基於堆積多量脂肪的脂肪細胞會分泌脂肪激素或細胞激素，抑制細胞內的胰島素訊息傳遞作用，引起胰島素阻抗。因此，本研究旨在針對那些體重比年輕時至少增加6 kg以上、但未達肥胖程度者，透過運動與適度飲食控制，在體重減少2、4 kg後，探討其胰島素敏感性是否可被提昇，以及代謝症候群有關之血液生化值是否可更臻理想，最終目的在宣揚永保理想體重的理念。
經16週執行體重控制，成功減重達4 kg者有6位女生，年齡為48.17±10.07 yrs、BMI為24.01±1.38 kg/m2、腰圍77.50±6.32 cm，資料經統計結果如下：
（一）血液胰島素與胰島素敏感性指數方面：
血液胰島素前測、減2 kg時、減4 kg時分別為6.51±1.58 mU/l、6.32±1.62 mU/l、4.96±1.13 mU/l（分別減少2.91％、23.84％）。HOMA指數分別為1.57±0.38、1.49±0.46、1.10±0.32（分別減少5.09％、30.12％）。QUICKI指數分別為0.359±0.015、0.363±0.020、0.381±0.021（分別增加1.11％、6.28％）。McAuley指數分別為7.99±0.8、8.33±0.8、9.14±0.68（分別增加4.26％、14.46％）。經以相依樣本單因子變異數分析考驗此四項變數，結果皆達顯著差異（p＜.05），進一步以費雪最小顯著差異法事後比較，胰島素、HOMA指數和QUICKI指數皆有一致的結果，即前測到減重2 kg未達顯著差異，前測到減重4 kg時以及減重2 kg到4 kg時達顯著差異，McAuley指數在每個階段皆達顯著差異。
（二）代謝症候群有關的血液生化值方面：
血糖、TC、HDL-C、LDL-C、TG、血壓值等以相依樣本單因子變異數分析，考驗結果除血壓值外，其餘皆達顯著差異（p＜.05）。
結論：非肥胖且尚未出現代謝症候群症狀之成年人，經以運動配合適度飲食控制，當體重減輕超過2kg體脂肪些許下降，並回復到接近其過往理想體重時，可使其胰島素敏感性提昇及代謝症候群有關之血液生化值更臻理想。

Because of the adipocyte which accumulated abundant of fat might impair insulin signal transduction function by secreting adipokines or cytokines, and consequently induce the insulin resistance. Thus, the purpose of this study was to investigate whether the insulin sensitivity of adults, whose weights were 6 kg heavier than they were young but yet had not reached the obesity degree, would be more sensitive and their blood profiles concerning the metabolism syndrome would be better, after they lost their weight at 2 kg and 4 kg .
Only six females ( 48.17 ± 10.07 yrs, BMI 24.01 ± 1.38 kg/m2, waist circum 77.50 ± 6.32 cm) succeeded in losing 4 kg by exercise combining with moderate energy-restricted diet during 16 weeks. The results were shown as follows:
(1) Insulin and insulin sensitivity index aspect:
The insulin level of the subjects were 6.51 ± 1.58 mU/l, 6.32 ± 1.62 mU/l and 4.96 ± 1.13 mU/l at pre-test, 2 kg , and 4 kg , respectively (reduced 2.91% at 2 kg, 23.84% at 4 kg). The HOMA index were 1.57 ± 0.38, 1.49 ± 0.46 and 1.10 ± 0.32 (－5.09％, －30.12％); the QUICKI index were 0.359 ± 0.015, 0.363 ± 0.020 and 0.381 ± 0.021(＋1.11％, ＋6.28％); the McAuley index were 7.99 ± 0.8, 8.33 ± 0.8 and 9.14 ± 0.68 (＋4.26％; ＋14.46％). By dependent event of the one-way ANOVA analysis to test these four variables, the results all reached the level of significance (p<.05). Posteriori comparisons of the Fisher’s Least Significant Difference to test the insulin had the consistent results. Namely, the HOMA index and the QUICKI index did not reach the significant differences in the 2kg reduction stage but reached the significant differences in the stage of 2 kg to 4 kg reduction and in the stage of 4 kg reduction. Furthermore, the McAuley indexs all reached the significant differences in each stage.
(2) The blood profiles concerning the metabolism syndrome
Except the blood pressure, the blood glucose, TC, HDL-C, LDL-C, TG at 2 kg and 4 kg were all significant better (p< .05) than pre-test.
Conclusion: The insulin sensitivity of the adults who were non-obesity and no metabolism syndrome might be induced, and their blood profiles concerning the metabolism syndrome might become better after they lose their weight more than 2 kg.

