臺灣博碩士論文加值系統

健康的人生須具備「營養、保養、修養」三養的境界，營養過剩是現代人極為關注及預防的議題，而保養及修養則需先養成對於生活上健康保健、醫學概念、風險認知的建立及提昇，許多備受爭議的議題如受到污染的牡蠣等水產品是否真的該停止養殖及販售？孕婦懷孕期間是否該食用水產品？保健食品真的只有保健而無其他危害健康的顧慮嗎？減重是否有潛藏的危害風險呢？等種種的健康危害風險總是遍佈在我們的生活週遭，但仍有許多民眾對於風險意識十分低落且不知如何才能降低風險。故本研究特別針對民眾對於減重塑身產品或行為上的風險認知進行探討，另外亦進行減重成效、身體狀態的改變、體內瘦體蛋白（leptin）與抗氧化酵素超氧化物歧化酶（Superoxide Dismutase, SOD）等方面的研究。

問卷訪視對象以一般民眾及某醫學中心之減重班個案為主，以便利取樣進行抽樣，並利用自填問卷方式進行資料蒐集，有效樣本共452人。繼而針對165位減重班個案採集血液樣本進行分析。研究結果發現民眾對於塑身減重產品或行為方面，較擔心身體風險及功能風險，較不擔心社會風險及時間風險。最怕買到冒牌的商品、怕會產生副作用以及怕商品太貴而沒有它的價值所在。而認為最能降低風險的策略有：請醫師推薦、選擇和以前有交易過並且滿意的廠商購買以及和可信賴的廠商購買等，認為最沒效用的是：購買經常看到廣告的品牌商品以及有知名藝人代言的廠商商品。

減重前女性的leptin濃度及抗氧化酵素SOD活性明顯比男性高（p<0.001；p<0.05）。經過八週減重後，不論是男性或女性，其體重、BMI值、體脂肪、腰圍及臀圍等皆有顯著下降（p<0.001）。且體內leptin濃度明顯下降，而抗氧化酵素SOD活性則明顯上升。推斷體內抗氧化酵素SOD活性的增加，途徑有三：（一）運動對身體造成氧化壓力；（二）經由減重使得抗氧化能力增加；（三）血中leptin使體內的氧化壓力增加，原因極有可能與SOD有關，當體內leptin濃度降低時，SOD活性便增加。減重前體內leptin濃度較高者，似乎會降低減重成效。另外，本研究利用線性方程式以減重前的leptin濃度推估預測其減重成效。若減重前的leptin濃度為5–30ng/mL，其經過八週的減重課程後，推測可以減少8.13-3.78kg的體重。

A healthy life must consist of the three followings: nutrition, maintenance of health and cultivation. Overconsumption has been a precautious and concerning issue nowadays. Maintenance of health and cultivation must be based on a good establishment and promotion of health care, medical concept, and risk perception. Should we stop selling and breeding of contaminated seafood? Should a mother eat seafood during their pregnancy? Do health foods really provide only nutrition but other harmful effects? Is there any potential endanger risks during weight reduction? These controversial issues always take place along with our daily life but there are still many people lack of the sense of risks. In addition, people exposed to these risks don’t know what or how to do to reduce the risks. Therefore, we investigate the risk perception of weight reduction products and behaviors of general public. Besides that, we also investigate the degree of weight loss, differences of body composition, leptin concentration and superoxide dismutase (SOD) activities after a body weight reduction (BWR) regime.

General public and personnel participated in the BWR regime held in a medical center are the study subjects. A questionnaire was filled in under a free will and 452 valid questionnaires are collected. Following the questionnaires, 165 BRW regime participants were selected for further blood sample analysis. Our results indicated that people worry about physical and functional risks on weight reduction products and behaviors rather than social and time risks. Fear for purchasing counterfeit merchandise, side-effects and also care about buying the merchandise that is not counter valuable as it was claimed. People recognize that asking for doctor’s recommendation, choosing a seller they deal with and choosing a reliable seller are effective approaches to reduce risk. In contrary, they recognize that products under advertising promotion and represented by artists are less effective.

Prior to the BWR regime, female leptin concentrations and RBC-SOD activities were significantly higher than in males (p<0.001; p<0.05). The BWR regime resulted in a significant decrease in body weight and BMI in both males and females (p<0.001) and significant changes in body composition variables such as body fat mass, waist and hip circumferences (p<0.001). Following the BWR program, leptin concentration decreased significantly (p<0.01) in females and males, respectively. The RBC-SOD activities increased significantly (p<0.01) in females and males, respectively, after the BWR regime. Three possible explanations exist that account for the increase in SOD activity: (A) oxidative stress produced by exercise during the BWR regime; (B) enhanced anti-oxidative ability after losing weight; and, (C) oxidative stress produced by plasma leptin is strongly correlated with SOD as RBC-SOD activity increased as plasma leptin levels reduced. Weight reduction following the BWR regime were negatively correlated with initial leptin (p<0.001). We summarized a linear regression equation that can predict a weight loss of 8.13-3.78 kg with the initial leptin concentration of 5-30ng/ml after 8-week BWR program.

