臺灣博碩士論文加值系統

Leptin（瘦素）字根源自希臘字leptos（瘦），合成瘦素的ob基因乃於1994年由Zhang等人定序出來。瘦素（Leptin）又稱為瘦體蛋白，是由脂肪組織中的 ob 基因所產生的一種荷爾蒙（adipocyte- derived hormone）。瘦素除了調節能量平衡之外與性成熟和生殖功能有關，在整個懷孕期間，瘦素傳遞訊息促使脂肪儲存，尤其於懷孕後期瘦素大量產生是為了擴大脂肪的儲存，以便提供整個孕產期能量的需求。國外許多研究報告指出，懷孕期間體重增加與瘦素之間有相當明顯的正相關，但是針對孕產期間熱量攝取與瘦素之間的關係卻不清楚。本次研究的目的欲了解國內婦女懷孕期間，瘦素濃度之改變與飲食攝取（熱量、蛋白質、脂質、醣類）及體位變化間的相關性。本研究招募55名健康孕婦，首先請受試者填寫個人資料，包括身高、未懷孕前體重、胎次；並指導受試者填寫24小時飲食紀錄。受試孕婦配合產檢於懷孕7-13週、21-27週、28-34週、生產時、產後6週回診抹片檢查時同時抽血、測量體重、體脂肪，並請孕產婦於前述懷孕三期、月子期間、產後6週回診時紀錄3天24小時飲食紀錄（2天平日1天假日）。生產時除收集母親血液外也收集臍帶血液並稱量新生兒體重與胎盤重。血液收集離心後，取血漿且存於-70C下，以RIA kit 分析瘦素濃度。結果顯示，於懷孕期間及產後6週的體重、身體質量指數 ( BMI )、體脂肪與瘦素量都有顯著的相關性，孕前體重、BMI與孕期的瘦素也有顯著相關性；新生兒體重與臍帶血中瘦素量有顯著的相關性而與母親的瘦素量無關。飲食攝取方面，產後6週飲食中的脂質與瘦素量有顯著相關性。根據結果，懷孕前體位較大者與瘦素濃度之間有明顯的相關性，懷孕總增加重量與新生兒體重具相關性，懷孕期熱量攝取與瘦素濃度則無相關性。

The word "leptin" is originally from “Leptos”, the Greek affix. Dr. Zhang and others scholars defined the ob gene of synthetic leptin in 1994. Leptin is also called the lean albumen that is the adipocyte-derived hormone produced by ob gene from the adipose tissue. Besides keeping the energy balance, leptin is also related to the sexual maturity and the reproductive function. During the pregnancy, leptin transmits messages to keep the fat inside the body. Leptin reproduces more on the later pregnancy in order to save more fat and provides the demands of energy for the whole pregnancy. Many foreign researches indicate that there is relation between gaining the weight during the pregnancy and the leptin. However, there is no evidence to clarify the relation between the intake of calories and the leptin during the pregnancy.
The purpose of this research is to exam the relation among the variations of leptin’s consistency, the change of body weight, body fat and the dietary intake (including energy, protein, fat and carbohydrate) during the pregnancy of Taiwan women. This research is based on the case studies from 55 healthy pregnant women. The first step of this research was to collect the personal data including the height, weight before the pregnancy, birth numbers and the 24-hour dieting recordings. When interviewees went back to the hospital for examination during the pregnancy, birth and the 6-week postpartum, they also did the blood drawing, weight and body fat measuring, and the 3-day 24-hour (2 weekdays and 1 holiday) diet recording during pregnancy, the period of the mother’s rest and the 6-week of postpartum. Besides mothers’ blood, the blood of the umbilical cords and the neonates’ weight and the placental’ weight during interviewees’ childbearing. After centrifugation, plasma and kept under the -70℃ for the leptin measurement using RIA kit. The result shows that there was correlation (p<0.01) between the weight (r=0.507), BMI (r=0.495), body fat (r=0.503) and the leptin concentration during the pregnancy. Also, BMI before the pregnancy and the leptin existed notable relation. There was the correlation (p<0.05) between the neonatal’s weight and the leptin (r=0.472). From the aspect of dietary intake, there was no remarkable relationship among the calories, protein, carbohydrate, body fat and the leptin during the pregnancy. But, the fat (% of total calories )in the postpartum food and the leptin existed the notable relation (r=0.975) (p<0.01). In conclusion, heavy weight and higher BMI before the pregnancy and the leptin’s consistency existed the significant correlation. There was no relationship between the calories intake and the leptin during the pregnancy.

