臺灣博碩士論文加值系統

近年來國人的肥胖盛行率有逐年增加的趨勢，在許多國家，肥胖症已儼然成為公共衛生上重要的問題。肥胖和許多慢性疾病有關，特別是腹部肥胖，罹患代謝症候群的風險高於一般人，而有代謝症候群者，罹患心血管疾病的危險遠較於沒有代謝症候群者高出許多。以營養科學觀點而言，熱量的攝取與消耗的不平均是造成肥胖的主要原因，故限制熱量的飲食控制與規律的運動，成為體重控制最重要的課題。
本研究以17位肥胖者，體重79.84±19.00公斤，BMI30.36 ±4.84 kg/m2，腰圍93.24±14.37公分，經過8週體重控制計畫後，比較減重前後體組成、血液生化值及代謝症候群指標的變化。結果顯示，在血液生化值方面，總膽固醇、HDL、LDL、GPT和Cr均有顯著的下降；在體組成方面，減重前後體重、BMI、體脂肪、皮下脂肪、內臟脂肪、瘦肉組織、腰圍和臀圍均有顯著性的差異；然而代謝症候群指標則在減重前是代謝症候群組明顯大於非代謝症候群組，減重後代謝症候群之各項指標並無統計上顯著的改變，非代謝症候群組則腰圍及HDL有顯著性的差異。經研究證實，肥胖確實易造成體組成及血液生化值的異常，增加慢性病的罹病率及致死率，若能以飲食控制，配合有氧運動及行為修正，可有效降低體重，改善體組成及血液生化值的異常現象，促進健康。

The prevalence of obesity is increasing in recent years. It has been important public health problem in many countries. Obesity is associated with risk factors of many diseases. Metabolic syndromes (MS) are linked with central obesity and may cause cardiovascular diseases (CVD). The energy intake and expenditure unbalancedly is the main cause of obesity. The most important of body weight control is to restrict calorie intake, modify dietary manner and keep doing exercise. The purpose of this study evaluated effect of 8-week body-weight-reduction program in 17 obesity subjects with body weight79.84±19.00kg,BMI30.36±4.84kg/m2, waist circumference 93.24±14.37cm,which preceded this approach by comparison of biochemical assessment, anthropometry, body weight and percentage of body fat, between pre and post weight reduction. The results showed that before the weight control program was administrated, After the weight control program, the biochemical characteristics which included total cholesterol,HDL,LDL,GPT and Cr were significantly improved;the body composition which included body weight, BMI, body fat, subcutaneous fat, isceral fat,lean body mass, waist circumference and hip circumference were also significantly improved. However, the improvement on indicators for metabolic syndromes before 8-week body-weight-reduction program is MS higher than, but after 8-week body-weight-reduction program MS subjects is no significantly improved ,non-MS subjects waist circumference and HDL were better than those in MS subjects. In conlusion, obesity could make abnormal of body composition and biochemical characteristics, and consider as a chronic disease with morbidity and motality. It is better to take diet control , exercise and modify intake behavior, could reduce body weight, improve body composition and biochemical characteristics, and more effects of psychological health.