第一章 緒論........................................................1
第一節 前言..............................................1
第二節 研究背景與動機....................................2
第三節 研究目的..........................................3
第二章 文獻回顧..........................................4
第一節 肥胖之相關探討....................................4
一、肥胖之定義............................................4
二、肥胖對健康之影響......................................4
第二節 減重之相關探討...................................6
一、減重之健康效應........................................6
二、減重對於健康上負面影響................................6
三、目前流行之減重塑身型態................................7
第三節 減重風險認知之探討...............................9
ㄧ、風險認知之內涵........................................9
二、風險認知的構面.......................................12
三、降低風險認知的策略...................................14
第四節 瘦體蛋白（leptin）...............................16
一、瘦體蛋白之構造 .......................................16
二、瘦體蛋白之生理功能...................................16
第五節 抗氧化酵素超氧化物歧化酶.........................18
一、超氧化物歧化酶之構造及生理作用.......................18
二、瘦體蛋白與抗氧化酵素超氧化物歧化酶之關係.............19
第三章 民眾對於減重風險認知之探討........................20
第一節 研究方法.........................................20
一、研究對象.............................................20
二、研究問卷設計.........................................20
三、問卷效度測量與預試...................................27
四、資料統計方法.........................................29
第二節 結果.............................................30
一、人口學之分布.........................................30
二、民眾對減重塑身產品或行為的風險認知...................51
三、民眾對於減重塑身的風險降低策略.......................65
第三節 討論.............................................83
一、性別、年齡及教育程度上之差異性探討...................83
二、民眾對於減重資訊來源之探討...........................84
三、民眾對於減重塑身產品或行為的風險認知差異之探討.......87
四、民眾對於降低風險策略之探討...........................89
第四節 結論.............................................92
第四章 肥胖者身體組成、血液生化值、leptin及抗氧化酵素SOD活性之探討.................................................93
第一節 研究方法.........................................93
一、研究對象.............................................93
二、分析項目與測量方法...................................93
三、資料統計方法.........................................96
第二節 結果.............................................97
ㄧ、人口學特性之探討.....................................97
二、性別對於生活習慣、血液生化值、身體組成狀態、體內抗氧化酵素SOD活性、leptin濃度之差異性分析.....................103
三、不同年齡對於血液生化值、身體組成狀態、體內抗氧化酵素SOD活性、leptin濃度等之差異性分析..........................107
四、教育程度對於血液生化值、身體組成狀態、體內抗氧化酵素SOD活性、leptin濃度等之差異性分析..........................108
五、婚姻狀況對於血液生化值、身體組成狀態、生活習慣等之差異性分析..................................................109
六、攝取健康食品與否對於血液生化值之差異性分析..........109
七、肥胖與否對於生活習慣、教育程度、血液生化值、身體組成狀態及leptin濃度等之差異性分析............................113
第三節 討論............................................117
一、性別、年齡等基本特性之探討..........................117
二、肥胖與身體組成之探討................................118
三、性別對於leptin濃度之差異............................118
四、肥胖與leptin濃度之探討..............................119
五、肥胖與SOD活性之探討.................................121
第四節 結論............................................123
第五章 減重成效與血液生化值、leptin及抗氧化酵素SOD活性之相關性探討................................................124
第一節 研究方法........................................124
一、研究對象............................................124
二、減重課程規劃........................................124
三、血液樣本分析........................................126
四、資料統計分析........................................128
第二節 結果............................................129
一、個案減重前的身體組成狀態及血液生化值................129
二、個案減重前後之身體組成上的差異......................131
三、血中leptin濃度及抗氧化酵素SOD活性...................133
四、身體組成、letpin濃度及SOD活性之相關性...............134
第三節 討論............................................139
一、減重對於血液生化值之改善............................139
二、減重與leptin濃度之探討..............................139
三、減重對於SOD活性之影響...............................142
四、減重對於leptin濃度與SOD活性之間的影響性.............143
第四節 結論............................................145
第六章 總結與建議......................................146
參考文獻................................................149
附 錄................................................163

方之光（1995），風險與利益知覺調整之實驗研究，國立中山大學系博士論文。

王建仁（2003），臺灣地區機車使用者風險感認與駕駛行為關聯之研究，交通大學運輸科技與管理系碩士論文。

丘昌泰（1999），公害社區風險溝通之問題與對策，法商學報，34: 17-8.