中文摘要 I
英文摘要 III
致 謝 V
目錄 VII
表目錄 IX
圖目錄 XI
第壹章 緒論 1
第貳章 文獻回顧 2
第一節 瘦素的介紹及其生理功能 2
第二節 瘦素與飲食營養素攝取的關係 8
第三節 瘦素在生殖功能上所扮演的角色 11
第四節 懷孕期間體重的變化及重要性 17
第參章 研究動機、目的與架構 19
第一節 研究動機 19
第二節 研究目的 20
第三節 名詞界定 21
第四節 研究架構 22
第肆章 實驗材料與方法 23
第一節 實驗大綱 23
第二節 實驗對象 25
第三節 研究工具 26
第伍章 結果 30
第一節 基本資料 30
第二節 飲食狀況 33
第三節 懷孕至產後體位之變化 36
第四節 新生兒體重與胎盤重 39
第五節 飲食、體位與瘦素之相關性 39
第六章 討論 39
第一節 飲食與營養素的狀況 39
第二節 飲食與瘦素相關性 39
第三節 孕產期體位變化與瘦素之關係 39
第四節 新生兒、胎盤與瘦素之相關 39
第五節 胎次與體重之間的關係 39
第柒章 總論與未來展望 39
第一節 總論 39
第二節 未來展望 39
第捌章 參考文獻 39
附錄一 39
附錄二 39
附錄三 39
附錄四 39
附錄五 39
附錄六 39
附錄七 39
附錄八 39
附錄九 39

（中文部份）
吳宜樺、郭素珍 （1999）本省婦女坐月子期間依傳統習俗執行飲食規範之探討。護理新象（91），64 — 74。
劉彥君（2000）正常妊娠婦女及新生兒臍帶血瘦素水平測定及臨床意義。中華婦產科雜誌35（7），392 — 395。
劉先俊（2000）產婦血羊水和新生兒臍帶血瘦素水平與其體重關係的研究。中華婦產科雜誌35（7），396 — 398。
朱鋐遠 （2000）孕婦血清瘦素水平測定。中華婦產科雜誌35（7），392 — 395。
洪志秀（2001）婦女在不同坐月子地點和時段之產後壓力及社會支持程度。公共衛生 28（3），241-253。
行政院衛生署（2001）國人膳食營養素參考攝取量
羅巧珍（2004）懷孕到產後飲食營養與體重變化之前瞻性研究。國立臺灣師範大學人類發展與家庭學系研究所碩士論文，台北市。
陳姮霏（2004）懷孕婦女營養狀況對新生兒健康影響之前瞻性研究。國立臺灣師範大學人類發展與家庭學系研究所碩士論文，台北市。
（英文部份）
Agarwal SK, Vogel K, Weitsman SR and Magoffin DA. Leptin antagonizes the insulin-like growth factor-I augmentation of steroidogenesis in granulosa and theca cells of the human ovary. J Clin Endocrinol Metab 1999; 84:1072-1076.
Ahima RS, Dushay J, Flier SN, Prabakaran D and Flier JS. Leptin accelerates the onset of puberty in normal female mice. J Clin Invest 1997; 99:391-395.
Ahmed ML, Ong KKL, Morrell DJ, Cox L, Drayer N, Perry L, Precce MA and Dunger DB. Longitudinal study of leptin concentrations during puberty: sex differences and relationships to changes in body composition. J Clin Endocrinol Metab 1999; 84:899-905.
Ainslie DA , Proietto J, FamB C and Thorburn W. Short — term high — fat diet lower circulatin circulating leptin concentrations in rats. Am J Clin Nutr 2000; 71:438-442
Atanassova P and Popova L. Leptin expression during the differentiation of subcutaneous adipose cells of human embryos in situ. Cells Tissues Organs 2000; 166:15-19.
Attanasio A and Blum W.F. Levels of leptin in maternal serum amniotic fluid and arterial and venous cord blood : relation to neonatal and placental weight. J Clin Endocrinol Metab. 1997; 82:1480-1483
Auwerx J. and Staels B. Leptin. Lancet 1998; 351:737-742
Baile CA and Della-Fera MA: Regulation of metabolism and fat mann by leptin. Annu Rev Nutr 2000; 20:105-127
Barash IA, Cheung CC, Weigle DS, Ren H, Kabigting EB, Kuijper JL, Clifton DK and Steiner RA. Leptin is a metabolic signal to the reproductive system. Endocrinology 1996; 137:3144-3147.
