woelnerhanssen, B., Peters, T., Christoffel-Courtin, C., Gass, M., et al. (2012). Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg, 22(5):740-748.

Praveen Raj, P., Gomes, R. M., Kumar, S., Senthilnathan, P., Karthikeyan, P., Shankar, A., & Palanivelu, C. (2015). The effect of surgically induced weight loss on nonalcoholic fatty liver disease in morbidly obese Indians: "NASHOST" prospective observational trial. Surg Obes Relat Dis 11(6):1315-1322.

Ren, Y., Yang, W., Yang, J., & Wang, C. (2015). Effect of Roux-en-Y gastric bypass with different pouch size in Chinese T2DM patients with BMI 30-35 kg/m2. Obes Surg 25(3):457-463.

Schafer, A. L., Weaver, C. M., Black, D. M., Wheeler, A. L., Chang, H., Szefc, G. V., et al. (2015). Intestinal Calcium Absorption Decreases Dramatically After Gastric Bypass Surgery Despite Optimization of Vitamin D Status. J Bone Miner Res 30(8):1377-1385.

Schollenberger, A. E., Karschin, J., Meile, T., Kuper, M. A., Konigsrainer, A., & Bischoff, S. C. (2016). Impact of protein supplementation after bariatric surgery: A randomized controlled double-blind pilot study. Nutrition 32(2):186-192.

Tai, C. M., Huang, C. K., Hwang, J. C., Chiang, H., Chang, C. Y., Lee, C. T., et al. (2012). Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg 22(7):1016-1021.

Triffoni-Melo Ade, T., Dick-de-Paula, I., Portari, G. V., Jordao, A. A., Garcia Chiarello, P., & Diez-Garcia, R. W. (2011). Short-term carbohydrate-restricted diet for weight loss in severely obese women. Obes Surg 21(8):1194-1202.

Voulgari, C., Tentolouris, N., Dilaveris, P., Tousoulis, D., Katsilambros, N., & Stefanadis, C. (2011). Increased heart failure risk in normal-weight people with metabolic syndrome compared with metabolically healthy obese individuals. J Am Coll Cardiol 58(13):1343-1350.

Yang, J., Wang, C., Cao, G., Yang, W., Yu, S., Zhai, H., & Pan, Y. (2015). Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m(2). BMC Surg 15:88.

二、 中文參考文獻

台灣代謝及減重外科醫學會 (2010-2015) 歷年台灣減重手術統計登陸。

行政院衛生署 (2011) 國人膳食營養素參考攝取量(Dietary Reference Intakes, DRIs)。

行政院衛生署食品藥物管理局 (2012) 每日飲食指南 台北市。

衛生福利部國民健康署 (2005) 腰圍測量及判讀之方法。

衛生福利部國民健康署(2013~2014) 國民營養健康狀況變遷調查 成人過重及肥胖 盛行率。

衛生福利部國民健康署 成人健康體位標準。


衛生福利部統計處(2015) 104年台灣國人死因統計。

三、 參考圖片

1. RYGB image. Updated December 2016 https://www.beliteweight.com/wp-content/uploads/2014/01/Gastric-Bypass-Roux-enY.png

2. SG image. Updated December 2016 https://www.beliteweight.com/wp-content/uploads/2014/01/Gastric-Sleeve-VerticalSleeve-Gastrectomy.png

論文全文使用權限
  • 同意授權瀏覽/列印電子全文服務,於2019-01-26起公開。


  • 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
    E-mail:etds@tmu.edu.tw
    Tel:(02) 2736-1661 ext.2519
    Fax:(02) 2737-5446