行政院衛生署（1999），衛生統計（一），公務統計。

行政院衛生署（2002），http://www.doh.gov.tw

李宜致（2002），醫院減重服務模式之分析，國立陽明大學醫務管理系碩士論文。

李昭瑢、陳建中（2002），消費者誇大不實食品廣告認知調查，質化研究報告，衛生署食品衛生處，網址：http://food.doh.gov.tw/chinese/academic/academic_1.htm。

李淑玲（2003），我國健康食品之管理、消費者認知與消費行為之調查研究，國立海洋大學食品科學系碩士論文。

吳宜蓁（2002），危機傳播－公共關係與語藝觀點之理論與實證，臺北：五南出版。

施伶穎（2001），環境污染與健康風險之網路教育---以重金屬與水產食品為例，臺北醫學大學公共衛生學系碩士論文。

高如月（1992），社會風險與風險溝通之研究，國立政治大學財政學系碩士論文。

徐莉蓁（2004），國內大學生對健康食品的認知及使用行為之研究，高雄醫學大學行為科學系碩士論文。

陳子穎（2004），攝取有機飲食與體內抗氧化酵素活性及銅、硒濃度之相關性研究，臺北醫學大學公共衛生學系碩士論文。

郭姿穎（2003），風險溝通方式對民眾風險認知之影響:以荷爾蒙補充療法之研究為例，中山醫學大學醫學系碩士論文。

彭巧珍（2002），肥胖症的飲食治療，台灣醫學，6: 46-52.

曾美智（2002），肥胖症的行為治療，台灣醫學，6: 53-56.

馮連世、楊奎生、宗丕芳、郭軍（1994），急性運動對血漿超氧化物歧化酶的影響及其與有氧能力的關係。中國運動醫學雜誌，13: 129-132。

黃美智（2002），血清瘦體素濃度對減重成效的影響，臺北醫學大學保健營養學系碩士論文。

黃國晉、陳慶餘、黃天祥（2002），肥胖症的藥物治療，台灣醫學，6: 57-63.

焦經隆（2003），女性消費者產品涉入對風險認知、資訊搜尋及散佈之影響－以「健康食品」為例，國立成功大學高階管理在職專班碩士論文。

楊智雅（2005），就診民眾對保健食品的食用風險認知與傳播影響，臺北醫學大學公共衛生學系碩士論文。

廖家祺（2001），中等強度有氧舞蹈訓練對女性身體組成、血液生化值及抗氧化能力之影響，國立體育學院教練研究所碩士論文。

潘文涵、章雅惠、陳正義（1998），以二十四小時飲食回顧法評估國人膳食營養狀況：國民營養變遷調查1993-1996年。

謝錦城（1997），耐力運動對人體骨骼肌抗氧化酶的影響。中華民國體育學會學報，第22輯，頁237-248。

Alba J and Hutchinson JW. (2000) Knowledge calibration in consumer research, in Durso, F. (Ed.). Handbook of applied cognition, Wiley ＆ Sons, Chichester, New York, NY: 343-374.

Balasubramaniyan V, Kalaivani JS and Nalini N. (2003) Role of leptin on alcohol-induced oxidative stress in Swiss mice. Pharm Res. 47: 211-216.

Banks WA, Altmann J, Sapolsky RM, Phillips-Conroy JE and Morley JE. (2003) Serum leptin levels as a marker for a syndrome X-like condition in wild baboons. J Clin Endocrinol Metab 88: 1234-1240.

Bauer RA. (1960) “Consumer behavior as risk taking” in R.S. Hancock (Ed.), Dynamic Marketing for a Changing World. Chicago: Am Mar Asso. 389-398.

Beatty S and Smith S. (1987) External search effort: an investigation across several product categories. J Consum Res. 14: 411-454.

Beltowski J, Wojcicka G and Borkowska E. (2002) Human leptin stimulates systemic nitric oxide production in the rat. Obes Res. 10: 939-946.

Beltowski J, Wojcicka G, Gorny D and Marciniak A. (2000) The effect of dietary-induced obesity on lipid peroxidation, antioxidant enzymes and total plasma antioxidant capacity. J Physiol Pharmacol. 51: 883-896.

Bouloumie A., Marumo T., Lafontan M. and Busse R. (1999) Leptin induces oxidative strerss in human endothelial cells. FASEB J 13: 1231-1238.

