臺灣博碩士論文加值系統

研究背景與目的：根據文獻資料發現動作發展遲緩兒童可能因活動障礙導致有過重或肥胖的現象，也可能因飲食問題導致過瘦情形，其體位分佈呈現兩極化現象。然而，相較於學齡兒童，學齡前的動作發展遲緩兒童之體位分佈變化與飲食及活動型態與體位的相關研究相對較缺乏。因此，本研究目的為探討解台灣0-6歲動作發展遲緩兒童體位分佈、體位與飲食及活動型態之相關。
研究方法：本研究共收集106位9-73個月大之動作發展遲緩兒童，採橫斷式與回溯性之調查研究。體位測量方法分為二種，身體質量指數（Body Mass Index，簡稱BMI）及重高指數（Weight-for-Length Index，簡稱WLI）。兒童一日總熱量攝取採用前24小時回憶法記錄；活動型態採用嬰幼兒活動作息調查表來統計各項活動型態之維持時間。以卡方檢定分析各年齡分層動作發展遲緩兒童之體位分佈與一般發展兒童之差異。利用斯皮爾曼相關係數（Spearman’s Rank Correlation Coefficient）及皮爾森相關係數（Pearson’s Correlation Coefficient）來分析兒童體位、一日總熱量攝取及活動型態間之相關性。而其多重影響體位因子則利用邏輯式迴歸分析以預測兒童過重或肥胖。
結果：以BMI與WLI二種方法來判定體位，其體位分佈具顯著差異（χ2＝54.9，p＜.001）。而以WLI分類判定標準，動作發展遲緩兒童體位分佈呈現出兩極化的現象更加明顯。而兩種體位方法之判定0-3歲動作發展遲緩兒童屬於正常範圍體位較一般發展兒童少（χ2＝10.2~41.9，p＜.01）。能量攝取越高，其皮下脂肪厚度值（Spearman's Rho, rs＝0.39，p＜.01；Pearson's, r＝0.43，p＜.01）越高，其BMI（Spearman's Rho, rs＝0.24，p＜.01；Pearson's, r＝0.25，p＜.01）或WLI（Spearman's Rho, rs＝0.26，p＜.01；Pearson's, r＝0.26，p＜.01）之分類則會較傾向於肥胖。主動活動維持時間越長，其BMI（Spearman's Rho, rs＝0.19，p＜.05；Pearson's, r＝0.23，p＜.05）或WLI（Spearman's Rho, rs＝0.29，p＜.01；Pearson's, r＝0.32，p＜.01）分類較傾向於肥胖。以邏輯式迴歸分析顯示，若以BMI為判定過重或肥胖的基準，動作發展遲緩兒童之攝取熱量越高（OR=1.003，p=.04）、服用抗癲癇藥物（OR＝12.465，p＝.02）與低社經地位（OR＝4.807，p＝.05其過重或肥胖之機率顯著較高；以WLI為基準，一日總熱量攝取越高（OR＝1.006，p＝.03）亦可預測過重或肥胖。
結論：動作發展遲緩兒童之體位分佈會因使用BMI或WLI二種方式而有所不同。然而，目前並無適合的生長常模可應用在動作發展遲緩兒童。年齡分層下，0-3歲動作發展遲緩兒童的正常體位比例皆明顯低於一般發展兒童。而飲食攝取、不同活動型態與體位三者之間有其相關性。此外，多重因子可預測針動作發展遲緩兒童之過重及肥胖。因此，在未來發展有待於長期追蹤研究來探討其因果關係。

Background and purpose: Previous studies have shown that children with motor delay would have higher possibility of being overweight or obesity due to their activities limitation, or being thinness because of the diet problem. The anthropometry status distribution for children with motor delay tended to be bimodal. However, comparing with normal children, the studies pertaining to the anthropometry status, energy intake and activity pattern is still lacking in preschool children with motor delay. Therefore, the purposes of this study were to investigate the anthropometry status distribution among in Taiwanese children with motor delay aged 0-6 years, and its relevance to diet, and activity patterns.
Methods: The study design was cross-sectional and retrospective study. A total of 106 children with motor delay aged 9 to 73 months were recruited. The anthropometry status was classified by two methods: Body Mass Index and Weight-for-Length Index (WLI). The children’s total daily energy intake was recorded by 24-hour dietary recall, and the time spent on every activity patterns was measured with Daily Routine and Activity Questionnaires for Young Children (DRAQ). The difference of anthropometry status distribution between children with motor delay and normal children was tested by chi-square statistics. The relationships among children’s anthropometry status, total daily energy intake and time spent in diverse activity patterns were tested by Spearman’s rank correlation coefficient and Pearson’s correlation coefficient. Logistic regression was used to analyze the multiple factors predicting overweight or obesity in children with motor delay.