Baskin DG, Figlewicz D.P.,Seeley R J. Woods S C. Porte Jr. Schwartz M.W. Inslin and leptin: dual adiposity signals to the brain for the regulation of food intake and body weight. Brain Res. 1999; 848:114-123
Bruning JC, Gautam D J, Gillette J and Schubert M. Orban insulin receptor in control of body weight and reproduction Science 2000; 289:2122-2125
Butte NF, Hopkinson JM and Nicolson MA. Leptin in human reproduction: serum leptin levels in pregnant and lactating women. J Clin Endocrinol Metab 1997; 82:585-589.
Caro F and Madhur K. Leptin: the tale of an obesity gene. Diabetes 1996.45: 1455-1462
Castracane VD, Kraemer RR, Franken MA, Kraemer GR and Gimpel T. Serum leptin concentration in women: effect of age, obesity and estrogen administration. Fertil Steril 1998; 70:472-477.
Chardonnens D, Cameo P, Aubert ML, Pralong FP, Islami D, Campana A,
Cioffi JA, Van Blerkom J, Antczak M, Shafer A, Wittmer S and Snodgrass HR. The expression of leptin and its receptor in pre-ovulatory human follicles. Mol Hum Reprod 1997; 6:467-472.
Considine and Madhur S Serum immunoreative-leptin concentrations in normal-weight and obese humans.N Engl J Med 1996; 334:292-295
Friedman M and Halaas L: leptin and the ergulation of body weight in mammals. Nature 1998; 395:763-769
Gaillard RS and Bischof P. Modulation of human cytotrophoblastic leptin secretion by interleukin-1 and 17 ß-oestradiol and its effect on HCG secretion. Mol Hum Reprod 1999; 5:1077-1082.
Gunderson EP, Abrams B and Selvin S. Dose the pattern of postpartum weight change differ according to pregravid body size? International Journal of Obesity. 2001; 25:853-862
Harigaya A, Nagashima K, Nako Y and Morikawa A. Relationship between concentrations of serum leptin and fetal growth. J Clin Endocrinol Metab 1997; 82:3281-3284.
Halaas L and Gajiwala S. Weight - reducing effects of plasma protein encoded by the obese gene. Science 1995; 269(28):543-546
Hassink SG , de Lancey E, Sheslow DV, Smith-Kirwin SM, O''Connor DM, Considine RV, Opentanova I, Dostal K, Spear ML, Leef K, Ash M, Spitzer AR and Funanage VL. Placental leptin: an important new growth factor in intrauterine and neonatal development? Pediatrics 1997; 100:1-6.
Havel P J,Townsend R , Chaump L and Teff K. High - fat meals reduce 24-h circulating leptin concentrations in women. Diabetes 1999; 48:334-341
Henson MC, Swan KF and O''Neil JS. Expression of placental leptin and leptin receptor transcripts in early pregnancy and at term. Obstet Gynecol 1998; 92:1020-1028.
Hickey MS, Israel RG, Gardiner SN, Considine RV, McCammon MR, Tyndall GL, Houmard JA, Marks RH and Caro JF. Gender differences in serum leptin levels in humans. Biochem Mol Med 1996; 59:1-6.
Institute of medicine . Nutrition in pregnancy . 1990 National Academy Press , Washington DC
Karlsson C, Lindell K, Svensson E, Bergh C, Lind P, Billig H, Carlsson LMS and Carlsson B. Expression of functional leptin receptors in the human ovary. J Clin Endocrinol Metab 1997; 82:4144-4148.
Kiess W and Reich A. A role for leptin in sexual maturation and puberty? Horm Res 1999; 51(suppl 3):55-63
Kiess W, Englaro P,Siebler T,Blum W.F and Demirakca T. Longitudinal analysis of maternal serum leptin levels during pregnancy, at birth and up to six weeks after birth: relation to body mass index, skinfolds, sex steroids and umbilical cord blood leptin levels. Horm Res 1998; 50:276-283.
Kolaczynski JW, Ohannesian J, Considine RV , Marco C Opentanova I, Nyce MR,Myint M and Caro JF. Response of leptin to short term fasting and overfeeding in humans: a link with ketogenesis but not ketones themselves. Diabetes1996; 45:1511-1515
Lage M, Garcia-Mayo RV, Tome MA, Cordido F, Valle-Inclan F, Considine RV, Caro JF, Dieguez C and Casanueva FF. Serum leptin levels in women throughout pregnancy and the postpartum period and in women suffering spontaneous abortion. Clin Endocrinol 1999; 50:211-216.