Bradley M and Golden E. (1990) Powdered meal replacements-can they benefit overweight patients with concomitant conditions exacerbated by obesity? Curr Ther Res. 47: 429-436.

Brown J and Reingen P. (1987) Social tie and word-of-mouth referral behavior. J Consum Res. 14: 350-362.

Burke RJ. (2001) Information sources: is there a gender issue? Corporate communications. An International Journal. 6: 7-12.

Caprio S, Hyman LD, Mccarthy S, Lange R, Brown M and Tamborlane WV. (1996) Fat distribution and cardiovascular risk factors in obese adolescent girl: importance of the intra abdominal fat depot. Am. J Clin Nutr. 64: 12-17.

Caro JF, Kolaczynski JW, Zhang PL and Considien RV. (1996) Leptin: the tale of an obesity gene. Diabetes 45:1455-1462.

Chan J, Rimm E, Colditz G, Stampfer M and Willett W. (1994) Obesity fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 17: 961-969.

Chang BN, Perlman LV and Epstein FH. (1969) Overweight and hypertension, a review. Circulation. 39: 403-421.

Chang SP, Chen YH, Chang WC, Liu IM and Cheng JT. (2004) Increase of anti-oxidation by exercise in the liver of obese Zucker rats. Clin Exp Pharmacol Physiol. 31: 506-511.

Chowdhury B, Lantz H and Sjöström L. (1996) Computed tomography-determined body composition in relation to cardiovascular risk factors in Indian and matched Swedish males. Metabolism. 45: 634-644.

Chung MYC. (2000) How positively do they talk? An investigation on how shlf-promotion motive induces consumers to give positive word-of-mouth. University of British Columbia, Vancouver.

Considine RV, Sinha MK and Heiman ML. (1996). Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 334: 292-295.

Cox DF. (1967) “Risk handling in consumer behavior- an intensive study of two cases” in Donald F. Cox (ed.), Risk Taking and Information Handling in Consumer Behavior, Boston: Harvard University Press: 34-81.

Cunningham SM. (1967) “The major dimension of perceived risk” in Donald F. Cox (ed.), Risk Taking and Information Handling in Consumer Behavior, Boston: Harvard University Press: 82-108.

Dawar N and Parker PM. (1994) Marketing universals: Consumer’s use of brand name, price, physical appearance and retailer reputation as signals of product quality. J Mark. 58: 81-95.

Davies KJA., Quintanilha AT, Brooks GA and Packer L. (1982). Free radicals and tissue damage produce by exercise. Biochem Biophys Res Commun 107: 1198-1205.

De Santis G. and Pinelli M. (1994) Microsurgical model of ischemia reperfusion in rat muscle: Evidence of free radical formation by spin trapping. Microsurgery 15: 655-659.

Dessein PH, Shipton EA, Stanwix AE, Joffe BI and Ramokgadi J. (2000) Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis. 59: 539-543.

Deurenberg P, Weststrate JA and Seidell JC. (1991) Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr. 65: 105-114.

Di Stefano G, Bini V, Papi F, Celi F, Contessa G, Berioli MG, Bacosi ML and Falorni A. (2000) Leptin serum concentrations predict the responsiveness of obese children and adolescents to weight excess reduction program. Int J Obes Relat Metab Disord. 24: 1586-1591.

Diaz MB, Eiden S, Daniel C, Steinbruck A and Schmidt I. (2006) Effects of periodic intake of a high-caloric diet on body mass and leptin resistance. Physiol Behav 88: 191-200.

Dyer AR and Elliott P. (1989) The INTERSALT study: relations of body mass index to blood pressure. J Hum Hypertens. 3: 299-308.

EI-Haschimi K, Pierroz DD, Hileman SM, Bjorbaek C and Flier JS. (2000) Two defects contribute to hypothalamic leptin resistance in mice with diet-induced obesity. J Clin Invest 105: 1827-32.

Faber A. (1924) Readings of blood pressure of 1000 healthy individuals aged 20~25 years: an anthropometry study. Scand Arch Physiol. 45: 189-203.

Fawzi AB, Zhang H, Van Heek M and Graziano MP. (1996) Purification of milligram quantities of human leptin from recobinant E. Coli. Horm Metab Res. 28: 694-697.

Fruhbeck G. (1999) Pivotal role of nitric oxide in the control of blood pressure after leptin administration. Diabetes. 48: 903-908.

Fujita K, Nishizawa H, funahashi T, Shimomura I and Shimabukuro M. (2006) Systemic oxidative stress is associated with visceral fat accumlation and the metabolic syndrome. Circ J 70: 1437-1442.