中文摘要.................................................................................vii Abstract .........................................................................................ix
第一章 緒言...........................................................................1
第一節 研究背景與動機..........................................................………2
第二節 研究目的......................................................................………3
第二章 文獻探討..........................................................................………4
第一節 體重過重及肥胖的定義..............................................………4
第二節 體重過重及肥胖的成因..............................................………5
第三節 體重過重及肥胖的趨勢..............................................………6
第四節 體重過重及肥胖對健康的影響..................................………7
第五節 減重行為的相關概念..................................................……....9
第六節 影響減重行為之相關因素..........................................……..11
第七節 各種減重方法及對身體的影響..................................……..13
第三章 代謝症候群......................................................................……..19
第一節 代謝症候群的定義....................................................……..19
第二節 代謝症候群之盛行率..........................................20
第三節 代謝症候群對健康的影響.........................................21
第四節 腹部肥胖與代謝症候群. .......................................21
第五節 胰島素阻抗與代謝症候群………………………………..22
第四章 研究對象與方法..............................................................……..25
第一節 研究設計....................................................................……..25
第二節 實驗對象....................................................................……..27
第三節 研究方法....................................................................……..28
第四節 體位測量....................................................................……..30
第五節 血液檢測....................................................................……..31
第七節 統計方法....................................................................……..32
第五章 結果................................................................................……..33
第一節 受試者基本資料........................................................……..33
第二節 受試者減重過程中體組成的……………………………..34
第三節 受試者減重過程中血液生化值的變化…………………..35
第四節 比較代謝症候群與非代謝症候群於減重前後各項生理指標的變化…………………………………………………..36
第五節 不同的減重程度對各項生理指標的影響………………..38
第六節 減重對不同肥胖程度的影響……………………………..39
第六章 討論..............................................................................……....93
第七章 結論..............................................................................……..102
第八章 參考文獻……………………………………………………103












圖 目 錄
圖1 第2型糖尿病與身體質量指數的關係.................................………8
圖2 心血管疾病的死亡率與身體質量指數的關係.................……….9
圖3 胰島素阻抗與代謝症候群....................................................……..22
圖4實驗設計流程圖.....................................................................……..26
圖5 17位受試者經過8週的體重控制後體重的變化………………42
圖6 GPT of all subjects before and after an 8-weeks weight-control program………………………………….………………………57
圖7 Effects of weight control program on body compositions in obese subjects with metabolic syndrome(MS) or NonMS…………..64
圖8 Effects of weight control program on biochemical characteristics in obese subjects with metabolic syndrome(MS) orNonMS ………………………………………………………..68
圖9代謝症候群指標變化差異比較…………………………………..71
圖10 MS與Non MS血脂變化差異比較……………………………..73
圖11 Effects of weight control on risk factors for coronary heart disease in obese subject…………………………………..75
圖12 BMI< 30 and BMI≧ 30分組減重前後各項變數的差異.…….81
圖13 BMI< 27 and BMI≧ 27分組減重前後各項變數的差異……...87






表 目 錄
表1行政院衛生署成人之肥胖定義……………………………………5
表2 各種運動的熱量消耗……………………………………………16
表3 運動30分鐘的熱量消耗（以體重70kg為例）………………17
表4受試者基本資料…………………………………………….…….41
表5 Effects of weight control program on body compositions in obesesubjects……………………………………………….……..43
表6 Body weight of all subjects before and after an 8-weeks weight-control program…..……………………………………..44
表7 BMI of all subjects before and after an 8-weeks weight-control program……….…………………………………………………45
表8 Body Fat of all subjects before and after an 8-weeks weight-control program………………………………….……..46
表9 Subcutaneous fat of all subjects before and after an 8-weeks weight-control program…..……………………………...……47
表10 Visceral fat of all subjects before and after an 8-weeks weight-control program..………………………………………48
表11 Waist of all subjects before and after an 8-weeks weight-control program………………………………….………………………49
表12 Hip of all subjects before and after an 8-weeks weight-control program………………………………….………………………50
表13 Lean mass of all subjects before and after an 8-weeks weight-control program………………………………….……..51
表14 Lean mass/Body fat of all subjects before and after an 8-weeks weight-control program………………………………………...52
表15 Waist/Hip of all subjects before and after an 8-weeks weight-control program……………………………………….53
表16 Effects of weight control program on biochemical characteristics in obese subjects………………………………..54
表17 Total cholesterol of all subjects before and after an 8-weeks weight-control program……………………………………….55
表18 HDL- cholesterol of all subjects before and after an 8-weeks weight-control program………………………………………..56
表19 GPT of all subjects before and after an 8-weeks weight-control program….………………………………………………………58
表20 Fasting plasma sugar of all subjects before and after an 8-weeks weight-control program..……..………………………………...59
表21 LDL- cholesterol of all subjects before and after an 8-weeks weight-control program……..………………………………...60
表22 Chol/HDL of all subjects before and after an 8-weeks weight-control program……………………………………….61
表23 Triglycerides (TG)of all subjects before and after an 8-weeks weight-control program……………………….………………62
`表24 Creatinine of all subjects before and after an 8-weeks weight-control program……………………………………….63
表25 Effects of weight control program on body compositions in obese subjects with metabolic syndrome(MS) or Non MS……………………………………………………………..67
表26 Effects of weight control program on biochemical characteristics in obese subjects with metabolic syndrome(MS) or Non MS……………………………………………………...70
表27代謝症候群指標變化差異比較…………………………………72
表28 MS與Non MS血脂變化差異比較……………………………74
表29 Effects of weight control on risk factors for coronary heart disease in obese subjects………………………….……………77
表30 減重變化<5 % and 減重變化≧ 5 %分組減重前後各項變數的差異…………………………………………………………….78.