Lin K-C. Increase of maternal plasma leptin concentrations during pregnancy:comparison with nonpregnant women. Kaohsiung J of Med. Sciences . 1999; 15(11)640-645
Lin K-C, Hsu S-C,Kuo C-H and Zhou J-Y Difference of plasma leptin levels in venous and arterial cord blood :relation to neonatal and placental weight . Kaohsiung J of Medical Sciences. 1999; 15(12)679-685
Luoh S-M, Di Marco F, Levin N, Armanini M, Xie M-H, Nelson C, Bennett GL, Williams M, Spencer SA, Gurney A and de Sauvage FJ. Cloning and characterization of a human leptin receptor using a biologically active leptin immunoadhesin. J Mol Endocrinol 1997; 18:77-85.
Mantzoras CS. The role of leptin in human obesity and disease: a review of current evidence. Ann Intern Med 1999; 130:671-680.
Masuzaki H, Ogawa Y, Sagawa N, Hosoda K, Matsumoto T, Mise H, Nishimura H, Yoshimasa Y, Tanaka I, Mori T and Nakao K. Non-adipose tissue production of leptin: leptin as a novel placenta-derived hormone in humans. Natl Med 1997; 3:1029-1033.
Masuzaki H and Ogawa Y. Nonadipose tissue production of leptin : leptin as a novel placenta - derived hormone in humans. Nature Med 1997; 3: 1029-1033
Matsuda J, Yokota I, Iida M, Murakami T, Naito E, Ito M, Shima K and Kuroda Y. Serum leptin concentration in cord blood: relationship to birth weight and gender. J Clin Endocrinol Metab 1997; 82:1642-1644.
Mukherjea R, Castonguay TW, Douglass LW and Moser-Veillon P. Elevated leptin concentrations in pregnancy and lactation: possible role as a modulator of substrate utilization. Life Sci 1999; 65:1183-1193.
Olson CM., Strawderman MS, Hinton PS and Pearson Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1y postpartum. International Journal of Obesity 2003; 27:117-127
Ong KKL, Ahmed ML, Sheriff A, Woods KA, Watts A, Golding J and Dunger DB. Cord blood leptin is associated with size at birth and predicts infancy weight gain in humans. J Clin Endocri Metab 1999; 84:1145-1148.
Pelleymounter MA and Cullen MJ. Effects of the obese gene product on body weight rerulation in ob/ob mice . Science 1995; 269(28):540-542
Prema Ramachandran, M. D. Maternal Nutrition-Effect on fetal Growth and Outcome of pegnancy. Nutrition Rev. 2002; 61(5), S26 -34
Ratna M and Thomas W. Elevated leptin concentrations in pregnancy and lactation :possible role as a modulator of substrate utilization . Life Sciences .1999; 65:1183-1193
Saad F and Ronald L . Sexual dimorphism in plasma leptin concentration. J Clin Endocrinol Metab1997; 82:579-587
Schubring C, Kiss W , Englaro P , Rascher W , Dotsch J , Hanitisch S , Cusin I, Sainsbuty A, Doyle P , Rohner — Jeanrenaud F, and Jeanrenaud B The ob gene and insulin : a relationship leading to clues to the understanding of obesity . Diabetes 1995; 44:1467-1470
Schubring C, Englaro P, Siebler T, Blum WF, Demiraka T, Kratzsh J
Shimizu H, Shimomura Y, Nakanishi Y, Futawatari T, Ohtani K, Sato N and Mori M. Estrogen increases in vivo leptin production in rats and human subjects. J Endocrinol 1997; 154:285-292.
Tamas P . Changes of maternal serum leptin levels during pregnancy. Gynecol Obstet Invest 1998; 46 :169-171
Tsuneobu T. Sreum leptin concentrations during pregnancy and their relationship to fetal growth . Obstet Gynecol 1998; 91:389-395.
Trayhurn P , Thomas MEA, Duncan JS and Rayner DV : Effects of fasting and refeeding on Ob gene expression in white adipose tissue of lean and obese mice . FEBS Lett 1995; 368:488-490
Yura S, Sagawa N, Ogawa Y, Masuzaki H, Mise H, Matsumoto T, Ebihara K, Fujii S and Nakao K. Augmentation of leptin synthesis and secretion through activation of protein kinases A and C in cultured human trophoblastic cells. J Clin Endocrinol Metab 1998; 83:3609-3614.
Zhang Y, Proenca R, Maffei M, Barone M, Leopold L and Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature 1994; 372:425-432.