Furukawa S, Fujita T, shimabukuro M, Iwaki M, Yamada Y and Nakajima Y. (2004) Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest 114: 1752-1761.

Gardner L. (1970) Assessment and outcome. Spec Educ. 59: 11-14.

Garrow JS. (1988) Health implications of obesity. In: Obesity and related diseases. Churchill Livingstone: London: 1-16.

Geffroy S, Vos PD, Staels B, Duban B, Auwerx J and Martinville BD. (1995) Localization of the ob gene (OBS) to chromosome 7q32 by fluorescence in situ hybridization. Genomics. 28: 603-604.

Giannopoulou I, Fernhall B, Carhart R Weinstock RS, Baynard T, Figueroa A and Kanaley JA. (2005) Effects of diet and/or exercise on the adipocytokine and inflammatory cytokine levels of postmenopausal women with type 2 diabetes. Metab Clin Exp. 54: 866-875.

Gong DW, Bi S, Pratley RE And Weintraub BD. (1996). Genomic structure and promoter analysis of the human obese gene. J Biol Chem 271: 3971-374.

Gonzalez MJ, Miranda-Massari JR, Ricart CM and Guzman AM. (2005) Effect of a dietary supplement combination on weight management, adipose tissue, cholesterol and triglycerides in obese children. P R Health Sci J. 24: 211-213.

Grassi G, Cattaneo BM, Seravalle G, Colombo M, Cavagnini F and Mancia G. (1996) Obesity and the sympathetic nervous system. Blood Press S43-S46.

Haffner SM, Mykkanen LA, Gonzalez CC and Stern MP. (1998) Leptin concentrations do not predict weight gain: The Mexico City Diabetes Study. Int. J. Obes. 22: 695-699.

Hampson SE, Andrews JA, Barckley M, Lichtenstein E and Lee ME. (2000) Conscientiousness, perceived risk, and risk-reduction behaviors: a preliminary study. Health Psychol. 19: 496-500.

Havel PJ, Townsend R, Chaump L and Teff K. (1999) High-fat meals reduce 24-h circulating leptin concentrations in women. Diabetes 48: 334-341.

Henriksen JH, Holst JJ, Moller S, Brinch K and Bendtsen F. (1999) Increased circulating leptin in alcoholic cirrhosis: relation to release and disposal. Hepatology. 29: 1818-1824.

Heymsfield SB, Greenberg AS, Fujioka K, Dixon RM, Kushner R, Hunt T, Lubina JA, Patane J, Self B, Hunt P and McCamish M. (1999) Recombinant leptin for weight loss in obese and lean adults. A randomized, controlled, dose-escalation trial. JAMA 282: 1568-1575.

Isidori AM and Caprio M. (1999): Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels. J Clin Endocrinol Metab 84: 3673–3680.

Jacoby J and Kaplan L. (1972) The components of perceived risk, proceedings of 3ed annual conference, association for consumer research: 383-393.

Jeffrey M and Jeffrey LH. (1998). Leptin and the regulation of body weight in mammals. Nature. 395: 763-770.

Jenkins RR, Friedland R and Howard H. (1984) The relationship of oxygen uptake to superoxide dismutase and catalase activity in human muscle. Sports Medicine. 5: 11-14.

Kanders BS and Blackburn GL. (1992) Reducing primary risk factors by therapeutic weight loss. New York, NY: Guilford Press: 213-230.

Kannel WB and Gordon T. (1979) Physiological and medical concomitants of obesity: the Framingham Study. In Bray G; ed. Obesity in America. Bethesda, Maryland: U.S. Dept. of Health. Education, and Welfare, Public Health, Health service. National Institutes of Health: 125-163.

Kaplan S. (1972) The challenge of environmental psychology: a proposal for a new functionalism. Am Psychol. 27:140-143.

Kawasaki S, Sugiyama S, Ishiguro N, Ozawa T and Mura T. (1993) Implication of superoxide radicals on ischaemia-reperfusion-induced skeletal muscle injury in rats. Eur Surg Res 25: 129-136.

Kayman S, Bruvold W and Stern J. (1990) Maintained and relapse after weight loss in women: behavioral aspects. Am. Clin. Nutr. 52: 800-807.

Klein S, Coppack SW, Mohamed-Ali V and Landt M. (1996). Adipose tissue leptin production and plasma leptin kinetics in humans. Diabetes 45: 984-987.

Kim HM, Park J, Kim HS and Kim DH. (2006) Prevalence of the metabolic syndrome in Korean adolescents aged 12-19 years from the Korean National Health and Nutrition Examination Survey 1998 and 2001. Diabetes Res Clin Pract. 3578: 4-7.