目次

國科會授權書
國家圖書館授權書
考試委員會審定書
人體評估申請書
謝詞
中文摘要………………………………………………………………………………………Ⅰ
英文摘要………………………………………………………………………………………Ⅱ
目次……………………………………………………………………………………………Ⅲ
表目次…………………………………………………………………………………………Ⅴ
圖目次…………………………………………………………………………………………Ⅵ


本文部分
第一章 緒論
一、問題背景……………………………………………………………………1
二、研究問題……………………………………………………………………4
三、研究目的……………………………………………………………………6
四、研究假設……………………………………………………………………6
五、研究範圍……………………………………………………………………7
六、研究限制……………………………………………………………………7
七、操作性定義…………………………………………………………………7
第二章 文獻探討
一、胰島素與胰島素阻抗………………………………………………………9
二、胰島素、非胰島素依賴路徑與胰島素阻抗的關係………………………14
三、肥胖與胰島素敏感性之探討………………………………………………18
四、減重促進胰島素敏感性、改善代謝症候群之探討………………………23
五、總結…………………………………………………………………………31
第三章 研究方法與步驟
一、研究對象……………………………………………………………………32
二、研究時間、地點與實驗流程………………………………………………32
三、實驗設計……………………………………………………………………36
四、實驗檢測項目與方法………………………………………………………38
五、實驗控制……………………………………………………………………44
六、資料處理……………………………………………………………………45
第四章 結果
一、受試者前測背景資料及同質性考驗………………………………………46
二、實驗組胰島素及胰島素敏感性指數之變化………………………………52
三、實驗組血液生化值、血壓之變化…………………………………………61
四、控制組前測、後測之變化…………………………………………………70
第五章 討論與結論
一、不等程度減重後對胰島素與胰島素敏感性指數之影響…………………72
二、不等程度減重後與代謝症候群有關血液生化值之影響…………………77
三、結論…………………………………………………………………………81

參考書目
一、 中文部分………………………………………………………………………………82
二、 外文部分………………………………………………………………………………83

附 錄
一 運動安全問卷調查表…………………………………………………………………92
二 受試者須知……………………………………………………………………………93
三 受試者同意書…………………………………………………………………………94
四 減重計畫………………………………………………………………………………95
五 好消息！享受‧想「瘦」專案………………………………………………………98
六 人體測量及採血之流程………………………………………………………………99
七 每週能量釋放執行統計表……………………………………………………………100
八 血液生化值檢測及計算方法…………………………………………………………101
九 受試者身體組成前測原始資料………………………………………………………106
十 受試者實驗結果原始資料……………………………………………………………107
十一 實驗組不等程度減重血液生化值事後比較結果…………………………………124