1.Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW, Jr. (1999) Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341: 1097-105.
2.Jung RT. (1997) Obesity as a disease. Br Med Bull 53: 307-21.
3.郭清輝. (2000) 肥胖症。臨床醫學 23: 227-37。
4.Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, et al. (1994) Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 73: 460-8.
5.行政院衛生署. (1998) 國民營養現況：1993-1996 國民營養健康狀況變遷調查結果， 行政院衛生署編，台北市。
6.Goldstein DJ. (1992) Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 16: 397-415.
7.Organization WH. (1998) Obesity: Preventing and managing the global epidemic: report of a WHO Consultation on Obesity, World Health Organization, Geneva.
8.WHO/IASO/IOTF. (2000) Asia-Pacific perspective: Redefining obesity and its treatment, Health Communications Australia Pty Limited.
9.衛生署食品資料網. (2007)。http://food.doh.gov.tw/chinese/health/health_5.htm。
10.Donahue RP, Abbortt RD. (1987) Central obesity and coronary heart disease in men. Lancet 2: 1215.
11.Perusse L, Chagnon YC, Weisnagel SJ, Rankinen T, Snyder E, et al. (2001) The human obesity gene map：the 2000 update. Obes Res 9: 135-69.
12.黃伯超、游素玲、林月美、朱志良. (1992) 我國成年人性別、年齡別、身高別體重及體重過重與肥胖界定之探討。 中華營養雜誌 17: 157-72。
13.高美丁、曾明淑、葉文婷、張瑛玿、潘文涵. (1998) 台灣地區居民體位及肥胖狀況。
14.Katzmarzyk PT, Craig CL, Bouchard C. (2001) Original article underweight, overweight and obesity：relationships with mortality in 13-year follow-up of the Canada Fitness Survey. J Clin Epidemiol 54: 916-20.
15.Field AE, Coakley EH, Must A, Spadano JL, Laird N, et al. (2001) Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 161: 1581-6.
16.Kannel WB, Gordon T, Castelli WP. (1979) Obesity, lipids, and glucose intolerance. The Framingham Study. Am J Clin Nutr 32: 1238-45.
17.Sahyoun NR, Hochberg MC, Helmick CG, Harris T, Pamuk ER. (1999) Body mass index, weight change, and incidence of self-reported physician-diagnosed arthritis among women. Am J Public Health 89: 391-4.
18.McNeely MJ, Boyko EJ, Shofer JB, Newell-Morris DL, Leonetti DL, Fujimoto WY. (2001) Standara definitions of overweight and central adiposity for determining diabetes risk in Japanese Americans. Am J of Clin Nutr 74: 101-7.
19.Chan J, Rimm E, Colditz G, Stampfer M, Willett W. (1994) Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 17: 961-69
20.Angulo P. (2002) Nonalcoholic fatty liver disease. N Engl J Med 346: 1221-31.
21.Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, et al. (2002) Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 123: 134-40.
22.Clark JM, Diehl AM. (2003) Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis. JAMA 289: 3000-4.
23.Manton ND, Lipsett J, Moore DJ, Davidson GP, Bourne AJ, Couper RT. (2000) Non-alcoholic steatohepatitis in children and adolescents. Med J Aust 173: 476-9.