Kimura M, Tateishi N, Shiota T, Yoshie F, Yamauchi H, Suzuki M and Shibasaki T. (2004) Long-term exercise down-regulates leptin receptor mRNA in the arcuate nucleus. Neuroreport 15: 713-716.

Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW Jr, Kris-Etherton P, Goldberg IJ, Kotchen TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St Jeor S, Suttie J, Tribble DL and Bazzarre TL. (2000) AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 102: 2284-2299.

Kuller LH, SimkinS, Laurey R, Wing RR and Meilahn EN. (2001) Women’s healthy lifestyle project: a randomized clinical trial: results at 54 months. J Am Heart Asso. 103: 32-37.

Kukkonen-Harjula KT, Borg PT, Nenonen AM and Fogelholm MG. (2005) Effects of a weight maintenance program with or without exercise on the metabolic syndrome: a randomized trial in obese men. Prev Med. 41: 784-790.

Lazzer S, Vermorel M, Montaurier C, Meyer M and Boirie Y. (2005) Changes in adipocyte hormones and lipid oxidation associated with weight loss and regain in severely obese adolescents. Int J Obes. 29: 1184-1191.

Lee GH, Proenca R and Montez JM (1997). Immunohistochemical localization of leptin and uncoupling protein in white and brown adipose tissue. Endocrinology 138: 797-804.

Leyva F, Godsland IF, Ghatei M, Prodler AJ, Aldis S, Walton C, Bloom S and Stevenson JC. (1998) Hyperleptinemia as a component of a metabolic syndrome of cardiovascular risk. Arterioscler Thromb Vasc Biol 18: 928-933.

Likert R. (1932) A technique for the measurement of attitudes. Archives of psychology. 140.

Lindsted K, Tonstad S and Kuzma JW. (1991) Body mass index and patterns of mortality among Seventh-day Adventist men. Int J Obes. 15: 397-406.

Lonnqvist F, Wennlund A and Arner P. (1997) Relationship between circulating leptin and peripheral fat distribution in obese subjects. Int J Obes Relat Metab Disord. 21: 255-260.

Maffei M, Halaas J, Ravussin E, Pratley RE, Lee GH, Zhang Y, Fei H, Kim S, Lallone R and Ranganathan S. (1995) Leptin levels in human and rodent: measurement of plasma leptin and ob RNA in obese and weight-reduced subjects. Nat Med 1: 1155-1161.

Mantzoros CS. (1997). Obesity, eating disorders and restrained eating in leptin the missing link? Mol Psychiatry 2: 377-380.

Masuzaki H, Ogawa Y, Isse N, Satoh N, Okazaki T, Shigemoto M, Mori K, Tamura N, Hosoda K, Yoshimasa Y, jingami H, Kawada T and Nakao K. (1995). Adipocyte-specific expression and regional differences in the adipose tissue. Diabetes 44: 855-858.

Matĕs JM. (2000) Effects of antioxidant enzymes in the molecular control of reactive oxygen species toxicology. Toxicology. 153: 83-104.

Mattila AS and Wirtz J. (2002) The impact of knowledge type on the consumer search services. International Journal of Service Inductry Management. 13: 214-230.

McCullough AJ, Bugianesi E, Marchesini G and Kalhan SC. (1998) Gender-dependent alterations in serum leptin in alcoholic cirrhosis. Gastroenterology. 115: 947-953.

McGregor GP, Desaga JF, Ehlenz K, Fischer A, Heese F, Hegele A, Lammer C, Peiser C and Lang RE. (1996) Radioimmunolohical measurement of leptin in plasma of obese and diabetic human subjects. Endocrinology 137: 1501-1504.

McGuire MT, Wing RR, Klem ML, Seagle HM and Hill JO. (1998) Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight? Int J Obes. 22: 572-577.

Michael WS, Stephen CW, Daniel PJr, Randy JS and Denis GB. (2000) Central nervous system control of food intake. Nature 404: 661-667.

Milagro FI, Campión J and martínez JA. (2006) Weight gain induced by high-fat feeding involves increased liver oxidative stress. Obesity 14: 1118-1123.

Mitra K, Michele CR and Louis MC. (1999) An examination of perceived risk, information search and behavioral intentions in search, experience and credence services. Journal of Services Marketing. 13: 208-228.

Morton TA and Duck JM. (2001) Mass and interpersonal influences on perceptions of risk to self and others. Communication research. 28: 602-626.

Murray M. (1991) All good things must come to a beginning. Caritas. 57: 8.

Murray KB. (1991) A test of service marketing theory: consumer information acquisition activities. J Mark. 55: 10-55.