Result: The anthropometry status classified by BMI were statistically significantly differed from that classified by WLI (χ2=54.9, p<.001) in children with motor delay. At the ages between 0-3 years, the proportion of children classified as normal anthropometry status was less in children with motor delay than in typically developed children （χ2=10.2~41.9, p<.01）by either methods of BMI or WLI. Furthermore, a bimodal distribution of anthropometry was more evident when WLI was used for anthropometry status classification. For the relationships among anthropometry status, energy intake and time spent on activity patterns, higher daily energy intake was correlated with skin-fold thickness (Spearman's Rho, rs=0.39, p<.01；Pearson's, r=0.43, p<.01) and higher tendency of obesity (BMI: Spearman's Rho, rs=0.24, p<.01；Pearson's, r=0.25, p<.01) (WLI: Spearman's Rho, rs=0.26, p<.01；Pearson's, r=0.26, p<.01). The tendency of obesity was also related to more time spent on active activity (BMI: Spearman's Rho, rs=0.19, p<.05；Pearson's, r=0.23, p<.05) (WLI: Spearman's Rho, rs＝0.29，p＜.01；Pearson's, r＝0.32，p＜.01). Multiple factors, such as higher daily energy intake (OR=1.003, p=.04), used of anti-epileptics medication (OR=12.465, p=.02), low socioeconomic status (OR=4.807, p=.05), and more time spent on floor activity (OR=1.006, p=.03) could predicting obesity or overweight.
Conclusions: Anthropometry status distribution in children with motor delay would depend on the method of either BMI or WLI. However, there was no suitable growth norm to be applied in children with motor delay. In children aged 0-3, the percentage of normal anthropometry status in children with motor delay was much lower than the normal children. There were inter-relationships among anthropometry status, total daily energy intake, and time spent on various patterns of activities. Besides, overweight or obesity could be predicted by multiple factors. The case-effect relationships between the multiple predicting factors and anthropometry status need to be verified by longitudinal studies in the future.

指導教授推薦書
口試委員會審定書
授權書 iii
謝辭 v
中文摘要 vi
英文摘要 viii
目次 xi
圖表目次 xiii
第一章、 緒論 1
第一節、 研究背景與動機 1
第二節、 研究目的 5
第三節、 研究假說 6
第四節、 名詞解釋 7
第二章、 文獻探討 9
第一節、 兒童體位之測量方法 9
第二節、 動作發展遲緩兒童之體位分類分佈及盛行率 18
第三節、 兒童能量攝取與兒童體位分類的關係 21
第四節、 兒童活動型態與體位分類的關係 23
第五節、 多因子預測體位之相關研究 25
第三章、 研究方法 26
第一節、 研究對象 26
第二節、 研究設計 27
第三節、 研究工具 28
第四節、 研究流程 34
第五節、 統計分析 38
第四章、 結果 40
第一節、 個案基本資料 40
第二節、 體位比例分佈 42
第三節、 動作發展遲緩兒童的BMI/WLI分類及皮下脂肪厚度與能量攝取、及活動型態之相關 48
第四節、 0-3歲與3-6歲動作發展遲緩兒童的一日總熱量、皮下脂肪厚度及四大類活動型態與BMI百分位分類及WLI分類之相關 53
第五節、 多重因子對動作發展遲緩兒童體位之預測 61
第五章、 討論 65
第一節、 不同體位分佈狀況 65
第二節、 BMI/WLI分類分佈及皮下脂肪厚度與能量攝取及活動型態之相關 67
第三節、 多重預測因子與體位之相關 71
第六章、 結論 73
第七章、 研究限制與建議 74
參考文獻 75
附錄 86
附件 95

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