24.Willett WC, Dietz WH, Colditz GA. (1999) Guidelines for healthy weight. N Engl J Med 341: 427-34.
25.Westenhoefer J. (2001) Prevalence of eating disorders and weight control practices in Germany in 1990 and 1997. Int J Eat Disord 29: 477-81.
26.張尹凡、盧豐華、吳至行、張秦松、吳坤陵、張智仁. (2001) 成年民眾體重認知與減重行為之研究。台灣家醫誌 。
27.Fogelman Y, Vinker S, Lachter J, Biderman A, Itzhak B, Kitai E. (2002) Managing obesity：a survey of attitudes and practices among israeli primary care physicians. Int J Obes 26: 1393-7.
28.Prochaska JO, DiClemente CC. (1983) Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol 15: 390-5.
29.Prochaska JO, Redding CA, Harlow LL, Rossi JS, Velicer WF. (1994) The transtheoretical model of change and HIV prevention: a review. Health Educ Q 21: 471-86.
30.Collazo-Clavell ML. (1999) Safe and effective management of the obese patient. Mayo Clin Proc 74: 1255-9.
31.洪建德、王菲菲. (1992) 減肥門診就診者之分析。 中華營養雜誌 17: 215-27。
32.Kottke TE, Clark MM, Aase LA, Brandel CL, Brekke MJ, et al. (2002) Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 77: 114-21
33.Marshall JA, Lopez TK, Shetterly SM, Baxter J, Hamman RF. (1995) Association of education level with atherogenic diets in a rural biethnic population. Am J Prev Med 11: 294-300.
34.Gutierrez -Fisac JL, Regidor E, Banegas JR, Artalejo FR. (2002) The size of obesity differences associated with education level in Spain, 1987 and 1995/97. J Epidemiol Community Health 56: 457-60.
35.Garn SM, Bailey SM, Cole PE, Higgins IT. (1977) Level of education, level of income, and level of fatness in adults. Am J Clin Nutr 30: 721-5.
36.Jakicic JM, Wing RR, Winters-Hart C. (2002) Relationship of physical activity to eating behaviors and weight loss in women. Med Sci Sports Exerc 34: 1653-9.
37.Healthy People (2000) National Health Promotion and Disease Prevention Objectives, Dept of Health and Human Services, Public Health Service; 1991. US Dept of Health and Human Services publication PHS 91-50212, Washington DC.
38.Haapanen N, Miilunpalo S, Pasanen M, Oja P, Vuori I. (1997) Association between leisure time physical activity and 10-year body mass change among working-aged men and women. Int J Obes Relat Metab Disord 21: 288-96. 39.Gillman MW, Pinto BM, Tennstedt S, Glanz K, Marcus B, Friedman RH. (2001) Relationships of physical activity with dietary behaviors among adults. Prev Med 32: 295-301.
39.Gillman MW, Pinto BM, Tennstedt S, Glanz K, Marcus B, Friedman RH. (2001) Relationships of physical activity with dietary behaviors among adults. Prev Med 32: 295-301.
40.Poston WSn, Foreyt JP. (2000) Successful management of the obese patient. Am Fam Physician 61: 3615-22.
41.Anderson DA, Wadden TA. (1999) Treating the obese patient. Suggestions for primary care practice. Arch Fam Med 8: 156-67.
42.Reaven GM. (1995). Pathophysiology of insulin resistance in human disease. Physiol Rev 75: 473-86.
43.Grundy SM, Hansen B, Smith SCJ, Cleeman JI, Kahn RA. (2004) Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation 109: 551-6.
44.Bray GA, Champagne CM. (2004) Obesity and the Metabolic Syndrome: implications for dietetics practitioners. J Am Diet Assoc 104: 86-9.
45.Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, et al. (2001) Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes 24: 683-9.
46.Sattar N, Gaw A, Scherbakova O, Ford I, O''Reilly DS, et al. (2003) Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 108: 414-9
47.Reusch JE. (2002) Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome. Am J Cardiol 90: 19G-26G.