Nakatani K, Komatsu M, Kato T, Yamanaka T, Takekura H, Wagatsuma A, Aoyama K, Xu B, Hirano T, Kasai H, Ando S and Takeuchi T. (2005) Habitual exercise induced resistance to oxidative stress. Free Radic Res. 39: 905-911.

National Institutes of Health. (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 6: 51S-209S.

Niwa Y, Ishimoto K and Kanoh T. (1990). Induction of superoxide dismutase in leulosocyter by paraguat; correlation with age and possible prediction of longevity. Blood 76: 835-841.

Osuna JA, Gomez-Perez R, Arata-Bellabarba G and Villaroel V. (2006) Relationship between BMI, total testosterone, sex hormone-binding-globulin, leptin, insulin and insulin resistance in obese men. Arch Androl. 52: 355-361.

Ozata M, Mergen M, Oktenli C, Aydin A, Sanisoglu SY, Bolu E, Yilmaz MI, Sayal A, Isimer A and Ozdemir IC. (2002) Increased oxidative stress and hypozincemia in male obesity. Clin Biochem. 35: 627-631.

Ozata M, Uckaya G, Aydin A, Isimer A and Ozdemir IC. (2000) Defective antioxidant defense system in patients with a human leptin gene mutation. Horm Metab Res. 32: 269-272.

Parise G, Phillips SM, Kaczor JJ and Tarnopolsky MA. (2005) Antioxidant enzymes activivty is up-regulated after unilateral resistance exercise training in older adults. Free Radic Bio and Med. 39: 289-295.

Park CW, Mothersbaugh DL and feick L. (1994) Consumer knowledge assessment. J Consum Res. 21: 71-82.

Perry M. and Hamm BC. (1969) Canonical analysis of relations between socioeconomic risk and personal influence in purchase decisions. J Mar Res. 6: 351-354.

Pietrobelli A, Rubiano F, St-Onge MP and Heymsfield SB. (2004) New bioimpedance analysis system: improved phenotyping with whole-body analysis. Eur J Clin Nutr. 58: 1479-1484.

Poonawala A, Nair SP and Thuluvath PJ. (2000) Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case-control study. Hepatology. 32: 689-692.

Power SK and Leeuwenburgh C. (1997) Exercise training-induced alterations in skeletal muscle antioxidant capacity: a brief review. Medicine and Science in Sports and Exercise. 31: 987-997.

Prohaska JR, Wittmers LE and Haller EW. (1988) Influence of genetic obesity, food intake an dadrenalectomy in mice on selected trace element-dependent protective enzymes. J Nutr 97: 138-141.

Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, Khalil L, Turpin G, Opolon and Poynard T. (2000) Liver fibrosis in overweight patients. Gastroenterology. 118: 1117-1123.

Rayner DV and Trayhurn P. (2001) Regulation of leptin production: sympathetic nervous system interations. J Mol Med 79: 8-20.

Reinehr T, Kratzsch J, Kiess W and Andler W. (2005) Circulating soluble leptin receptor, leptin, and insulin resistance before and after weight loss in obese children. Int J Obes. 29: 1230-1235.

Robertson JI. (1984) The risk-benefit equation: when to initiate treatment. Br J Clin Pharmacol. 18 Suppl 2: 181S-187S.

Roselius T. (1971) Consumer rankings of risk reduction methods. J Mark. 35: 56-61.

Rosenbaum M and Leibel RL. (1998) Leptin: A molecule integrating somatic energy stores, energy expenditure and fertility. TEM 9:117–124.

Rosenbaum M and Leibel RL. (1997): N Engl J Med 337: 396–406.

Rossner S. (2002) Obesity: the disease of the twenty-first century. International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity. 26: 63-75.

Saito T, Shimazaki Y, Kiyohara Y, Kato I, Kubo M, Iida M and Yamashita Y. (2005) Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study. J Periodont Res. 40: 346-353.

Salonen JT, Lakka TA, Lakka HM, Valkonen VP, Everson SA and Kaplan GA. (1998) Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men. Diabetes 47: 270-275.

Sartorio A, Agosti F, Resnik M and Lafortuna CL. (2003) Effects of a 3-week integrated body weight reduction program on leptin levels and body composition in severe obese subjects. J Endocrinol Invest. 26: 250-256.

Seidell JC and Bjoぴrntorp P. (1990): Visceral fat accumulation in men is positively associated with insulin, glucose, and C-petide levels, but negatively with testosterone levels. Metabolism 39: 897–901.

Seidell JSC, Pérusse L, Després JP and Bouchard C. (2001) Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. Am J Clin Nutr. 74: 315-321.

