臺灣博碩士論文加值系統

本研究探討營養教育配合不同程度商業減重代餐的應用在減重計畫上，對減重成效及生活品質之評估。實驗A組使用所提供之減重代餐一包取代一天的部份飲食，實驗B組每日使用兩包代餐取代部份飲食。兩組控制熱量的攝取是依照個別體重與活動量計算出總熱量後再減五百大卡，並完成自填式問卷包括生活品質問卷、及背景資料問卷等，實驗進行為期12週。實驗A組共16名，平均減輕體重和減輕BMI分別為8.23±3.70公斤和3.09±1.38，減輕體重和BMI分別為9.44±3.67%和9.75±3.87%。B組共14名，平均減輕體重和減輕BMI分別為9.43±2.74公斤和3.68±1.03，減輕體重和BMI分別為11.65±3.03%和11.60±3.04%。實驗A組減重後追蹤三個月之體重仍持續下降，體重從78.18±9.57降至73.96±6.92。實驗B組亦有顯著下降，體重從71.79±11.02公斤降至68.27±9.38公斤。A、B兩組追蹤六個月體重及BMI則與減重後三個月所測得的數值大致相同, 並無顯著下降。減重前後兩組腰臀圍、腰臀比、血糖、尿酸、血膽固醇、三酸甘油脂及低密度脂蛋白有顯著下降（p＜0.05）。但兩組間改變的差異並無達顯著的不同。SF-36兩組健康相關生活品質量表在減重12 週後，其SF-36健康相關生活品質量表中，生理功能（PF）、因生理功能問題而角色受限（RP）、身體疼痛（BP）、一般健康（GH）、活力（VT）、社會功能（SF）、因情緒問題而角色受限（RE）、心理健康（MH）八個構面及「體能綜合評估」（PCS）、「心理綜合評估」（MCS）兩個面向呈現統計學意義上的進步，尤其在一般健康（GH）最顯著。惟兩組之間在所測向度中也並未達顯著的不同。結論：代餐減重配合營養師的諮詢，可異於傳統的取代全餐的代餐介入方式，將代餐取代部分餐食，不僅有良好的減重成效並可全面提昇健康相關之生活品質，代餐介入的程度不同對減重成果及生活品質並無顯著的影響。

The purpose of this study was to evaluate the effectiveness of weight loss and life quality by the method of nutrition education along with providing different degree of liquid meal replacements. Group A and group B received meal replacements once and twice daily, respectively, for 12 weeks of study. The total calories controls in both groups are based on the calculated energy needs minus 500 Kcal/day. Body weight, waist and hip, biochemical examination and several structured questionnaires were used for data collection at before and after study. Group A (n＝16； male＝3，female＝13) and group B (n＝14；male＝6，female＝8) were aged 38.3±15.2 and 32.6±9.5 years, with body weights of 86.41±10.87 and 81.22±11.79 kg, and BMI of 31.54±3.65 and 31.81±3.24 kg/m2, respectively, before treatment. There were significant weight loss in both groups, 9.44±3.67% and 11.65±3.03%, however, no significant difference was found in between groups. Waist and hip measurements, blood sugar, cholesterol, triglyceride, and LDL concentrations had significantly decreased in both groups (p＜0.05), however, no significant difference was found in between groups. Physical functioning(PF), role-physical(RP), bodily pain(BP), general health(GH), vitality(VT), social functioning(SF), role-emotional (RE), and physical component summary (PCS) in the Medical Outcomes Study Short-Form 36 Health Survey (SF-36, as the assessment of HRQL) were also showed significant improvement, but again there was no significance in between groups. We concluded that the use of nutrition education along with liquid meal replacements provide significant weight loss and improvement in quality of living. However, the degrees of intervention did not contribute significant difference in the treatment outcomes.

目錄
中文摘要..................................................................................................... I
英文摘要................................................................................................... II
目錄..........................................................................................................III
圖表目錄.................................................................................................. VI
第一章 緒論...............................................................................................1
第一節 研究動機................................................................................................................. 1
第二節 研究目的................................................................................................................. 4
第三節 研究問題................................................................................................................. 5
第四節 名詞界定................................................................................................................. 6
第二章 文獻回顧......................................................................................8
第一節 肥胖流行病學......................................................................................................... 8
第二節 肥胖的定義及判斷標準....................................................................................... 11
第三節 肥胖的成因........................................................................................................... 13
第四節 肥胖對身體的影響............................................................................................... 18
第五節 減重的方法........................................................................................................... 22
第六節 飲食與肥胖之關係............................................................................................... 28
第七節 代餐減重之應用................................................................................................... 30
第八節 生活品質定義與相關研究................................................................................... 33
第三章 研究方法....................................................................................45
第一節 研究執行流程圖與實驗設計............................................................................... 45
第二節 研究對象............................................................................................................... 47
第三節 飲食介入............................................................................................................... 49
第四節 研究工具............................................................................................................... 51
IV
第五節 統計方法............................................................................................................... 59
第四章 研究結果....................................................................................60
第一節 基本資料............................................................................................................... 60
第二節 熱量及三大營養素控制的成效........................................................................... 61
第三節 減重成效............................................................................................................... 63
第四節 生活品質在代餐介入前後之比較....................................................................... 65
第五章 討論.............................................................................................78
第一節 代餐飲食調整對減重的影響............................................................................... 78
第二節 減重對體位測量值影響之探討........................................................................... 80
第三節 受試者血液生化值之探討................................................................................... 82
第四節 代餐減重對自覺健康狀態的影響....................................................................... 85
第六章 結論與建議................................................................................88
參考文獻...................................................................................................89
英文部分............................................................................................................................. 89
中文部分........................................................................................................................... 101
附錄一 義大醫院醫學倫理委員會同意臨床試驗計畫證明書........105
附錄二 受試者同意書........................................................................106
附錄三 飲食原則與食物代換............................................................107
附錄四 食物熱量介紹........................................................................108
附錄五 每日飲食記錄........................................................................109
附錄六 運動熱量消耗表....................................................................110
附錄七 配方食品說明書....................................................................111
V
附錄八 問卷...........................................................................................112
附錄九 SF-36 授權同意書.................................................................117
VI
圖表目錄
表一、受試者之基本資料概況..............................................................68
表二、受試者之生理基本資料..............................................................69
表三、減重前後總熱量及三大營養素的變化......................................70
表四、代餐減重介入十二週的體重及BMI 變化.................................71
表五、代餐減重介入十二週的體位測量值的變化..............................72
表六、代餐減重介入十二週的體位測量值的變化..............................72
表七、代餐減重介入十二週的血液生化值的變化..............................73
表八、代餐減重介入十二週的血液生化值的變化..............................73
表九、比較兩組之減重前後體位及生化測量值的變化......................74
表十、SF-36 健康量表代餐減重介入前後的變化..............................75
表十一、SF-36 健康量表代餐減重介入前後的變化..........................75
表十二、代餐減重介入十二週之SF-36 健康量表的變化.................76
圖一、減重前後及追蹤三個月、六個月之體重變化情形…………77
圖二、減重前後及追蹤三個月、六個月之BMI 變化情形…………77

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網路資料
行政院衛生署（2002/04/15）。國人肥胖定義及處理原則出爐。民94年3月1日，取自：http://www.doh.gov.tw/cht/content.aspx?dept=R&class_no=25&now_fod_list_no=3942&array_fod_list_no=&level_no=2&doc_no=32&show=
孫崇文（2002）肥胖與疾病，http://www.a-sir.com.tw/news.asp