48.Scott CL. (2003) Diagnosis, prevention, and intervention for the metabolic syndrome. Am J Cardiol 92: 35i-42i.
49.Després JP, Lemieux I, Prud''homme D. (2001) Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 322: 716-20.
50.Park HS, Lee K. (2005) Greater beneficial effects of visceral fat reduction compared with subcutaneous fat reduction on parameters of the metabolic syndrome: a study of weight reduction programmes in subjects with visceral and subcutaneous obesity. Diabet Med 22: 266-72.
51.Stefanick ML, Mackey S, Sheehan M, Ellsworth N, Haskell WL, Wood PD. (1998) Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med 339: 12-20.
52.Leenen R, van der Kooy K, Meyboom S, Seidell JC, Deurenberg P, Weststrate JA. (1993) Relative effects of weight loss and dietary fat modification on serum lipid levels in the dietary treatment of obesity. J Lipid Res 34: 2183-91.
53.Hellénius ML, de Faire U, Berglund B, Hamsten A, Krakau I. (1993) Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis 103: 81-91
54.Suastika K. (2006) Update in the management of obesity. Acta Med Indones 38: 231-7.
55.Ashley FWJ, Kannel WB. (1974) Relation of weight change to changes in atherogenic traits: the Framingham Study. J Chronic Dis 27: 103-14.
56.Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: 1343-50
57.Marette A. (2002) Mediators of cytokine-induced insulin resistance in obesity and other inflammatory settings. Curr Opin Clin Nutr Metab Care 5: 377-83.
58.Maison P, Byrne CD, Hales CN, Day NE, Wareham NJ. (2001) Do different dimensions of the metabolic syndrome change together over time? Evidence supporting obesity as the central feature. Diabetes Care 24: 1758-63.
59.Poobalan A, Aucott L, Smith WC, Avenell A, Jung R, et al. (2004) Effects of weight loss in overweight/obese individuals and long-term lipid outcomes--a systematic review. Obes Rev 5: 43-50.
60.蔡崇煌, 黃素雲, 林高德. (2006) 台灣家醫誌 16: 112-22。
61.Hanley AJ, Williams K, Festa A, Wagenknecht LE, D''Agostino RBJ, et al. (2004) Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes 53: 2623-32.
62.Nakanishi N, Suzuki K, Tatara K. (2004) Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care 27: 1427-32.
63.Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, et al. (2001) Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 50: 1844-50.
64.Guy-Grand B, Drouin P, Eschwège E, Gin H, Joubert JM, Valensi P. (2004) Effects of orlistat on obesity-related diseases - a six-month randomized trial. Diabetes Obes Metab 6: 375-83.
65.Torgerson JS, Hauptman J, Boldrin MN, Sjöström L. (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27: 155-61.
66.Baratta R, Amato S, Degano C, Farina MG, Patanè G, et al. (2004) Adiponectin relationship with lipid metabolism is independent of body fat mass: evidence from both cross-sectional and intervention studies. J Clin Endocrinol Metab 89: 2665-71.
67.Bruun JM, Lihn AS, Verdich C, Pedersen SB, Toubro S, et al. (2003) Regulation of adiponectin by adipose tissue-derived cytokines: in vivo and in vitro investigations in humans. Am J Physiol Endocrinol Metab 285: E527-33.
68.詹欣隆, 黃麗卿. (2006) 台灣家醫誌 16: 181-91。
69.Reaven GM, Lithell H, Landsberg L. (1996) Hypertension and associated metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system. N Engl J Med 334: 374-81.
70.Kahn BB, Flier JS. (2000) Obesity and insulin resistance. J Clin Invest 106: 473-81.
71.Minehira K, Tappy L. (2002) Dietary and lifestyle interventions in the management of the metabolic syndrome: present status and future perspective. Eur J Clin Nutr 56: 1262-8.
72.Teh BH, Pan WH, Chen CJ. (1996) The reallocation of body fat toward the abdomen persists to very old age, while body mass index declines after middle age in Chinese. Int J Obes Relat Metab Disord 20: 683-7.