Shimizu H, Shimomura Y, Hayashi R, Ohtani K, Sato N, Futawatari T and Mori M. (1997) Serum leptin concentration is associated with total body fat mass, but not abdominal fat distribution. Int J Obes Relat Disord 21: 536-541.

Shimizu H, Oh-I S, Okada S and Mori M. (2006) Leptin resistance and obesity. Endocrinology 1507: 1-14.

Sims EAH and Weed LB. (1987) A plea for an integrated approach to characterization and management of obesity type II diabetes, hyperlipidemias, and hypertension: a role for the personal computer? Am J Clm Nutr. 46: 726-733.

Sikharulidze MD, Dzhanashiia NG, Sanikidze TV and Gogeshvili SG. (2006) The role of oxidative stress in pathogenesis of obesity. Georgian Med News. 135: 123-126.

Srinivasan N and Ratchford B. (1991) An empirical test of a model of external search for automobiles. J Consum Res. 18: 233-242.

Stone RN and Gronhaug K. (1974) Perceived risk: further considerations for the marketing discipline. Eur J Mar. 38: 54-60.

Stunkard AJ. (1996) Current views on obesity. Am J Med. 100: 226-230.

Tauler P, Aguilo A, Guix P, Jimenez F, Villa G, Tur JA, Cordova A and Pons A. (2005) Pre-exercise antioxidant enzyme activities determine the antioxidant enzyme erythrocyte response to exercise. J Sports Sci. 23: 5-13.

Thong FS, Hudson R, Ross R, Janssen I and Graham TE. (2000) Plasma leptin in moderately obese men: independent effects of weight loss and aerobic exercise. Am J Physiol Endocrinol Metab. 279: E307-E313.

Tungtrongchitr R, Pongpaew P, Phonrat B Tungtrongchitr A, Viroonudomphol D, Vudhivai N and Schelp FP. (2003) Serum copper, zinc, ceruloplasmin and superoxide dismutase in Thai overweight and obese. J Med Assoc Thai. 86: 543-551.

Tyroler HA, Heyden S and Hames CG. (1975) Weight and hypertension: Evans county studies of blacks and whites. In: Epidemiology and Control of Hypertension. 177-205.

Ustundag B, Gungor S, Aygün AD, Turgut M and Yilmaz E. (2006) Oxidative status and serum leptin levels in obese prepubertal children. Cell Biochem Funct (In press).

Van Heek M, Compton DS, France CF, Tedesco RP, Fawzi AB, Graziano MP, Sybertz EJ, Strader CD and Davis HR Jr. (1997) Diet-induced obese mice develop peripheral, but not to ccentral resistance to leptin. J Clin Invest. 99: 385-390.

Van Itallie TB. (1985) Health implications of overweight and obesity in the United States. Am Intern. Med. 103: 983-988.

Wardle J, Haase AM and Steptoe A. (2005) Body image and weight control in young adults: international comparisions in university students from 22 countries. Int J Obes. 1-8.

Warren GT, Nicole RH, Denise JJ, Jeffrey MS, Kristin LM and Michael BZ. (2005) Effect of energy-reduced diets high in dairy products and fiber on weight loss in obese adults. Obes Res. 13: 1344-1353.

Widdowson PS, Upton R, Buckingham R, Arch J and Williams G. (1997) Inhibition of fodd response to intracerebroventricular injection of leptin is attenuated in rats with diet-induced obesity. Diabetes. 46: 1782-1785.

Willett WC, Stampfer M, Manson J and VanItallie T. (1991) New weight guidelines for Americans: justified or injudicious? Am J Clin Nutr. 53: 1102-1103.

Wing RR, Sinha MK, Considine RV, Lang W and Caro JF. (1996) Relationship between weight loss maintenance and changes in serum leptin levels. Horm. Metab. Res. 28: 683-700.

Wirtz J and Chew P. (2002) The effects of incentives, deal proneness, satisfaction and tie strength on word-of mouth behavior. International Journal of Service Industry Management. 13: 141-162.

Woods SC, Seeley RJ, Porte DJr and Schwartz MW. (1998) Signals that regulate food intake and energy homeostasis. Science 280: 1378-1383.

Woodside AG. (1968) Interactions of Consumption Situations and Brand Attitudes. J App Psy. 61: 764-769.

Zhang Y, Proenca R and Maffei M. (1994). Positional cloning of the mouse obese gene and its human homologue. Nature. 372: 425-432.

Zimmet P, Boyko EJ, Collier GR and Courten M. (1999) Etiology of the metabolic syndrome: potential role of insulin resistance, leptin resistance, and other players. Ann N Y Acad Sci 892: 25-44.