表 目 次

表4-1 受試者前測背景資料與代謝症候群定義對照表…………………………………48
表4-2 受試者胰島素、胰島素敏感指數與學者相關研究對照表………………………50
表4-3 實驗組與控制組同質性考驗結果…………………………………………………51
表4-4 實驗組減重兩公斤時身體組成檢定結果…………………………………………54
表4-5 實驗組減重兩公斤時胰島素與胰島素敏感性指數檢定結果……………………55
表4-6 實驗組不等程度減重在血液胰島素one-way ANOVA分析摘要表……………56
表4-7 實驗組不等程度減重血液胰島素事後比較結果…………………………………56
表4-8 實驗組不等程度減重HOMA指數one-way ANOVA分析摘要表…………………58
表4-9 實驗組不等程度減重HOMA指數事後比較結果…………………………………58
表4-10 實驗組不等程度減重QUICKI指數one-way ANOVA分析摘要表……………59
表4-11 實驗組不等程度減重QUICKI指數事後比較結果……………………………59
表4-12 實驗組不等程度減重McAuley數one-way ANOVA分析摘要表………………61
表4-13 實驗組不等程度減重McAuley指數事後比較結果……………………………61
表4-14 減重兩公斤時實驗組血液生化值檢定結果……………………………………63
表4-15 實驗組不等程度減重在血糖one-way ANOVA分析摘要表……………………64
表4-16 實驗組不等程度減重在血液TC one-way ANOVA分析摘要表………………65
表4-17 實驗組不等程度減重在血液HDL-C one-way ANOVA分析摘要表……………66
表4-18 實驗組不等程度減重在血液LDL-C one-way ANOVA分析摘要表……………67
表4-19 實驗組不等程度減重在血液TG one-way ANOVA分析摘要表…………………68
表4-20 實驗組減重兩公斤時血壓檢定結果………………………………………………69
表4-21 控制組身體組成檢定結果………………………………………………………71
表4-22 控制組血液生化值、血壓、胰島素敏感性指數檢定結果…………………71







圖 目 次
圖3-1 研究計畫說明會…………………………………………………………………33
圖3-2 第一次採血情形…………………………………………………………………33
圖3-3 人體組成測量情形………………………………………………………………34
圖3-4 大步快走運動訓練情形…………………………………………………………34
圖3-5 阻力運動訓練情形………………………………………………………………34
圖3-6 實驗流程圖………………………………………………………………………35
圖3-7 測量血壓前的休息情形…………………………………………………………38
圖3-8 實驗檢測程序及流程圖…………………………………………………………39
圖3-9 血液生化檢測情形………………………………………………………………41
圖3-10 ELISA Reader分光光譜儀……………………………………………………41
圖3-11 BIO-RAD SmartSpec Plus分光光譜儀………………………………………42
圖4-1 實驗組減重兩公斤時血液胰島素變化……………………………………………52
圖4-2 實驗組減重兩公斤時HOMA指數變化……………………………………………53
圖4-3 實驗組減重兩公斤時QUICKI指數變化…………………………………………53
圖4-4 實驗組減重兩公斤時McAuley指數變化………………………………………54
圖4-5 實驗組不等程度減重血液胰島素變化情形………………………………………56
圖4-6 實驗組不等程度減重HOMA指數變化……………………………………………57
圖4-7 實驗組不等程度減重QUICKI指數變化…………………………………………59
圖4-8 實驗組不等程度減重McAuley指數變化………………………………………60
圖4-9 實驗組減重兩公斤時血糖變化…………………………………………………62
圖4-10 實驗組減重兩公斤時血液TC變化…………………………………………………62
圖4-11 實驗組減重兩公斤時血液HDL-C變化……………………………………………62
圖4-12 實驗組減重兩公斤時血液LDL-C變化……………………………………………62
圖4-13 實驗組減重兩公斤時血液TG變化………………………………………………63
圖4-14 實驗組不等程度減重血糖變化情形………………………………………………64
圖4-15 實驗組不等程度減重血液TC變化情形…………………………………………65
圖4-16 實驗組不等程度減重血液HDL-C變化情形……………………………………66
圖4-17 實驗組不等程度減重血液LDL-C變化情形……………………………………67
圖4-18 實驗組不等程度減重血液TG變化情形………………………………………68
圖4-19 實驗組減重兩公斤時收縮壓變化………………………………………………69
圖4-20 實驗組減重兩公斤時舒張壓變化………………………………………………69

參考書目
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